Post-Baby Body Blog Part 3
Clogged milk ducts and how physical therapy can help:
Within the first three months of my breastfeeding journey, I had two bouts of mastitis with a fever. Mastitis is more common than you might think – some studies have reported incidence as high as 33% in lactating women. I was able to avoid taking antibiotics on both occasions using self-care techniques, which I will review in this blog. However, sometimes self-care techniques aren’t enough. (Lactating breasts can be very stubborn.)
During this blog, I am going to debunk some well-known assumptions about clogged ducts/mastitis and explain why physical therapy can be an excellent avenue for treatment.
Clogged ducts are areas of the breast where milk flow is obstructed and mastitis is where inflammation builds due to obstruction or infection.
Essentially, one of the key signs that your clogged duct has turned into mastitis is a fever or feeling flu-like symptoms. There are great online resources that review the difference between mastitis and clogged milk ducts:
At Home Treatments:
- Let your ladies be free… take off your bra for a few days! They can compress the painful site and some have theorized that they restrict milk flow. In fact, if you find yourself with bilateral clogged ducts and/or mastitis it would not be a bad idea to take a closer look at your bras… do they breathe? Do you wear underwire? Are your breasts compressed in certain areas of the bra? Random factoid: a recent study done in France has revealed that women who do not wear bras may have perkier breasts than those who do (https://www.cbsnews.com/news/french-study-suggests-younger-women-should-stop-wearing-bras/). Just sayin’.
- Feed on demand and feed frequently. It is completely safe for your baby to drink milk from a breast with a clogged duct or mastitis. Start each feed on the affected breast in effort to clear as much milk from the breast as possible. Even better- angle baby’s tongue and chin toward the clogged duct.
- Use different breastfeeding positions throughout your day. It is common to have a “go-to” position (most commonly the “cradle” position). Change it up! Try the side-lying position (my personal fav), football, cross-cradle, or laid back position. Not sure what these are? For images and descriptions: http://www.llli.org/faq/positioning.html.Utilizing different breastfeeding holds allows the baby to extract milk from different parts of the breast. Keep in mind the first few times might be a learning experience for both you and your baby.
- Use gentle massage and self-expression to reduce the congestion of milk in the affected breast. It is important that you do not go crazy hard with the massage. Usually it is painful enough that you won’t want to anyway. Use soft downward motions starting at the armpit stroking toward the nipple. Gradually move down the breast until you reach the affected site.You may begin to let down (or droplets of milk come out of the breast). This is good. You can use self-expression of milk to continue to remove milk from that area. Go back and forth between massage and self-expression until the affected region feels more empty and/or softer/less painful to the touch. *Pro-tip: Self-expression of milk is an extremely useful and convenient thing to know. If you are unsure how to self-express talk to a lactation consultant, physical therapist who treats clogged ducts, or look up youtube tutorials.
- Use warm compresses and/or take warm showers. The great thing about a warm shower is that you can massage and self-express at your leisure. I recommend at least twice a day (once in the morning and once at night) when you have a clogged duct or mastitis.
- It is common for babies to not completely empty the affected breast. If this is the case you can pump or self-express after a feed. Don’t go crazy with this either – I had a patient who pumped every two hours around the clock increasing her milk production, which lead to more pain from the engorgement. That being said, it is common for milk production to decrease slightly on the affected breast. Most likely, once your symptoms have subsided and breastfeeding has resumed as normal your milk production level will restore itself.
- Get some rest. Rolling your eyes? Most moms really like it when I say this. Okay – hear me out… One of the MAJOR reasons we get mastitis in the first place is usually because our immune system is shot. We sleep inconsistently and likely have been nourishing ourselves with spoonfuls of peanut butter. When’s the last time you had an uninterrupted shower? Can’t remember? Me too.When your baby’s pacifier is your boob it can be REALLY hard to pass them off to someone. Here’s the thing… give that munchkin to your partner and calmly look them straight in the eye and say “I have a clogged duct, I need to take a warm shower, drink some bone broth, and take a three hour nap. Please leave the house and do not return for 4-5 hours. Here are three pumped bottles and some back-up formula. Goodbye.” They can do this. You can do this. You need to do this.
- Try a castor oil pack to reduce pain at affected breast. For a simple guide: http://feedthebabyllc.com/castor-oil-compress/. After using the castor oil, make sure you clean your breast thoroughly before you nurse. *Pro-tip: a lot of online sources recommend cabbage leaves, which are known to decrease milk supply. I would skip on the cabbage leaves unless you are trying to wean.
What physical therapy has to offer…
Once you have exhausted self-management techniques at home or experience repeated bouts of clogged ducts or mastitis, physical therapy is the appropriate next step. We offer therapeutic ultrasound, manual techniques, and guidance for at-home care.
The therapeutic ultrasound we use to treat clogged ducts is different than ultrasound used for the purpose of imaging a baby. A recent study published in 2015 followed 30 women with blocked milk ducts receiving physical therapy care (http://journals.lww.com/jwhpt/Citation/2006/30020/Physical_Therapy_Intervention_for_Treatment_of.6.aspx).
Most of them were seen for only 1 or 2 visits and received therapeutic ultrasound, massage and expression by the therapist. These women were found to have reduced pain and reduced difficulty of breastfeeding. (We really like it when science supports our treatments!) In order to get a referral for physical therapy, contact your OB or primary care physician.
If you suspect you have clogged ducts or mastitis, call your OB or primary care physician and report your symptoms.
Antibiotics are commonly prescribed if you report symptoms of mastitis. It is not a bad idea to have them on hand. In most cases, your nurse or doctor will give you 24-48 hours to decrease your symptoms using at-home care without medication. This is on a case by case basis and should be a decision you make with your doctor. In rare cases, mastitis can turn into an abscess.
At that point you will likely be instructed to go to the ER with follow-up care at a breast center. In my experience, these women usually have severe symptoms and it was obvious that they needed additional care. If you do end up taking antibiotics, consider probiotics for both you and your baby.
Written by Jessica Hawley-Gamer, PT, DPT for Rehab Specialists Inc,~ heart-led mother, runner/yogi, Pilates instructor, prenatal/postpartum/pelvic physical therapist living/working in Encino, CA.
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