Clogged, blocked, and plugged ducts. There are many terms for the same problem. Restricted milk flow, or "milk stasis”, leading from the milk-storing alveoli (those grape-like clusters in the breasts), may lead to a fatty blockage that soon becomes painful, and even infectious mastitis, if not treated quickly enough. These clogs can very well lead to other problems and occurrences, including lower supply thresholds, nerve pain in the breast tissue, lessened pumping output and bruising sensations.
The most common reasons behind clogs are of the following, but not limited to:
- Poor latching - shallow, weak, uncomfortable
- Restrictive clothing and bras
- Block feeding/feeding schedules
- Incorrect flange fit or pumping technique, if pumping
- Nipple damage/blebs - secondary issues from poor latching
- Abrupt weaning
- Long stretches in between pumping, 4+ hours
- Fibroids in the breast tissue pushing on ducts/channels
- Lowered immune system
- High stress
- Thrush or bacterial infections
The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the utmost part of the breast tissues leading into the armpits. The ducts leading from these channel the milk to meet behind the nipple inside the areola area, and release. Too much compression without proper release, be it due to improper bra fitting or tight, shallow latching, can create the buildup to occur. Poor suction from latching or pumping can also leave behind the fattier part of the milk, not properly draining, which may lead to the same problem.
This network is also designed to be tapped into frequently. If milk is allowed to sit and settle for too long, say during block feeding versus feeding frequently and on demand, the risk for blockage to occur drastically increases.
Most women can feel the backed-up milk occurring with a clog. Clogs can be anything to a tender knot in the deep tissue, to a blocked outlet on the nipple, also known as a bleb. Pain may also occur while having a letdown, as other channels push up against it, and while hand expressing. While a small fever may occur due to localized inflammation, clogged ducts are mostly a nuisance and a pain than anything else. Symptoms beyond this are now more in line with mastitis, which is an infection of the breast tissue, and need immediate attention.
Expressed milk may show strings or grainy appearance. While this may look unappetizing, its is completely safe to give to your baby.
The most common forms of treatment involve warm compression, massage and nursing through it and massaging the area during the feed. However, other methods have also been shown to be effective.
- Epsom soaks - dangling the breasts in a tub of warm water with epsom salt can encourage release of the clog.
- Dangle feeding - lying baby down on a safe surface and dangling over to feed.
- Vibration and gently shaking the breast are both ways to break up a clog.
- Lecithin - a fat constituent found in foods and supplement form, such as sunflower and soy, known to help emulsify fatty milk for easier release.
- Pump - if baby does not feed well or has already fed, pump immediately after a feed to encourage more thorough emptying and clog removal.
- Stay hydrated - this is important in flushing out potential infectious tendencies.
- Pain relievers.
Antibiotics are NOT needed unless it progresses into mastitis.
Another important note - while massage is a primary go-to for dealing with clogs, it’s crucial to realize that the clog is in FRONT of the backed-up milk, which is the knot most feel. Massaging in front of the knot will release the clog faster, while pushing behind it may be adding to the milk back-up.
While clogs may happen regardless of effort, there are ways to help prevent them.
Addressing latching issues as quickly as possible will not only help with frequently-occurring clogs, but help prevent from happening again. If clogged ducts are a common occurrence, rule out latching and mechanical feeding problems.
Avoid fad block-feeding and sleep training recommendations, especially for the first six months. Breastfeeding is designed for small and frequent meals for a healthy metabolism, and the mother’s body is set up to work with that design, not modern conveniences or preferences.
If pumping, take time to learn proper handling and technique, and just as important, flange-sizing. Just like with a shallow latch or too much compression, a flange that is too big or too small will cause the same problems. Adjust strength settings to a comfortable level to avoid compression of the ducts.