If You’re Haunted By Recurrent Mastitis: Help & Tips

It comes on suddenly and leaves without a trace. I always forget how bad mastitis is until I get it again, then I’m surprised I’ve lasted this long with breastfeeding because I’ve felt hounded by those ‘quitting feelings’ during many a run with this illness.

I just recovered from my 8th (in 5 years) and hopefully final battle with mastitis; my second bout of the “boob flu” in two weeks.

Thankfully I’ve learned something new with each run of the boob flu madness…

In my experiences some treatments have worked like a charm and others made me feel quite uncomfortable. I’ll list some remedies below as well as one I’ve just come across that seems especially promising. Many of these I’ve tried myself but, of course, other women may respond differently.

PLUG VS. MASTITIS

When it comes to a breast infection, proper diagnosis is key; avoiding antibiotics is ideal. Mastitis and blocked ducts are similar enough that it can be confusing to figure out which condition you have, especially since a severely blocked duct can be as painful as mastitis and can present with a fever like mastitis. The main difference is that mastitis is commonly treated with antibiotics (though this is not the ideal solution) because it’s caused by an infection in the breast (which may occur with an untreated clog), and a clogged duct is not. Though very rare, please be aware that Inflammatory Breast Cancer has the same symptoms as mastitis.

So, is it mastitis? Survey your breasts for a sudden red rash, often in a triangular shape along where one or more ducts should reside. The rash may be hot to the touch with angry-looking red streaks or in a patch. There’s your first clue. If you see this rash, it’s a good time to take preventative measures against it worsening into full-blown mastitis. If you have come down with full-blown mastitis, you’ll know! The sudden flu-like symptoms can’t be missed.

Predisposing causes of mastitis include: a cracked nipple, a plugged duct, ineffective drainage by the baby or a pump, wearing a tight-fitting bra, waiting too long between feedings, stress, fatigue, poor nutrition/hydration, bacteria (see note on probiotics below), obstructing ducts with a finger (improper ‘sandwich hold’), abrupt weaning, and anemia. About 1 in 20 breastfeeding mothers gets mastitis at least once; it’s most common in the first 28 days of breastfeeding. Take careful note of these potential triggers as it may help with prevention.

Mastitis symptoms include: intensely painful, swollen, red, hot, inflamed breast; feels like the flu with body aches and pain, chills, fever, malaise, lethargy, migraine.

*Note: I am not a medical provider; this is not to be taken as individual medical advice. All content is for educational purposes only. Please bring any treatment plans to the attention of your lactation-educated care provider to discuss priorly.*

Mastitis Relief Tips

 

DISCUSS

• Alert your employer that you need to request a sick day(s).
• Let your lactation-educated health provider know you have mastitis as soon as possible, even if you don’t think an appointment is necessary yet. You can work on a care plan together if you wish. This also helps them prepare in case you do need to go in for an assessment, and you have time to try a variety of remedies before antibiotics may become needed.
• Be prepared for bad advice from non-breastfeeding educated health professionals in regard to breast infections. I encourage you to do your own research and learn to become hyper-vigilant and aware of what your body needs from you.
• If you have a breastfeeding support person, educate them about mastitis so they can help you. You’ll need time to rest, sleep, and do nothing else but nursing and treating the illness. Ideas for a friend, family, or partner: they can start a meal train for you, go out to buy diapers or run a cloth diaper load, take children off your hands so you get uninterrupted recovery time, bring your child to you for nursing, prepare and deliver mastitis relief items such as brewing tea or heating up a rice sock.
• Remind others that if you don’t have time to properly recover, you’re at risk of getting sicker or coming down with mastitis again, rendering you pretty useless for even longer.

NURSE

• Nurse frequently on the affected side (don’t completely ignore the other side though!). If it’s too painful, you can try pumping as sometimes that’s more tolerable. Either way, you must keep your breasts in a continued process of draining because this will help clear the infection.
• Rest assured, the infection is restricted to the breast tissue and does not reach the milk, so there’s no possibility of infecting the nursling.
• Neglecting to continuously nurse the breast can actually result in delayed recovery or an abscess, so you really want to avoid a compounding of eventually insurmountable problems.
• If you do mixed feedings/supplementing, do what you can to keep baby feeding exclusively from the breasts for now.
• La Leche League gives a mastitis management reminder to change the baby’s position while nursing in order to effectively drain all the ducts.
• Dangle feed. This means laying baby in a comfortable supine position and nursing from above — breast dangling, gravity aiding in movement of milk.

DRINK

• Stay hydrated.
• Drink mastitis-fighting tea or tincture (lots of recipes online! Echinacea root is a helpful ingredient).
• Infuse boiling water with rosemary. From KellyMom: Add 2-4 teaspoons of fresh or dried rosemary to a cup of boiling water. Infuse (steep) for 10 minutes, then strain.

EAT

• Eat nutrition-packed food and take Vitamin C.
• Eat chopped raw garlic cloves (5 per day works for me, but I’ve seen 2 recommended).

SLEEP

• Rest! Bunk up in bed skin-to-skin with your baby and forget house chores for now. KellyMom observed that “mastitis appears to be the body’s way of telling mom to SLOW DOWN.”
• Avoid sleeping on your stomach.

MASSAGE

• Learn how to perform a proper hand massage to relieve clogged milk.
• Hold a vibrator or gentle back massage device on your breast to stimulate the clogged area. A vibrator offers minimal discomfort as it’s designed for use on sensitive areas.

