Mastitis puerperalis is an inflammation of the milk-producing (lactating) breast caused by a bacterial infection and is the most common complication during lactation, along with milk stasis. Mastitis puerperalis affects about one in a hundred women after delivery, and the condition is usually easily treatable.
What is mastitis puerperalis?
Mastitis puerperalis is the term used to describe acute inflammation of the mammary glands during lactation that is due to bacterial pathogens (more than 90% are Staphylococcus aureus). Two forms of mastitis puerperalis are differentiated depending on the way it spreads. In most cases, puerperal mastitis spreads diffusely in the connective tissue of the breast via the lymphatic system or the blood (interstitial puerperal mastitis). In addition, mastitis puerperalis may spread through the milk duct system of the affected breast, with transmission occurring primarily during breastfeeding. Mastitis during breastfeeding is extremely painful and should be examined and treated by a physician. Initial relief can be achieved with cooling compresses.
Causes
Mastitis puerperalis is caused by contamination with a bacterial pathogen that usually originates from the baby’s germ-infested nasopharynx. The child may have been infected by the mother or by hospital staff (nosocomial infection). In addition, contamination is possible as a result of contact between the skin of the breast and the lochia classified as infectious (wound secretion after birth). The pathogens enter the breast via rhagades (fine cracks) in the nipple (mammilla), areola or skin during breastfeeding, spread and cause mastitis puerperalis. Furthermore, mastitis puerperalis can be caused by milk engorgement, in which the multiplication of the pathogens can be additionally favored, similar to a “stagnant water“.
Symptoms, complaints, and signs
Complaints of mastitis during breastfeeding can be many-sided. Initially, the inflammation will be noticeable by an increased feeling of tension throughout the breast. These tensions will gradually develop into more severe pain. The breast will swell and be harder than normal. There will also be redness. Since the breast is inflamed, it will feel hot. In connection with this, fever may appear, as if “out of nowhere”. Furthermore, affected women often suffer from sweating and circulatory problems. Many feel ill and fatigued. The affected breast will also increase significantly in size. These symptoms usually occur only once during the breastfeeding period. Nevertheless, in some cases, there may be a recurrence. In rare cases, mastitis leads to the development of encapsulated pus collections (abscesses). In the worst case, fistulas develop as a result. Through these fistulas, pus can penetrate into surrounding tissue, under the skin, or even into organs. In this case, touching the diseased breast is almost unbearable. Cooling compresses have a soothing effect. The symptoms described should have subsided after two weeks at the latest. If this is not the case, a doctor should be consulted.
Diagnosis and course
In the case of puerperal mastitis, the diagnosis is made during a clinical examination. Thus, a painful swelling in the area of the affected mammary gland accompanied by redness, overheating of the skin, and sudden onset of fever, pain in the limbs, and swollen axillary lymph nodes are characteristic symptoms of mastitis puerperalis. The diagnosis is confirmed by blood analysis, which tests the blood for inflammatory markers. In some cases (4-12%), an abscess (collection of pus) forms in puerperal mastitis within 1 to 3 days. If abscess formation is suspected, sonography (ultrasonography) is required to determine the size and location of the abscess. Generally, the course of mastitis puerperalis is good and the inflammation quickly resolves itself or with treatment. However, if mastitis puerperalis was already present, the disease may become chronic and the risk of recurrent mastitis puerperalis is increased.
Complications
Breast inflammation during breastfeeding is usually very unpleasant and leads to burning pain and further restrictions. Therefore, in order to avoid consequential damage, treatment by a doctor is necessary in any case. Those affected suffer mainly from fever during breastfeeding. In addition to the fever, there is also fatigue and exhaustion. The mother’s breasts become inflamed, causing pain and unpleasant sensations at the breast. This results in severe pain, especially during breastfeeding. The breasts may also enlarge or swell due to the breast inflammation during breastfeeding. Furthermore, the usual symptoms of flu also occur, so that patients suffer from headaches and aching limbs. The quality of life is significantly reduced by this disease. In many cases, however, mastitis in the breastfeeding period does not lead to further complications and disappears on its own. Only rarely is treatment necessary. However, this is carried out with the help of antibiotics and does not lead to further complications. The patient’s life expectancy is also not affected by mastitis in the breastfeeding period.
When should you go to the doctor?
