Mastitis

Lactational Mastitis occurs in up to 25% of nursing mothers most commonly between 2-5 weeks after delivery.

Blocked milk ducts or engorgement can both cause very similar symptoms and signs to infection.

Symptoms include redness, tenderness and warmth in the breast.

Initial treatment in all of these situations consists of adequate breast emptying, lots of fluids and rest.

Good lactation advice is essential to ensure adequate emptying of the breast and to minimise nipple damage caused by poor breastfeeding techniques.

Problems due to blocked ducts or engorgement should improve within 24 hours.

Cabbage leaves are an effective old home remedy for engorgement and breast pain. The leaves should be rinsed and the hard central vein removed. They can be cooled in the refrigerator. Place leaves inside bra and leave in place for an hour or two.

If symptoms do not settle, antibiotics should be prescribed. The usual cause is a bacterium called Staphylococcus, which enters the breast through small cracks and abrasions in the nipple. Antibiotics are effective treatment at this early stage.

Flucloxacillin is usually effective and for those with a possible Penicillin allergy, Erythromycin is a reasonable alternative.

If there is no improvement within 48-72 hours of starting antibiotic therapy then you need to seek further help. The most common reason for a poor response to antibiotics is that an abscess has formed in the breast tissue. An abscess is a collection of pus walled off by fibrous tissue and the antibiotics cannot penetrate into this area. The best way to look for an abscess is with ultrasound. Drainage of the pus will improve the situation very quickly. (See breast abscess below)

Less common causes for a poor response to antibiotics include other medical conditions such as fat necrosis, inflammatory cancer, unusual infections such as TB and granulomatous mastitis. Triple assessment including appropriate imaging and biopsy, is necessary to exclude these problems in anyone who does not respond to antibiotic therapy within a few days.

Prevention is better than cure. Lactation advice and appropriate care of cracked nipples will avoid many of these problems.

Cracked nipples can be managed with moist dressings to aid wound healing and this is preferable to vigorous cleaning and drying of the area, which can aggravate the problem.

Lanolin ointment is commonly used to maintain suppleness of the nipple skin