Causes of Nipple Pain
Click on a condition below to find out more:
Nipple Thrush
Nipple thrush is often blamed for nipple pain. Patients will often self-treat for this condition too; however, not all nipple pain is thrush and a careful history and examination of your nipples needs to be done for correct diagnosis. A swab may be suggested.
Nipple or breast thrush is more common in women who are on or have recently finished antibiotics; those that are prone to vaginal thrush; and those that have nipple trauma. Symptoms of nipple thrush can include: pink/redness to the nipple and areola; cracks at the base of the nipple; itching; flaking; and pain with breastfeeding and sometimes pain between feeds too. The pain can be out of proportion to the clinical examination findings and can radiate into the breast and be burning in nature. Often, the nipples have no outward changes. Baby’s mouth needs to be examined for oral thrush.
Treatment can involve any or all of the following: topical gel to the baby’s mouth; ointment to the nipple after breast feeds; oral anti-fungal tablets for mum; as well as trying to keep the nipple dry and exposed to the air if possible. Treatment duration is often quite prolonged (ie at least 1-2 weeks), to ensure full treatment of the condition.
Resources:
- ABM clinic protocol on Persistent Pain with Breastfeeding
- The Womens – Royal Women’s Hospital “Infant feeding – Breast and Nipple Thrush” (treatment guideline)
- The Royal Women’s Hospital “Breast and Nipple Thrush” (patient information)
Nipple Vasospasm
This is a very painful condition of the nipple. It is where the vessels vasoconstrict, causing pain and colour change of the nipple (white, blue/purple then red). Commonly, it is a response to trauma of the nipple. This is where we need to work really closely with correcting fit and hold during breastfeeds.
Other women may also get this sensation when they are exposed to cold environments. For some, just exposing their nipple to the air will be excruciating. This happens particularly in those women who suffer from Sjogren’s Syndrome, or Raynaud’s of the fingers or toes in winter. It can occur more commonly in those with autoimmune diseases. If this is the case, warmth after a breastfeed is what is needed to help ease the symptoms.
If this isn’t enough, there is a medication that can be trialled.
Resources:
Bacterial Nipple Infections
This may be suggested by exudate (pus) coming from a crack in the nipple. This needs to be swabbed to make sure the right treatment is given. The most common bacteria, Staphylococcus aureus, is increasingly resistant to some antibiotics, so a swab will help us choose the right one. A bacterial infection on the nipple can quickly lead to mastitis. If it is just localised to the nipple, you may have localised pain, discharge, an ulcer/sore, and/or redness.
Treatment is topical antibiotic ointment, which is often quickly effective, and safe to use with breastfeeding. If the infection is more severe, or does not respond, oral antibiotics may be needed. Bacterial infections of the nipple always occur in the setting of nipple trauma due to poor fit and hold, so it is vital that we work together to correct this to prevent re-infection.
Resources:
Viral Nipple Infections
Predominantly, this is caused by the “cold sore” virus – Herpes Simplex. It presents as an ulcer (or several ulcers) around the nipple/areola/breast that is usually very sore. Often, tender lumps under the armpit may be felt, which are swollen lymph nodes. The other viral infection is Herpes Zoster, or shingles (a reactivation of the Chicken Pox virus). This will present as a cluster of painful blisters/ulcers and can occur anywhere on the body. If it occurs on the breast in a breastfeeding mother, this can be harmful to the baby.
Viral nipple infections are very dangerous for the baby, as the virus can be easily passed onto the infant by the fluid in the blisters or ulcers. Babies can become very unwell if they contract the cold sore virus as they usually get the systemic (or “whole body”) infection that can cause sepsis or brain damage, not just a few ulcers on their skin.
It is so important that this is diagnosed properly. A swab can be taken from a blister or an ulcer to determine what, if any, virus is present. Treatment can then be tailored to the specific circumstance.
In general, the following advice is recommended if there is a viral infection of your nipple or the skin near your nipple: prescription oral anti-viral medication; prevent baby from coming into contact with the lesion (ie keep the lesion covered); do not breast feed from the affected side OR do not give expressed breast milk from the affected side UNTIL the lesions have healed.
Nipple Dermatitis
This is a skin condition of the nipple. It can present quite dramatically with red, itchy, flaky skin and also cause ulceration and weeping/oozing of the tissue. It is more common if women have dermatitis or other skin conditions elsewhere. It can also easily get infected with bacteria.
It can be caused by exposure to something you’re allergic to, or something that irritates the skin. This can include ointments and creams (including medications); treatments for nipple trauma (ie discs/pads); moisture from full breast pads; laundry detergents; fragrances.
The treatment is to avoid potential causes/triggers. Apply a good emollient (such as Dermeze Ointment) to the nipple regularly. A steroid cream may need to be prescribed to get on top of the inflammation.
Using Nipple Shields
We have written a blog post on how to use nipple shields, which are often useful for helping heal nipple trauma and reducing pain when feeding (where adjusting fit and hold is not quite enough).
