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After nursing comfortably you have started to feel pain in one breast. At first you wonder if it's just your imagination, but the area is beginning to look a bit pink. Could it be a plugged duct?

A plugged duct is a milk-flow obstruction, that can be in the nipple or deeper within the breast. It typically affects only one breast and comes on gradually.

"No one knows the specific cause of plugged ducts, but they are usually found in mothers who have an abundant milk supply and who do not adequately drain each breast," writes Jan Riordan, author of Breastfeeding and Human Lactation.

"A plugged duct is indicated by either of these two sets of symptoms: complaints of tenderness, heat, and possible redness in one area of the breast or (if the plug is located in a duct close to the skin) a palpable lump of well-defined margins without a generalized fever. Sometimes a tiny white milk plug can be seen at the opening of the duct on the nipple."

What You Need to Know about Plugged Ducts

Plugged ducts are usually caused by doing too much!
Stress and exhaustion can play a major role in developing plugged ducts. Take some time each day to get the rest you need, crawling into bed with your baby.

Take a look at your diet.
A healthy diet helps boost your immune function. Drink to satisfy your thirst. Too little to drink can contribute to plugged ducts. As a new mom, you often get so busy that you forget to drink the amount you need, so make a habit of having some water every time you sit down to nurse.

Breastfeeding expert, Ruth Lawrence, M.D., also recommends limiting saturated fats and adding one tablespoon of lecithin a day to your diet.

The suspected area may not be the actual area of backup.
Because the ducts within the breasts do not run in a straight line, the problem may be in an area that is different than where you actually feel the pain or see the engorgement. When using ice or heat and massage, treat the entire breast rather than focusing on what appears to be the affected area.

A plugged duct will usually improve quickly.
Most plugged ducts resolve within one to two days.

Before Nursing

Gently remove dried milk secretions on your nipple.
Apply a warm, wet washcloth to your nipple or soak your breast to remove the dried milk. Express a bit of milk to get your milk flowing.

Use moist heat and gentle massage, followed by milk expression.
Soak your breasts in a big bowl filled with warm water, submerging your breast for around 10 to 15 minutes, and use firm, but gentle massage. Start at the outer quadrants of your breast, where much of your breast tissue is located.

When you're not using moist heat prior to a feed, you can also use an electric vibrator on a gentle setting.

During a Feed

Nurse or express your milk every two hours.
Pay special attention to the affected breast. If you are unable to nurse, or your breasts still feel full after nursing, express your milk by hand or by using an automatic electric double breast pump.

It's time to get innovative with positioning.
Some moms find relief from plugged ducts by leaning over their baby to feed, a position that takes advantage of gravity. Though the traditional advice of pointing a baby's chin toward the plugged area is probably not as effective as once thought, it can be helpful to try breastfeeding in different positions.

Remember that whatever position you choose, good positioning and attachment, as well as comfort, are key.

Massage your breasts or use constant compression during a feed.
To massage, cup your breast, using your thumb to massage from the outer quadrants toward the nipple. Move your hand around the breast to get different areas.

Compression while breastfeeding can quickly clear a plugged duct. Compress areas of your affected breast, using as much firm, steady pressure as you can tolerate.

In Between Feeds

Use cold compresses to relieve pain and reduce inflammation.
Place an ice pack, covered with a thin towel, on your affected breast for around 15 minutes in-between feeds. (Frozen peas work well because they conform to the shape of your breast.)

Safety Note

• Don't ignore a plugged duct. Left untreated, it can lead to mastitis.
• If you have symptoms of mastitis contact your doctor. Symptoms of mastitis usually come on abruptly, unlike plugged ducts. With mastitis your breast may be red or hot, and the pain might be described as intense. Mothers with mastitis usually feel ill and may have a fever over 101.3.
• Reasons for plugged ducts can include, but are not limited to:
  • inadequate breast "drainage"
  • previous plugged duct
  • milk blisters
  • pressure on the breast (making an airway for your baby; tight bra, underwire bra, or restrictive clothing; sleeping on your stomach)
  • sore nipples
  • overabundant milk supply
  • tongue tie
  • timed feeds or skipped feeds
  • a sleepy baby
  • food allergies (with plugged ducts occurring premenstrually or prior to ovulation)
  • a diet high in saturated fats
  • too much or too little salt
• Any lump that is not getting smaller within a couple of weeks needs to be evaluated by a breastfeeding-friendly surgeon.