Nipple Inflammation: Causes, Symptoms & Treatment

Nipple inflammation or mastitis is characterized by reddened and painful nipples and swelling of the breast. Depending on the severity of the infection, simple measures and rest are sometimes sufficient to bring about rapid improvement. However, if the nipple infection is advanced, treatment with antibiotics or even surgery may be advised.

What is nipple inflammation?

Mastitis, or inflammation of the mammary glands, is an inflammation or infection of the breast that can cause severe swelling and pain, often accompanied by fever. Often the infection is caused or accompanied by inflammation of the nipple in question. In this case, mastitis can be caused by micro-injuries and the penetration of bacterial pathogens, for example. Other causes can be hormonal fluctuations, allergic reactions or pathological tissue changes. Both women and men can get nipple inflammation. However, breastfeeding mothers are most often affected at the beginning of their nursing period.

Causes

The nipple (mammilla) with the adjoining areola (areola) and the mammary glands (mammae) present in the female body is a sensitive region of the body because of the numerous nerve tracts that end here. The breast and nipple are sometimes very sensitive to external or internal body-related irritations. Since breast or nipple inflammation occurs most frequently, but not exclusively, in nursing mothers, a distinction is made in the remainder of this text in each case between breastfeeding-related mastitis and those nipple inflammations that are due to other causes. Breastfeeding-related causes:

When milk is let in shortly after birth or when a long time has elapsed between breastfeeds, one breast or both breasts may become overfull and swell. Normally, this uncomfortable condition goes away quickly as soon as the baby feeds. However, for various reasons, milk engorgement can also occur, in which individual areas of the breast become hard and painful. Causes for this can be, for example, too long feeding breaks, psychological or physical impairment of the milk flow reflex or injuries to the breast or nipple. If, in the case of a milk stasis, germs now multiply in the stagnated milk, which have spread through a sore nipple or along the bloodstream in the body, a breast inflammation occurs due to the formation of a painful abscess (pus focus). This inflammation then, in turn, often leads to inflammation of the affected nipple as well. Other causes:

Injuries (abrasions or cuts) to the breast or nipple can also cause bacterial infections in men. For example, bleeding or inflamed nipples are common, especially in long-distance runners. Due to the frequent training and without the use of supportive functional underwear as in women, the textiles rub against the sensitive nipples, causing irritation and even inflammation. Another cause that affects not only women but also men of advanced age is hormonal changes. During menopause, due to the decrease in testosterone production, there is an increase in estrogen levels in the male blood, which can also cause change processes in the breast and nipple. Other changes in hormone levels, e.g. during puberty or cycle-related hormone fluctuations in women before menstruation or during the menopause, are also frequently the cause of tension, pain and inflammation. Furthermore, inflammation of the nipple can be caused by allergies or general intolerance to certain substances or chemicals (detergents, fabric softeners, cosmetics). Tumors in the breast tissue are among the more serious causes of nipple inflammation, although fortunately they occur rather rarely.

Symptoms, complaints and signs

Because the nipple is very sensitive, irritation shows up early with redness, pain, and increased sensitivity to pressure. Nipple inflammation can occur on one or both sides, depending on the cause. The pain can radiate to the entire breast, which is then tense and hot and feels extremely painful when pressure is applied.The transition to the infectious stage is indicated by fever, usually above 39°, which may be accompanied by a general feeling of faintness, chills, sometimes vomiting, and flu-like aching limbs. In nursing mothers, there may also be an altered-looking breast milk secretion (bloody or purulent), crusting, or discharge. Other symptoms may include the formation of a purulent and palpable abscess or swelling of the affected lymph nodes. Incidentally, there may also be a non-breastfeeding secretion with partial blood or pus components from the mammary gland. In this case, consultation with a physician is advised in any case.

Complications

The transition between lactic congestion and mastitis in breastfeeding women or nipple inflammation and mastitis from other causes is fluid. True mastitis is a dangerous complication that requires antibiotic treatment. Abscesses are considered a complication that, if not treated early, can worsen to the point that only surgery can bring improvement.

