How to diagnose and treat a blocked milk duct

Pregnancy and childbirth are, in so many ways, a physical journey. But for new mothers, the experience of re-learning your body doesn't stop once you've had the baby.

From navigating those post-birth periods to discovering just how little sleep you can survive on, those days, weeks and months postpartum are defined by a new sense of self, and that's rarely felt more than in the experience of breastfeeding.

Managing milk supply and helping your baby learn to latch is one thing, but your breasts are going through real changes in order to produce milk, and sometimes those changes can lead to complications.

An anecdotal study published in The Journal of Human Lactation found that approximately two-thirds of women experience plugged ducts at some point in their breastfeeding experience, and when untreated, that can sometimes lead to mastitis or worse.

But what are plugged milk ducts? And how do you treat them when you have them?

What is a blocked milk duct and what does it look like?

A blocked milk duct is pretty much what it sounds like — it's when a blockage occurs in the breast, obstructing milk flow and causing an often tender swelling in the breast tissue.

This swelling can form a tender lump or sore spot, which indicates where milk flow has been stopped and can be accompanied by the following symptoms:

• An area of the breast becomes red or blush-pink, and might be tender, hard or painful
• The area becomes warm to the touch
• A white spot known as a milk bleb might appear on the nipple
• There's slower milk flow on one side
• You might come down with a low-grade fever.

These blocked duct symptoms usually progress pretty gradually, so what might start as a little bit of discolouration can grow redder and more painful as the blocked milk duct backs up.

In this sense, monitoring it is crucial and early intervention and treatment can prevent it from becoming more serious.

Wait, does that mean it's infected?

Nope, a blocked milk duct itself isn't an infection, and in fact, it's important that you continue breastfeeding to clear the blockage.

That said, blocked ducts can lead to mastitis or an infection, which we'll talk about in a minute.

What's causing the blocked ducts?

Like a lot of questions around birth and babies, this answer is a bit of a how-long's-a-piece-of-string one.

There's no one exact cause for clogged ducts, but it's generally understood that the main cause is poor drainage, meaning not enough breast milk is getting emptied during feedings.

For breastfeeding mothers with an oversupply of milk, or with babies with a weak latch, this can be especially difficult and can lead to recurrent mastitis or blocked ducts, which are not anyone's idea of a good time.

There are other factors that play a role in causing blocked milk ducts including stress, fatigue, anaemia and a weakened immune system as well as a poor latch (particularly from babies who are sleepy or tongue-tied), missed or rushed feedings, and pressure on the breast from tight clothing, underwire bras, or tight baby carrier straps.

Will my blocked milk duct unclog itself?

Fortunately, the answer to this one is a lot clearer, even if it's not necessarily the ideal one — no, it won't unclog itself.

Your blocked ducts need early intervention to be cleared, otherwise, the blockage can get worse and risk factors can lead to mastitis, a breast infection or a breast abscess.

What is mastitis?

Mastitis is an inflammation of the breast and it's caused by blocked ducts, cracked nipples, broken skin or a bacterial infection. It's basically like the worst sort of levelling up and can be both painful and pretty dangerous.

A lot of the mastitis symptoms are the same as those for a blocked duct, but they also include:

• More intense pain, heat and swelling in your breast than the blocked duct, often including nipple pain
• The skin of your affected breast may look tight and shiny, with red streaks extending outward from the affected area
• Fever and flu-like symptoms including joint aches and lethargy

These symptoms usually appear quickly and intensely, and once you have them, you should make an appointment with your healthcare professional or lactation consultant to ensure you do not develop a breast abscess.

What do I do if I think I have a plugged duct or mastitis?

Luckily, there is plenty you can do at home if you think you have a plugged duct or mastitis.

Acting as soon as you feel any sort of discomfort in your breast during breastfeeding or otherwise can help you move the blockage quickly and recover.

• Before you breastfeed or express milk, place a warm cloth against your sore breast. This can help loosen up the affected area and relieve pain.
• Massage any tender lump in your breast towards the nipple while you breastfeed or while you're in a warm shower or bath.
• Remove milk by fully draining the breast during breastfeeding, and try to keep it as empty as possible. You can do that by feeding with the affected breast first when your baby is hungriest and continuing to feed on the affected side as often as you can.
• Experiment with different feeding positions as the different angles can help to get all the breast milk out.
• Make sure your baby's latch is properly attached and that they can get the milk easily. If you're having difficulties with this, talking to your lactation consultant or the Australian Breastfeeding Association can help.
• Relax to help your let-down reflex work.
• If your breast is still tender after feeding, cold packs can then help to relieve pain and swelling in the affected breast.
• If you're experiencing breast pain, take pain relief that is safe to have while breastfeeding such as paracetamol or ibuprofen.
• Keep your fluids up.
• Don't pinch or try to 'pop' the clogged milk ducts, or pull on the milk bleb. The bleb will flow out of your breast as the blocked milk ducts clear.

If you're not able to clear the lump or blockage within a few days, or if you feel it's getting worse, talk to your doctor as soon as possible.

Breastfeeding with a clogged milk duct

Keep in mind that your breast milk is safe for your baby even if you have mastitis or a breast abscess, and are on antibiotics prescribed by your doctor.

Keeping up a frequent feeding schedule and frequent milk removal is the best way to generate milk flow and move the blockage.

How do I prevent getting a blocked milk duct again?

While some causes of blocked milk ducts are hard to combat (after all, how do you try to beat back the stress of having a newborn?), there's still a lot you can do to avoid recurrent blockages and give your breasts the TLC they deserve while breastfeeding.

• Breastfeed or express milk regularly (this should generally be about eight to 12 times in 24 hours).
• Establish a good latch at every feeding, and make sure the baby's mouth holds well, or if pumping, make sure the breast pump is correctly positioned.
• Don't miss or put off feeds, and try to maintain a regular schedule, even if your baby is sleeping irregularly.
• Regularly examine your breasts for any obvious lump and massage them by hand or with a lactation massager while feeding or expressing.
• Express after feeds if your breasts still feel full.
• Avoid tight clothing and wear a nursing bra that fits and doesn't have an underwire.
• Try not to sleep on your stomach as that can put a lot of pressure on your breasts.
• Rest where you can and drink lots of fluids.
• Use a nourishing nipple cream for sore, cracked or bleeding nipples.
• Talk to a lactation consultant or to the Australian Breastfeeding Association if you have any questions.

You should not try weaning if you have a blocked duct or are suffering mastitis. You must continue to remove milk from your breasts at this time to reduce the risk of a breast abscess.

Be sure to reach out for professional help if you need it.