HOT/COLD

• Try frequent, consistent applications of the following, rather than lengthy, sporadic attempts.
• Apply moist heat – hot shower, submerge breast in bowl of hot water, hot rice sock on affected area.
• Make a fenugreek seed poultice. KellyMom also shares instructions for a dandelion compress: Boil about an ounce of minced dandelion root in two to three cups of water until only half the liquid remains; use compresses of the resulting brew.
• Cold compresses can help bring down inflammation. Try a cool washcloth, specially shaped cooling packs for the breast, bag of frozen veggies.
• Try chilled grated potato or carrot applied to breast, or chilled cabbage leaves to ‘cup’ the breast.

• Potato treatment (adapted by Bridget Lynch, RM):
  Cut 6 to 8 washed raw potatoes lengthwise into thin slices. Place in a large bowl of water at room temperature and leave for 15 to 20 minutes. Apply the wet potato slices to the affected area of the breast and leave for 15 to 20 minutes. Remove and discard after 15 to 20 minutes and apply new slices from the bowl. Repeat this process two more times so that you have applied potato slices 3 times in an hour. Take a break for 20 or 30 minutes and then repeat the procedure.

IN GENERAL

• Ditch the bra for now.
• Do NOT immediately resume your usual routine once acute symptoms subside.
• Get help with baby biting or dry areolas if it leads to chronic broken skin.
• If mastitis symptoms are improving, they should increasingly lessen with continued treatment until you’re ship-shape again. The lump(s) might take a week to decrease in size enough that it’s no longer sore, but the fever stage usually only lasts for 24 hours.

MEDS

• Start taking a mastitis fighter (I like Mastitis Relief by Mothers Herbal) at the first sign of a plugged duct (rash, lump, etc).
• Essential oils – tea tree, oregano, and anti-infectious/anti-pain blends can be researched online.
• Research recipes for herbal remedies in a soak, poultice, or externally applied infused oil – marshmallow root, calendula, dandelion, yarrow leaf, comfrey, parsley, echinacea root.
• Probiotic treatment in place of antibiotic treatment looks promising, though controversial at this time. There is some evidence that certain probitiotic strains (Lactobacillus fermentum or Lactobacillus salivarius) may be more helpful to combat mastitis than a course of antibiotics and without the latter’s unwanted side effects. More real-life exercise of this treatment seems to be a needed and worthwhile prospect, so hopefully more research is conducted in addition to these studies.

“By day 21, a greater bacterial reduction occurred in women receiving probiotics compared with antibiotics, with the greatest reduction in the L. salivarius group. Breast pain scores were also significantly lower in the probiotic groups, with complete recovery in 88 percent of the L. fermentum and 85 percent of the L. salivarius group by day 21, compared with 28.7 percent of the antibiotic group. Recurrence of mastitis was also significantly more common in the antibiotic group than in the L. fermentum or L. salivarius group (30.7, 10.5, and 7.1 percent, respectively). […] The authors conclude that L. fermentum or L. salivarius is an effective alternative to antibiotics for the treatment of infectious mastitis during lactation.” – Arroyo R, et al. Treatment of infectious mastitis during lactation: antibiotics versus oral administration of lactobacilli isolated from breast milk. Clin Infect Dis. June 15, 2010;50(12):1551–1558.

• Antibiotics – Fortunately, even severe cases of mastitis can resolve on their own without a course of antibiotics. But, if your symptoms haven’t cleared or improved after 12-24 hours of treating the affected breast, many health care providers may urge you to fill that prescription.

This may not necessarily take into account whether other treatments are being faithfully used, or used at all (I took antibiotics only the first time I had mastitis, but I wasn’t encouraged to try anything else and wasn’t informed about the risks).

Is it an unnecessarily conservative measure or responsible care to put a mother’s recovery on a timer? Either way: Untreated mastitis (or delayed treatment attempts) can result in an abscess that can require invasive correction or a more severe infection that leads to hospitalization.

Mastitis is serious business deserving of more than nonchalance. Last week I learned anecdotally of a U.S. mother who died after coming down with it and, though I’m sure this case had its own compounding factors and also not the only case, let’s just say it wasn’t exactly encouraging news to hear whilst dealing with the most stubborn, most widespread, most painful network of plugs I’ve ever had!

That said, I don’t aim to fear-monger and I do believe women are completely capable of being responsible for their own health care when motivated and properly informed. Personally I think individually tailored, watchful treatment is more effective than putting recovery on a standardized timer, and I’m sure many others feel the same. In any case, this is just a blog with ideas — talk to your care provider and don’t be afraid to ask tons of questions and bring some ideas with you!

It’s very important to openly discuss any concerns with your care provider throughout a run of mastitis. Working with a care provider who keeps your own treatment interests in mind is crucial (whether you want to go straight to antibiotics or use alternatives). If you do wish to take antibiotics, ask about a probiotic protocol to use after the dose is completed and ways to prevent thrush. If you wish to avoid the risk of contracting nipple/breast thrush (yeast) from the course of drugs, consider exhausting other options first.

Breastfeeding Inc. warns that if you must take an antibiotic, be sure to get the right one:

“Amoxicillin, plain penicillin and some other antibiotics used frequently for mastitis do not kill the bacterium that almost always causes mastitis (Staphylococcus aureus). Some antibiotics which kill Staphylococcus aureus include: cephalexin (our usual choice), cloxacillin, dicloxacillin, flucloxacillin, amoxicillin combined with clavulinic acid, clindamycin and ciprofloxacin. Antibiotics that can be used for community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA): cotrimoxazole and tetracycline.”

Here are a few words by Dr. Jack Newman about mastitis.

Other Posts:

• Mastitis Overview
• Oversupply Problems
• Assessing Breast Lumps

Other Resources:

• “Blocked Ducts & Mastitis” – Breastfeeding Inc.
• “Management of Mastitis in Breastfeeding Women” – American Family Physician
• “Mastitis” – Ask Dr. Sears
• “Treatments for recurrent plugged ducts or mastitis” – KellyMom
• How to find a quality IBCLC in your area