When should you see a doctor?

Breastfeeding mothers should consult a midwife or lactation consultant immediately upon the occurrence of milk engorgement or emergence of difficulties with breastfeeding. Often, such serious complications as abscesses can be prevented by prompt and vigorous action. In any case, breastfeeding should be continued initially. If there is no improvement within 24 hours, the indication of an antibiotic should be discussed with a physician. In general, it can also be said in the case of non-breastfeeding-related nipple infections: If fever and worsening of the pain occur, the progression of the infection should be prevented by a doctor. A medical professional should also be consulted if there is any uncertainty regarding changes in the shape or color of nipples or if unclear secretions appear or lumps or abscesses are palpated, since malignant, cancerous changes in breast tissue can also be accompanied by such symptoms.

Diagnosis

Regardless of whether nipple inflammation has occurred as a concomitant of breastfeeding or due to other causes, the attending physician or midwife or lactation consultant will first palpate the breast in question after a patient interview and, if necessary, also examine it by ultrasound. Abscesses and indurations can be quickly detected in this way. If the secretion is conspicuous, a smear is taken and examined in the laboratory for pathogens and blood. If, on the other hand, the problem is suspected to be within the female milk ducts, a so-called galactography can be performed. Here, a contrast medium is introduced into the milk ducts by means of a probe in order to be able to show and examine them in detail on an X-ray. To confirm the diagnosis, other invasive and non-invasive examination methods can be used. Mammography, for example, is one of the most common breast examinations. Here, any tumors can also be detected with comparative certainty. For this reason, this examination method is also a standard part of the early detection of breast cancer for women over 40. If a suspicious lump or thickening is detected during the examination, this change can be examined in detail by means of a biopsy. In case of doubt and if there is a suspicion of a more extensive disease, a blood and hormone examination can provide complementary findings.

Treatment and therapy

Because there are different causes for nipple inflammation, specified treatment is also recommended. In the case of milk engorgement and problems with breastfeeding, for example, cooling and gentle measures are often sufficient to bring about a rapid improvement. If in doubt, the measures should be discussed with a midwife or lactation consultant. For example, depending on the problems that occur, cold is recommended to relieve pain and contain inflammation, and heat is recommended to dilate the blood vessels. For example, ice packs or cool compresses can be applied between breastfeeding sessions. In acute cases, home remedies are also said to achieve very good results, for example chilled cabbage leaves, which, when applied, quickly reduce the swelling and curb milk production somewhat. Curd or honey compresses or poultices with Retterspitz can also reduce the inflammation more quickly. In any case, breastfeeding should be continued!Not only mother and child benefit from a longer breastfeeding relationship, but also the measure helps to let the milk flow well and to prevent an aggravation of the inflammation. If sufferers are open to homeopathic treatment, Phytolacca Cl 2, or Nux vomica C6 may possibly help with milk congestion, and Belladonna C6, Hepar sulfur C6, or Silicea C6 may help with breast inflammation. Bach flowers can also be used for relief, for example Aspen, Larch, Mustard or Crab Apple. If the nipple in particular is affected, herbal ointments can provide quick relief. Preparations with ingredients such as lanolin and calendula ointment have shown the fastest improvements here. If there is no obvious improvement after treatment, drug treatment with antibiotics may be indicated. In the worst case, if an abscess does not recede by other means, only surgical measures will help. In this case, the pus abscess is opened during a minor operation to allow the pus to drain.

