Dear Doctor,

It has been two months of breastfeeding so far but my nipples still hurt. I thought it would’ve gone down by now. This is really making me hate the experience yet it is supposed to be a beautiful bonding time with my baby. Will it stop, and when? What can I do to make it easier?

Sharon

If nipples hurt while breastfeeding a two-month-old baby, there is something definitely wrong.  Many women think or have received advice from seniors that breastfeeding is painful initially. But it is not so. Breastfeeding is a natural process and should go on smoothly with no pain, particularly in early weeks. It is after the baby has grown teeth that it can hurt nipples.

Most common cause for painful breasts and or nipples is blocked milk ducts. If residual milk remains in the milk ducts after feeding, it becomes a source for bacteria to grow. The subsequent infection and inflammation can cause pain on touch, with or without swelling and redness. This can happen due to too much milk production or if the baby is unable to suck adequately for multiple reasons.  This can be prevented by ensuring that the breast is emptied completely, after feeding.  The baby can be given more frequent feeds to avoid breasts being engorged. Treatment is by antibiotics and anti-inflammatory drugs.

Poor latching by the baby on the nipples is yet another common cause for painful nipples. If the nipple is not properly positioned inside the baby’s mouth, he/she can exert pressure with the tongue over the nipples, causing pain. If the baby is correctly positioned and latched on the breast, this problem should correct over a short time.

One can have painful nipples while breast feeding due to fungal infection of nipples or tissue around. This can occur due to dampness present around nipples. Nylon under clothes tends to aggravate the problem.  In case of a fungal infection, along with pain, there may be associated itching. It is easily diagnosed clinically and is curable by antifungal drugs.

Eczema of the nipples or around it can also cause painful nipples, which hurt more when the baby is breastfeeding. This can occur due to allergy to anybody care product like cream, lotion, and et cetera, being used over the breasts. Eczema once present is aggravated by nylon underclothes. Treatment is by anti-allergy drugs. Wearing soft, cotton under garments can prevent these problems.

Squirting few drops of milk on the nipples, before feeding the baby is said to provide a soothing sensation over the nipples. However, one suffering from fungal infection should not attempt it. Damp hot compresses put on the breasts and even ice compresses are useful in easing the pain. Anybody using anti-fungal or steroid ointment over the nipples should avoid breastfeeding without prior cleaning of the nipple and around adequately. Another option is to suck the milk out by a breast pump and feed the baby.

Severe cases need treatment by painkillers and anti-inflammatory drugs.                                                Dr. Rachna   Pande is a  specialist in internal medicine.