If the breasts of a breastfeeding mother harden in the first few weeks or in the course of further breastfeeding, then a milk congestion may be present. This is manifested by a hardened and hot as well as painful breast. In addition, there may be complaints such as fatigue, headaches and aching limbs or even fever.
What is milk stasis?
If breastfeeding does not result in complete emptying of the breast, then milk remains. This cannot drain away, causing a buildup in the milk ducts. Such milk engorgement is uncomfortable and can also cause pain. Usually, milk engorgement occurs at the beginning of breastfeeding, when the mother’s breast produces a lot of milk as a result of the milk let-down. In most cases, the baby is not yet able to drink all of this milk. But even after a few months, milk retention can still occur. It is often enough for the baby to sleep through just one meal and the breasts begin to tighten. You can then also feel hardening, which feels like a small warm lump. Milk engorgement should not be confused with the precursor to mastitis (breast inflammation), in which the tissue around the milk duct is swollen, pressing on it and preventing the flow of milk.
Causes
Several glandular lobes make up the mammary gland. These glandular lobes consist of milk-forming vesicles as well as a milk duct network. Milk flows from here to the nipple. Milk engorgement occurs when these milk ducts are blocked and therefore do not empty completely. There is an increase in pressure in the milk ducts, which is associated with tension and pain. The causes of such a milk stasis are very diverse. First of all, a lack of milk donor reflex can cause a milk stasis. Normally, the mother’s organism releases the hormone oxytocin. As soon as the baby sucks on the breast, the milk flows. However, physical exertion, stress or exhaustion can impair the milk-giving reflex and cause milk to engorge. Furthermore, excessive milk production can also be the cause. In this case, more milk is produced than the baby actually needs. An imbalance usually occurs when an infant suddenly sleeps through the night and no longer needs a nighttime meal, or when a milk meal is replaced by porridge. The amount of milk thus increases while the amount to drink decreases. Normally, this quickly regulates itself. However, the most classic cause of milk retention is usually mechanical obstruction. The reasons for this are incorrect latching on or incorrect sucking as well as too short and infrequent breastfeeding. This means that the breast cannot be emptied completely. Sometimes a bra that is too small or clothing that is too tight can also lead to a blockage of the milk flow. In addition, some women are more prone to breastfeeding problems, which then increases the risk of milk engorgement. This is the case, for example, with mothers of multiples or women who have had previous breast surgery.
Symptoms, complaints and signs
During the breastfeeding period, many mothers experience milk engorgement. In most cases, this occurs shortly after birth, the breastfeeding relationship is still very fresh and the baby has not yet found the optimal sucking technique. The milk ducts are therefore not completely emptied. Classic signs of milk engorgement are localized pain in the breast, induration and small palpable lumps in the breast, or small and white blisters on the nipple. The breast is also excessively plump and warm to hot, and the nipples are also very sensitive to touch. Furthermore, the skin on the breast may be red and there is a slightly increased temperature, but the general well-being is not affected.
Complications
If milk engorgement remains untreated and the breast continues to be incompletely emptied, breast inflammation may be the result. This is usually caused by germs that multiply in engorged breast milk. But even without germs, an infection can develop in the milk ducts. This happens when breast milk gets into the surrounding tissue of the breast, leading to inflammation. Breast inflammation caused by bacteria (e.g. Staphylococcus aureus) is accompanied by fever of up to 40 degrees Celsius and causes flu-like symptoms. Milk engorgement can cause sore nipples.The sore nipples, in turn, can cause germs from the infant’s mouth and throat to enter the breast through the sore areas due to more vigorous sucking, where inflammation of the nipples then occurs. One problem of breast inflammation resulting from milk engorgement: The milk has a different taste and sometimes the infant may stop drinking after just a few pulls or refuse the breast altogether. To avoid further pain, the breast should then be emptied by pumping.
When should you go to the doctor?
If the pain becomes more severe in the case of milk engorgement, or if there is still no improvement after two days and the affected areas are swollen, warm and red, the nursing mother should see the doctor. This is especially important if there is a worsening of the general condition, headache and pain in the limbs, fever and chills. In this case, the milk stasis has already developed into a mastitis. Therefore with complaints: Rather once too much to the doctor to avoid such a mastitis.