Mastitis puerperalis occurs only in women after childbirth and during breastfeeding. If there is pain or changes in the skin appearance of the breast, a doctor should be consulted. Painkilling medications should only be taken in consultation with a doctor, as they can lead to complications for the mother as well as the infant. Any swelling of the breast or nipple should be assessed by a doctor. If the mother refuses to breastfeed the infant due to the existing symptoms, a doctor should be consulted. Ensure that there is no impairment or deficiency in the care of the newborn infant. If the mother has a fever, a general malaise or sweats, a doctor is needed. If there are irregularities of the heart rhythm or a collapse of the circulation, clarification of the complaints by a doctor is recommended. Pus formation, the development of lumps or fistulas on the breast must be examined and treated. If the mother suffers from anxiety, rejects her child, or other emotional irregularities occur, a physician or therapist is needed. A decreased sense of well-being, mood swings, or behavioral abnormalities should be presented to a physician. These are signs of a health disorder that needs to be investigated and treated.
Treatment and therapy
Physical measures are used first for puerperal mastitis. These include cooling as well as consistent emptying of the breast to prevent milk stasis. In addition, milk production can be reduced with medication using prolactin inhibitors. Furthermore, the affected breast should be immobilized if possible. If no improvement can be seen within 24-48 hours, antibiotic therapy is recommended. Since about 80 percent of strains of Staphylococcus aureus are resistant to penicillin, a swab is taken by the physician to determine an antibiotic to which the pathogen is not resistant. If an abscess has formed in the further course, the physician can drain the abscess through an incision (minimal skin incision) by placing a flap or a small tube to drain the wound secretion into the abscess cavity (suction-irrigation drainage). Daily wound irrigation is required until mastitis puerperalis has completely resolved. If only minor subcutaneous abscesses develop in the course of puerperal mastitis, they may be punctured and the wound secretion aspirated with the aid of a syringe. While breastfeeding can be continued after the first two days in cases of mild puerperal mastitis, breastfeeding should be avoided in all cases of abscessed puerperal mastitis.
Outlook and prognosis
The prognosis of mastitis within the breastfeeding period is favorable. Spontaneous healing is often documented in many affected individuals. To avoid secondary disorders or long-term complications, medical care should be provided. In consultation with a trained physician, different approaches are taken to alleviate the symptoms. In a large number of cases, immobilization of the breast is already sufficient to achieve an improvement in the overall situation.In addition, the breast should be cooled and a complete emptying of breast milk should take place. If no improvement occurs within a few days, the administration of medicines will induce a regression of milk production. As soon as the organism stops producing milk after birth, the irritations can heal completely. Since the disease is caused by bacteria, active substances are administered that are aimed at killing the pathogens. Subsequently, they are removed from the organism and excreted. If the course of the disease is favorable, the patient is free of symptoms after a few days of rest. If the course is unfavorable, recovery can be expected as soon as milk production has ceased. A few days or weeks later, the inflammation is completely healed. If mastitis occurs again after a new pregnancy, the prognosis is also favorable.
Prevention
Adequate skin care of the breast to prevent rhagades (ointments, creams) can prevent mastitis puerperalis during lactation. Regular and careful emptying of the breast can also contribute to prevention via a reduced risk of milk engorgement. In addition, it is essential to prevent direct contact of the breast with lochia to prevent mastitis puerperalis.
Follow-up care
Mastitis puerperalis can recur at will after successful healing, so it is important to specifically monitor milk flow immediately afterward. Above all, it is crucial to take care to empty the breast as much as possible. If the child has not drunk all of it, it may help to express the remaining milk in order to avert renewed engorgement. Aftercare therefore tends to focus on preventing mastitis. Once invading germs have settled in the accumulated breast milk and caused an infection, further complications can result. It is important to normalize the child’s changed drinking behavior as quickly as possible. In the event that this does not seem feasible, it is necessary to switch to bottle feeding as an alternative so that the child does not suffer from dehydration and nutrient deficiency.
What you can do yourself
In the case of mastitis puerperalis or mastitis during breastfeeding, the affected person can take some measures herself to relieve the symptoms and heal the inflammation. First, a well-fitting bra is beneficial should mastitis occur. Furthermore, a warm compress can be placed on the breast before each breastfeeding. This stimulates the flow of milk due to the warmth. During the time between breastfeeding, cooling the breast with the help of ice packs or quark compresses can improve the inflammation. Wraps with acetic clay can also lead to cooling and thus improvement. The breast should be emptied regularly so that there is no buildup of milk in the breast. In addition, the affected person should ensure adequate fluid intake. Likewise, attention should be paid to bed rest. If puerperal mastitis is too severe, the affected woman is often unable to breastfeed due to pain. A physician should be consulted who will prescribe medications that cannot harm the infant. If there is no improvement in mastitis puerperalis after applying the above self-help measures, a doctor should be consulted, who will then usually start treatment of the mastitis with antibiotics.
