Pain and infection are often caused by plugged milk ducts.
Breastfeeding is not always easy. Common challenges faced by many mothers include pain and infection, often caused by plugged milk ducts.

A plugged (or clogged) milk duct occurs when the duct leading to the nipples from the milk-making cells becomes blocked or there's a delay in the removal of milk. The nipple pore may be blocked, which is referred to as a "milk blister" or "bleb" and usually feels like a hard swelling in the breast with a lump that can be the size of a pea or larger. Below are some common questions related to plugged ducts:

1. How do you know if you have a plugged duct?

You might see a red area that can feel warm to the touch. It usually comes on gradually in one breast. There can be tenderness and/or pain. It's usually more painful before nursing.

2. Why do plugs/clogs occur?

Some possible reasons:
  • Inefficient milk transfer
  • Poor positioning of baby at breast
  • Not nursing frequently enough
  • Too tight bra

3. How can you prevent plugged ducts?

First, be sure to fully empty the breast at each feeding.

By responding to baby's cues to nurse, you'll be sure to not go too long between nursing sessions and by making sure baby's latch is effective, the transfer of milk will be efficient and thorough. Check out this helpful information on effective latching, and read this article by lactation consultant, Nancy Mohrbacher for a guide for optimal positioning.

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Second, invest in a widetooth comb.

As a breastfeeding mama and helper to other moms, I highly recommend keeping a basic widetooth comb in the shower. Sure, it's perfect for combing your conditioner through to detangle your hair with ease, but even more helpful than that: at the first sign of a possible plugged milk duct, a widetooth comb can be a lifesaver!

Simply run the comb over some soap (to make it slide) and "comb" your breast, from the nipple outward, in all directions. Combing over your possible clog will help to loosen it and get the milk flowing again. The warm water also helps! This isn't a guaranteed fix for a plug, but by doing this at the first sign of one, you can really help to keep those ducts open and clear.

4. How can you overcome a plugged duct?

Heat, massage, rest, empty breast.

If you can, stay in bed. The more you nurse and rest, the quicker your body will overcome the issue. Definitely do not decrease nursing - keep it up as much as baby wants to drink. A baby's suckle is more efficient than a pump, but if baby isn't willing to nurse and you feel engorged or the need to get that milk out, try hand expressing or pumping (but still continue to offer and nurse often).

Heat and massage are hugely helpful: many moms like to use a very warm, damp washcloth held over the breast before massaging. Nurse frequently on the affected side and point baby's chin toward the plug - which might mean getting creative with your positioning.

One of my favorite ways to fully drain the breast when dealing with a plug is using the help of gravity with mom on all fours lying over baby while baby nurses. You might feel strange, but it's very effective (and older nurslings usually find it to be pretty funny).

Don't wear a bra and just let baby nurse as much as possible. Try using cold/ice between feedings to ease discomfort. Increase water intake and find a good quality vitamin C supplement.

5. How can I tell if I have mastitis?

Mastitis is an infection of the breast's tissue that occurs when bacteria enters the milk duct through a crack in the nipple.

Some signs of mastitis are (in addition to the same signs as a plugged duct):
  • Flu-like feelings
  • Fever
  • Chills
  • Possible red streaks extending outward from affected area
  • Milk may taste salty to baby, causing them to refuse the breast
  • Lumpy or stringy looking milk
  • Possible mucous or blood in milk

6. Do I need antibiotics?

Antibiotics are no joke and wipe out the good, beneficial bacteria as well as the bad. If you notice the following, talk with a doctor immediately because antibiotics might be necessary:
  • Mastitis in both breasts
  • Broken skin on breasts and obvious look of infection
  • If baby is less than 2 weeks old or you've recently been in the hospital
  • A sudden increase in your temperature
  • Blood present in milk
  • Symptoms are severe and sudden
Remember to take a good probiotic to replace the beneficial bacteria if you start a course of antibiotics. This can help you to avoid thrush as well.

7. Seek help.

If you aren't able to deal with a plugged duct on your own, seek out some reliable, trustworthy and accurate-information-based help. I highly recommend calling your local La Leche League leader for help - that's what we're here for (mom-to-mom breastfeeding support, encouragement and accurate information). If your problem is beyond their scope, an LLL leader can help you find a reliable lactation consultant.