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How Can Mastitis be Prevented and Treated

Woman wearing gray from the neck down clutching breast area.

Previously, I wrote about the causes of mastitis. Here are some ideas and suggestions on how mastitis can be prevented, and what to do if and when it occurs.

Reduce conditions that lower natural defenses

Fatigue and stress are often correlated with mastitis. We cannot assume those factors cause mastitis. But fatigue and stress can contribute to mastitis because natural body defenses are depleted. Help with household chores and baby care can create increase opportunities to rest.

Because skin acts as a natural barrier to infection, cracked nipples increase chances of developing infectious mastitis. Good latch-on almost always prevents this problem. However, cracked nipples can also occur as the result of improper use of a breast pump, not breaking the suction before taking the infant off from the breast, or other causes.   

Avoid milk stasis

Minimizing or avoiding milk stasis is a major strategy for strategy for preventing mastitis.

Milk stasis is unlikely to develop when a healthy infant latches on well and has unrestricted access to his mother’s breasts. The mother of an ill infant who is unable to completely drain the breast at each feeding should express the remaining milk after the feeding.

Infrequent feedings, missed feedings, skipping night feedings, or abrupt weaning can cause milk stasis. There are some more subtle variations on this theme. For example, overdistention of the ducts can cause stasis. An overabundant milk supply, which can occur in mothers with singletons but more frequently happens in mothers of multiples, is one example of overdistention.

Some factors that contribute to an obstructed duct might not be immediately evident. For example, a bra that is too tight or the carrying strap of a heavy shoulder bag can impede circulation leading to milk stasis and later on, an obstructed duct. Even a seatbelt!

Frequent suckling and massaging the breast behind the tender area while breastfeeding alleviates obstructed ducts. Similarly, hand expression, making sure that all the ducts have been massaged and expressed, is very helpful.

What are common treatments for mastitis?

In the early stages of inflammatory mastitis, simple strategies aimed at frequent breast drainage and maternal rest are frequently effective.

In many cases, however, the early signs are missed, and the mastitis becomes infectious. Prescribed medical treatment is often indicated. 

Begin and continue prescribed antibiotic therapy

Mastitis is usually treated with a 7-14 day course of antibiotics. However, the Academy of Breastfeeding Medicine, as well as the observations from other experts, recommend a  regimen of dicloxacillin or flucloxacillin 500 mg four times a day for 10–14 days. Hence, a woman who has been prescribed a seven-day round or a lesser dosage may end up with an unresolved mastitis.

Because mothers usually experience relief within 24 hours, however, they often discontinue the antibiotics. They may forget, or they may have unfounded fears that the medication will hurt the baby.

Treatment must continue as prescribed; resistant strains of bacteria are more likely to develop when the treatment is prematurely discontinued. A very common reason for recurrent or chronic mastitis is premature discontinuation of treatment. Furthermore, the problem can become exacerbated and lead to a breast abscess, a pus-containing cavity surrounded by inflamed breast tissue. This condition is more painful and requires surgical incision and drainage.

Continue to breastfeed

Continuation of breastfeeding is critical because it drains the breasts as completely as possible. Most experts recommend feeding from the affected breast first because the baby suckles most vigorously on the first side and hence empties the breast more efficiently.

This is best accomplished by a healthy infant who is latched on well. Achieving effective latch-on is the preferred strategy since expression is less effective than the baby.

However, if the baby is unable to achieve a good latch-on due to illness or temporary separation (or some other reason), expressing milk by hand or with a pump is a good alternative.

Mastitis that occurs during the first two weeks or so is a red flag; milk stasis may be happening because of poor milk transfer. This requires a more thorough evaluation of the infant’s well-being.

It is not harmful for a well baby to consume the mastitic milk. Unfortunately, some people equate the danger of transferring antepartum infections to the fetus via the umbilical cord to transferring a postpartum infection to the infant via the milk. However, this is not the case.

First, the fetus receives the blood continuously via the umbilical cord, whereas the breastfeeding baby consumes the milk only at intervals.

Second, although bacteria is present in the cord blood or in the mother’s milk, the milk is a better “barrier” because of the greater number of white blood cells and antibodies in the milk.

Finally, the fetus is in a much more dependent state and therefore cannot be treated directly with antibiotics. There are no reported cases of adverse outcomes when healthy or compromised infants consume mastitic milk.

Get plenty of rest

Rest is essential for all tissue repair. Also, rest is needed to accommodate the increased metabolism that occurs in the presence of fever.

