Mastitis 101

What is mastitis? What causes it? What are its symptoms?

Mastitis is an infection of the breast. The infection can be superficial or deep in the breast tissue. It occurs when bacteria enters a milk duct through a crack in the nipple. Mastitis can be caused by oversupply if a baby is not effectively emptying the breast (which can be due to a tongue tie, among other things) or if a mother goes longer between feedings than usual. Symptoms include pain in the breast, swelling, redness, red streaks, a lump, fever, chills, aching, and/or general malaise.

A clogged duct is not mastitis, though a clogged duct can lead to mastitis if not attended to. A clogged duct is a lump or fullness of a mammary gland without the systemic issues characteristic of mastitis. Initial treatment of a clogged duct includes massaging the lump while breastfeeding or pumping after a hot shower.

Mastitis is traditionally treated with antibiotics (dicloxacillin, clindamycin), which can create several unwanted side effects. These medications are powerful and can disrupt the (good) bacterial flora of the mother and baby. Symptoms of antibiotic side effects include candida (yeast) of the breast in mothers and thrush (also yeast) of the mouth in infants, both of which can take several weeks to get rid of. Infants can experience diaper rash and diarrhea, and mothers can have a general upset stomach. Antibiotics also make the mother and baby vulnerable to sickness depending on the season. In some cases of mastitis, antibiotics can’t be avoided. If a mother with mastitis has a fever for over 48 hours, or if she’s diagnosed with an abscess (pus pocket) of the breast, antibiotics are indicated.

What are some alternative treatments for mastitis?

The purpose of this blog is to identify alternative treatments for mothers who don’t fit into the above categories (48+ hours with fever, abscess of the breast). Keep in mind that every situation is different, and these suggestions should be utilized on a case-by-case basis in conjunction with your care provider.

Cabbage or potato. Cabbage and potato help to reduce the production of milk as to overall reduce inflammation in the breast (though not recommended for women who already have a low milk supply). Green cabbage is recommended over purple cabbage. Put a leaf or slice in your bra to help decrease swelling in the area.

Heat and ice. Heat allows for milk to flow. Taking a hot shower while hand-expressing or using a heating pad while pumping is helpful. Apply heat for no more than 20 minutes at a time so as to not increase blood flow, which can increase inflammation. Following heat, ice the area for 20 minutes to reduce inflammation and bring comfort.

Ibuprofen. Ibuprofen should be taken around the clock every 6 hours. Sometimes the fever can be so high that it doesn’t allow the mother to function well enough to even try these other treatments. Ibuprofen will help keep the fever down, and it is also anti-inflammatory in nature, which will help decrease the inflammation. To help the liver recover after several days of ibuprofen use, take milk thistle herbs and add lemon to your drinking water..

Vitamin C. The immune system uses Vitamin C to help with white blood cell function, and as the body is fighting a bacterial infection, this is very important. Take as much Vitamin C as you can tolerate without getting diarrhea, usually between 1000 mg and 5000 mg.

Echinacea and astragalus. These herbs help the immune system fight infection. They come in tincture form. Take small doses of each 3 to 4 times daily (also see directions on bottle).

Probiotics. Take a probiotic daily. Due to the infection, the flora in the body are becoming imbalanced. Probiotics should be taken whether the mother is using antibiotics or not.

Garlic. Garlic is a natural antibiotic. It is recommended to take 4-5 garlic cloves daily. Chop up and put in hummus to make it more palatable. If it causes upset stomach, pair it with papaya enzyme.

Pump. In situations where the infant is not emptying the breast completely, it is important to pump and empty it. Hand expressing or massaging while using a mechanical pump is up to 50 percent more effective than just pumping alone.

Ultrasound. Ultrasonic waves can break up inflamed tissue and bring healing to the area. Sometimes even after antibiotic use a lump can remain. Dr. Kristen Walkerwicz at Nashville Spine, Sport and Family Chiropractic Center and Dr. Kevin Bradshaw at Bradshaw Chiropractic perform in-office ultrasound therapy. This decreases inflammation so milk can flow freely. Nursing your baby immediately following therapy is ideal (their offices also promote this).

Using the above treatments, you should start to see improvements in your symptoms within 24 hours. Continue treatment for two days following the resolution of symptoms. If there are no improvements within 24 hours, consider taking antibiotics. All of these treatments can continue to be used in conjunction with antibiotics. Your provider can also culture your milk to confirm exactly what’s growing.

Mastitis is a normal occurrence that affects many moms, but knowing how to address it, and early, helps to lessen its effects.

Jaimeé Arroyo, FNP