What is Mastitis?
Mastitis is a painful inflammation of the breast tissue in someone who is lactating. It results when milk in the breast isn't clearing (either due to a blocked duct, or when there is compression from clothing or squeezing the breast or the breast hasn't been drained in a long time). The breast is excellent at creating and flowing milk out, however the tissue does not respond well to milk being static for a long period of time. When milk isn't moving (milk stasis) inflammation can develop around the area and the milk can leak in to the surrounding breast tissue. This can occur with an infection as well, but bacterial infection is not always present.
What are the symptoms?
Most of the time mastitis starts with flu-like symptoms such as feeling generally unwell, feeling hot and cold, fever, shivers and body aches. The breast that is affected will be painful, and often red, swollen, and hot to the touch.
Symptoms can often come on very quickly and seemingly "out of the blue" without noticing a blocked duct beforehand.
What can I do if I have Mastitis?
We strongly recommend you start treatment as soon as you feel a lump or sore spot in your breast to minimise the severity, but also to try to reduce the length of time you feel unwell.
Drain the breast often and gently
Your breast milk is safe for your baby even if you have mastitis, so continue to breastfeed or express from the affected breast. Make sure to start each feed on the sore breast.
There are ways of helping the breast to 'empty' or drain more easily:
Make sure your bra is very loose or take it off.
Relax your whole body while you feed to help your milk flow.
Breathe deeply and evenly.
Listen to soothing music and think about your baby to help start the let-down reflex.
Change feeding positions - try to choose positions that allow the milk to flow downhill from the affected area to your baby.
Gently massage the breast by stroking toward the nipple while your baby feeds.
Hand express to 'empty' the breast if your baby won't suck.
Apply warmth and cold
Using COLD packs on the affected breast can help reduce swelling and relieve pain. You can apply cold packs for 10-15 minutes at a time every 2 hours.
You can use WARMTH before and during a feed as this can stimulate a let-down and reduce pain while feeding from the affected breast.
We like the circular hot/cold packs for breasts as they shape well and can sit in your bra.
Rest
We often get a laugh when we say this, but rest really is vital when you have mastitis. If you have someone who can come over and help you with child care, then that will help. We recommend you lie down (or at least rest with your feet up) and sleep as much as your can until your symptoms are resolved. Rest will allow your body to heal faster, and if you do have an infection it will allow your immune system to fight it off faster. You can even feed lying down or reclined to help you keep resting!
Drink plenty of water (at least 8 glasses each day)
We know dehydration is not good for milk production, and it's also not good if you're fighting off a possible infection. Keep a drink bottle handy so you can keep drinking small amounts throughout the day.
Ensure Good Nutrition
As with water, your body needs enough nutrients to do what it needs to do for recovery. Keep up your 3 meals per day for adequate nutrition as much as your symptoms allow.
Seek medical help
If you don’t start to feel better after a few hours, you should see a doctor as soon as you can. It's important that if you have had mastitis more than 24 hours that you be considered for antibiotic treatment. When making the appointment tell the clinic you think you have mastitis. If you are prescribed antibiotics, make sure you finish the course. A GP can also recommend breastfeeding-safe pain medication.
Your Physiotherapist can help you by providing:
Therapeutic Ultrasound (to reduce inflammation, kill bacteria, improve milk flow and reduce pain)
Gentle, broad-stroked massage (using the whole hand to sweep over the breast) to reduce swelling and help drain the breast. It is important not to apply firm massage directly over the area, as breast tissue is delicate and strong massage can make inflammation worse.
Use of Kinesio Tape or Tubigrip (or both) for support of the breast
Advice on feeding postures to help your condition
If Therapeutic Ultrasound is going to work for you, you should have relief in the first session, and normally should not require more than 3 treatments (normally spaced 1-2 days apart). Where appropriate and safe, we can also teach you to use the Ultrasound machine and hire it to you for home use for 1-2 days to reduce the number of appointments you need.
Remember, early treatment can mean you get better faster, you feel less ill and be at less risk of a breast abscess.
Prevention:
The old saying is that prevention is better than cure. By knowing the common causes for mastitis, you may be able to work to prevent mastitis. But keep in mind that even if you do everything right, you may still have mastitis and it's not your fault. If this happens it's important to seek professional help to determine the cause for you.
Some common causes for mastitis include:
Issues with attachment or latch to the breast, such as if your baby has a tongue or lip tie
Damage to the nipple
Too long between feeds, leading to engorgement and blocked ducts from the pressure
Breast engorgement (too full)
Blocked milk ducts
Compression to the milk ducts such as an overly tight bra, ill-fitting flange of a breast pump, or applying too much pressure to the breast while feeding/pumping/expressing
Stopping breastfeeding too quickly
Things you can do to minimise the risk of Mastitis:
Breastfeed as often as your baby needs (normally 8-12 times in 24 hours for a young baby).
Try not to miss or put off feeds (you can express if you can't feed your baby at the time).
Feed or express for comfort if your breasts become too full.
Get some help from a Lactation Consultant if you aren't sure whether your baby is attaching well at the breast. We encourage you to have someone experienced check for lip and tongue ties to ensure these are not impacting on feeding if present.
Try to ensure that the breasts don't become engorged- either from the baby skipping a breast in a feed or from waiting too long to feed (such as when baby starts sleeping longer at night, or returning to work and skipping pumping sessions).
You may consider the use of probiotics, with specific breastfeeding probiotics (such as Qiara) having some research demonstrating a reduction in frequency of mild mastitis episodes.
Avoid pressure on your breasts from clothes or from your fingers when feeding. If you pump, then ensure the flange doesn't press into your breast.
Try to get some rest during the day wherever you can. Being overtired and rundown can make you more susceptible to infections.
References:
The Royal Women’s Hospital https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-problems/mastitis
Australian Breastfeeding Association https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/mastitis
HealthDirect https://www.healthdirect.gov.au/mastitis