While many of the manifestations of increased metabolism are not evident, the increased heart rate that accompanies fever is an obvious example of the effects of increased metabolism. The increased metabolism makes the mother feel tired. That’s nature’s way of signaling the body that rest is critical for recovery.

Use comfort measures

Warm, moist heat is soothing to the area. The warmth increases circulation to the area, which helps nutrients in the blood stream to reach the affected tissue. Applying a warm wet towel to the breasts works well. (Not I said “warm” not “hot”!)

Or, bending over in a warm shower to increase drainage through warmth and gravity can help.

That said, some find ice packs helpful.

I am unable to find any compelling research to substantiate the efficacy of thermal therapy. But I and other experts have sometimes (not always) found milk that warmth before the feeding can get the milk flowing, and cold therapy afterwards help decrease inflammation.

Ibuprofen is not contraindicated during breastfeeding, and it reduces both pain and inflammation.

Increase fluid intake

As with any other infection, plenty of fluids are required to replace the body fluids lost through fever. Also, the increased fluids help to rid the body of toxins. The mother with an oversupply of milk may fear that increasing her fluid intake will add to her oversupply. However, studies have shown no correlation between increased fluid consumption and increased milk supply.

Increase protein intake

Protein, obtained in the food the woman ingests, helps to build and repair cells damaged by pathogens. Sources high in protein include meat and fish, along with cottage cheese and soy protein.

What about if there’s no improvement?

Typically, signs and symptoms of mastitis subside within 24 hours of when the antibiotic was started.

Unfortunately, women are often hesitant to report a lack of improvement. They often assume that relief will eventually come, or they fear being labeled as “complainers.” However, this situation warrants follow up.

Sometimes, mastitis is resistant to penicillin — the most commonly-prescribed antibiotic for mastitis — and a different course of treatment is therefore indicated. Pain is the body’s signal for help, and ignoring the pain only delays corrective treatment and invites further trouble.

Without effective treatment, the condition can worsen to become either chronic or more acute. Chronic mastitis is sometimes accompanied by a secondary fungal infection (for example, yeast). A more acute complication is the development of an abscess that requires incision and drainage of the accumulated pus.

Here, I’ve given some simple descriptions, and addressed some common corrective strategies, but there are certainly more to be explore.

Do you have tips for preventing and treating mastitis? What has worked for you? Share your thoughts in the comments below.

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  1. Karen Friedrich

    This is outdated information. If you look at Katrina Mitchell’s website “Physician’s guide to” you will find accurate info on mastitis and related topics. Katrina is one of the authors of the new ABM protocol on mastitis. She also has an excellent free online presentation explaining all of this. There is no such thing as a “plug in a duct”.

    • Marie Biancuzzo

      Karen, I’m having a hard time following why you’d think that according to Dr. Mitchell, there’s “no such thing as plugged duct.” I’m looking at the resource you named, the “Physician’s Guide” by Dr. Mitchell, and I’m not seeing that. Her exact words are, ” A breast “plug” represents a focal area of swelling in the breast and more accurately reflects full alveoli (milk-making cells – the “grapes”) lymphatic fluid (connective tissue fluid like the kind that can give you swollen ankles) and lots of blood flow in an area than a discrete “plug of milk.” I realize this is semantics, but she is using 38 words to more accurately what most of us just call a “plug”. And I can tell you that when that “thing”, whatever you want to call it, is relieved, flow of milk does occur! If you can suggest 1 or 2 words, rather than 38, to describe what’s going on, we’d be all ears! And, even after searching twice, I was unable to find that my blog post used the word “plug” at all.

  2. Kim Cook

    I recently had a client present with a headache. I was concerned about pre-eclampsia so went right over to her house. She then said she felt like she had the flu and her right breast hurt. No signs of high blood pressure so I suspected mastitis. The breast was warm to touch but no redness noted. She went to doctor later that day and was diagnosed with mastitis. Now we are trying to build up supply as it dropped due to a plugged milk duct also. She was placed on antibiotic for the mastitis. She is able to fully feed from other breast and is pumping and feeding with the affected breast.

    • Marie Biancuzzo

      Kim, as usual, you’re a rock star clinical expert! Yes, at first blush, I’d have wondered the same thing. But you did a good assessment, and realized, no, this is something else. The scenario you describe is not unusual, and I’m hoping that new readers will learn from the excellent description you gave.

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