A pain in the breast


Mastitis and Physiotherapy for inflammatory conditions of the lactating breast.

By Jen Vardy

My husband comes from a dairy farm and his knowledge of mastitis was limited to teats and udders. Insert roll of the eyes! Removal from the herd for treatment with antibiotics is not an option for breastfeeding mamas and the more we understand about inflammatory conditions of the lactating breast (ICLB) we realise why women need the right support and treatments to support continued feeding.

Most women have heard of mastitis if not experienced it on their breastfeeding journey. For some it will be the painful end to their nursing days while others will endure several bouts, often when they are run down, tired or coming down with a cold. A welcome night’s sleep when baby drops a feed may be unfairly rewarded by a full, red and tender breast by morning. Or a night out in a fancy ‘non maternity’ bra may result in the squishing of sensitive breast tissue and inflammation. The penalties for attempting to reclaim a little bit of pre-baby life can indeed be severe.

To establish breastfeeding relies on good teamwork with the smallest person in the house and perhaps a bit of luck. You may need to support feeding with expressing to build your supply. You may be pumping to feed a babe with a poor latch or using a nipple shield due to flat or inverted nipples. Informed is best when it comes to breastfeeding and there is plenty of support and information out there to support your individual journey. 

The symptoms of ICLB likely occur on a continuum from milk stasis to inflammation resulting in blocked ducts or non-infective mastitis. This can progress to infective mastitis and if left untreated become a nasty breast abscess which may eventually and thankfully rarely here in Australia result in sepsis. Most women with inflammation and blocked ducts complain of local pain, redness and a palpable lump or wedge of breast. These symptoms can crop up remarkably quickly and when things tip over to the infective side can include fever and flu like symptoms such as chills and body aches and pains. Women can feel like they’ve been hit by a truck and put themselves to bed but mastitis needs timely management. So, what is the best course of action and why involve a Physio?

Physio’s with special interest in Women’s Health are well placed to educate and reassure women with blocked ducts and mastitis. Encouraging women to seek help with toddlers/babies and household chores is first priority. In fact, we spend a lot of time giving supermums permission to lie down and rest during the day. Better for pelvic floor recovery too but let’s not get distracted!

Frequent feeding and feeding from the affected side first to try to completely drain the breast is encouraged. Keeping up or increasing fluids for breast milk production and to encourage lymphatic flow. Checking the fit or loosening bras/crop tops to avoid unwanted pressure. Ice or even the ubiquitous cabbage leaf in the bra can help with pain between feeds while a hot pack or warm compress prior to feeding may help to improve milk flow. 

Inflammation and blocked ducts may respond to gentle massage. No need for fingertip or firm pressure as bruising may actually make the condition worse. And milk ducts don’t travel in straight lines so pressure should be light and circular and start from the axilla towards the nipple for milk flow and then in reverse to assist lymphatic drainage. Kinesiotaping can provide support and improve comfort of painful breast tissue. We can assess and advise on breastfeeding positions to maximise milk flow and drainage but also to relieve other aches and pains in neck and shoulders that may result from poor positioning. 

There is evidence for the use of therapeutic ultrasound for blocked ducts, inflammation and mastitis. Ultrasound treatment can commence with first signs of non-infective mastitis or infective mastitis. If commenced in the first 48 hours treatment may prevent the onset of infective mastitis and the need for antibiotics or in fact reduce the length of their use. There is growing evidence it may even enhance the effect of antibiotics by disrupting the bacterial biofilm.

Ultrasound has the potential to improve milk flow and women are encouraged to feed after their session to enhance this effect. Treatment should be followed up daily for 2-3 sessions or until symptoms improve or resolve. There is no need for referral to Physio for mastitis but we may communicate with your lactation consultant to ensure any other underlying issues are resolved to prevent recurrence or with your GP if your symptoms are not improving.

Breastfeeding can be an emotive rollercoaster for many women so it’s important to know what supports are out there to assist. Physio can be an important part of your journey.

Same day treatment is the ideal either in rooms or by home visit to manage symptoms in a timely manner. Please call the clinic on 9751 0400 to discuss or arrange an appointment with Jen Vardy our Women’s Health Physio.