Outlook and prognosis

In the case of nipple inflammation – especially breastfeeding-related conditions – literally every minute counts. The earlier an impending inflammation is detected and the sooner therapeutic measures are started, the sooner improvement can be observed. If, for example, a milk stasis has been successfully removed, the inflammation of breast tissue can be prevented in most cases. If inflammation has occurred after all, the described home or herbal remedies usually help within a few days. If antibiotics are administered, a few weeks should be sufficient to allow the inflammation and accompanying symptoms to heal successfully and completely. In contrast, the prognosis for untreated inflammation is rather poor. The formation of purulent abscesses to the formation of indurations, skin rashes or, in rare cases, malignant tumors required a comparatively protracted therapy, which often requires surgical interventions.

Prevention

Even before breastfeeding, it is possible to prevent against breast and nipple inflammation. It is observed that heat helps effectively in this regard. For this purpose, either a moist warm cloth can be applied to the breast or simply take a warm shower more often. A tip among midwives is also a potato wrap shortly before breastfeeding. To do this, wrap warm boiled potatoes in a kitchen towel, mash them and place the towel around the breast in question. Alternatively, compresses made of powdered fenugreek seed mixed with hot water to form a paste can help. Like potatoes, this seed contains an anti-inflammatory component and prevents the breast tissue from becoming inflamed in the first place. During breastfeeding, strict hygiene should generally be observed. For example, regular changing of nursing pads is recommended. The correct breastfeeding technique also has a decisive influence on the good flow of milk. A midwife or lactation consultant will be happy to provide advice and support. The costs of postpartum care are usually covered by health insurance. You should therefore find a midwife early on and while you are still pregnant. To prevent inflammation of the nipple due to allergic reactions, you should pay attention to skin irritations after changing cosmetics or detergents and replace them if necessary. The same applies when wearing certain fabrics or textiles. Many people complain of skin irritation when using synthetic fabrics. Often it helps to wear a garment made of natural fibers under the synthetic garment. Against bleeding and inflamed nipples due to chafing, endurance athletes best tape the nipples with a plaster before training and competition.

Aftercare

After nipple inflammation, it is essential to take aftercare measures. Otherwise, it will quickly come to a renewed inflammation. The earlier you recognize their signs, the easier it is to avoid a painful infection. If nipple inflammation occurs more frequently during breastfeeding, it is advisable to change the breastfeeding method and breastfeed more often. During breaks in breastfeeding, the sensitive skin areas can either be treated with cold to relieve and reduce swelling, or heat can be used to dilate the vessels and promote blood circulation. Old home remedies such as cold quark compresses or warm potato compresses are suitable for this purpose.Herbal ointments such as calendula ointment have also proven to be a good preventive measure. If the nipple inflammation is allergic, one should change detergents and cleaning agents and possibly do research into the causes with regard to the intolerance of certain cotton blends. Often, a different, hypoallergenic detergent or a change in the cotton content of tops is sufficient to completely prevent recurring nipple inflammation. Athletes can wear functional underwear to protect against friction of the textiles on the skin or tape off the sensitive areas with plasters before training. Medical follow-up after nipple inflammation is usually not necessary. However, if one observes the preventive measures, a further infection can be avoided, or usually alleviated without antibiotic treatment.

What you can do yourself

Especially with breastfeeding-related nipple inflammation, you can help yourself well as a person affected. Above all, you should allow yourself to rest. Life with a baby first turns everything before upside down and demands a lot from the body and mind of young mothers. It often helps just to lie down in bed with the baby for a day or two and get some rest. The designation of the first weeks after birth as “postpartum” also makes the profound change in everyday life clear linguistically. At the very least, you should try to slow down for at least a few days. Midwives often advise keeping the breast empty in case of breastfeeding problems. Breastfeeding should be done at least every one to two hours if necessary, so that the affected breast does not fill up too much. If only one side is affected, the baby should always be put on this side first so that it is emptied safely. The correct breastfeeding technique is also important. If there are any uncertainties or questions, a midwife should help with latching on and during breastfeeding. For breastfeeding mothers, it is also generally advisable to avoid incisive and constricting clothing. Psychological insecurities and problems are often behind breastfeeding problems. In this sensitive situation, it is therefore particularly important to talk to a lactation consultant or midwife.