Diagnosis
On the basis of a detailed medical history and a physical examination, a milk stasis can usually be diagnosed quite easily. As part of the history, questions are asked about symptoms. During the physical examination, the affected breast is palpated very carefully in order to cause the patient as little pain as possible. The doctor will also ask about possible psychological stresses in order to search for a possible cause of the milk stasis. During the diagnosis, an additional examination will be performed to determine whether there are already signs of the development of mastitis. In this context, if symptoms such as fever and chills appear immediately after delivery, further examination is advisable to rule out puerperal fever, as this can become life-threatening if not treated.
Treatment and therapy
Treatment of mammary congestion primarily requires the “cooperation” of the affected patient. In most cases, conservative treatment measures such as emptying the breast through regular breastfeeding or, if necessary, expressing and pumping, the correct breastfeeding position, warming the breast before and cooling it (e.g., with quark compresses or cool pads) after breastfeeding, and plenty of rest and relaxation are the most important treatment approaches to treat milk engorgement. In the past, nasal sprays containing oxytocin were also often advised to help with milk let-down. However, such nasal sprays are no longer approved in Germany due to a lack of information on their safety. In most cases, specific medical treatment is not necessary. However, if mastitis develops from the milk stasis, the doctor will prescribe antibiotics. If milk stasis occurs during or even a short time after weaning, weaning tablets are often helpful. In consultation with the doctor or even the midwife, breastfeeding-friendly painkillers can also be taken if the pain is unbearable. Alternative treatments such as acupuncture, traditional Chinese medicine, as well as the use of medicinal plants and herbs and essential oils can also be useful in the case of lactation congestion. Homeopathic remedies such as globules can also be helpful without adding chemicals to her milk.
Outlook and prognosis
Overall, the prognosis for milk stasis is very good. It is very easily treatable, and affected women have several options to choose from. However, pumping has the best chance of success with milk engorgement, although it should be noted that this in turn promotes milk production. However, it gives the breast the necessary relief and eliminates the milk stasis for some time. However, it can recur at any time for many reasons. For example, physical and psychological stress are considered important causes of milk retention. Accordingly, there are some women in whose lives milk congestion is more common than in others. Frequent milk stasis is also easily treatable, but carries a certain risk of developing mastitis or inflammation of the mammary glands. Such inflammation is also treatable, but very painful. In almost all cases, however, emptying the breast in case of milk engorgement will eliminate it. There is then no need to worry about consequential damage or any complications. The breasts will not become altered or diseased even in the case of frequent milk engorgement if quick action is taken.It is more important to take precautions so that milk stasis occurs less frequently.
Prevention
Milk engorgement cannot be completely prevented. However, some preventive measures can reduce the risk. For example, nursing mothers should always wear loose clothing that does not constrict. Especially after birth, excess milk that the infant does not yet need should be pumped out or at least expressed until the supply and demand for milk are optimally matched. If too much breast milk is produced, or if milk engorgement is already beginning, certain milk-promoting beverages should be avoided. Breastfeeding and herbal teas in particular should then be eliminated from the beverage list. In addition, sufficiently long recovery phases are useful, because stress can also promote milk retention. The household and also the care of the child should be left calmly also times to the father.
Aftercare
A milk congestion can reoccur at will after successful healing, which is why it is important to specifically control the milk flow immediately afterwards. In doing so, it is especially crucial to make sure 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
Already at the first signs of milk stasis, breastfeeding mothers should consult their midwife or even a lactation consultant. These have experience with such problems and can give good assistance. Of course, it is also important to continue breastfeeding. Contrary to what is often recommended, breastfeeding should not be reduced or shortened. Especially for prevention or in case of milk engorgement, it is important that the breast is drunk empty. Breastfeeding as needed and already at early signs of hunger is therefore the motto. Since the problems usually start with sore nipples, a change of breastfeeding position can be helpful, because an incorrect attachment and breastfeeding technique is often responsible for sore nipples. Furthermore, sufficient hygiene should be ensured. Since germs can get into the open areas and cracks, especially in the case of sore nipples, regular hand washing before touching the breast is extremely important. In the case of a milk congestion, a warm full bath can also be helpful, because the warmth makes the milk flow almost by itself after a period of about 30 to 40 minutes. The warm water also has a relaxing effect and helps stimulate the milk-giving reflex. Warm showers, compresses or church core pillows can also be helpful. Midwives and lactation consultants are also happy to show expectant mothers certain massage techniques that can be used to gently and gently express the milk.
