102. Clogged Milk Ducts
"The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release."
Milk flow obstruction often results from milk not fully draining from the breast, causing inflammation and tenderness. If left unaddressed, clogged ducts can develop into more severe issues like mastitis, underscoring the importance of prompt and effective resolution.
Clogged, blocked, and plugged ducts. There are many terms for the same problem. Restricted milk flow, or “milk stasis”, leading from the milk-storing alveoli (those grape-like clusters in the breasts), may lead to a fatty blockage that soon becomes painful, and even infectious mastitis, if not treated quickly enough. These clogs can very well lead to other problems and occurrences, including lower supply thresholds, nerve pain in the breast tissue, lessened pumping output and bruising sensations.
The breasts are not an empty cavity to be filled with milk, but contain a network filled with alveoli that can be found even in the uppermost part of the breast tissues leading into the armpits. The ducts leading from these, channel the milk to meet behind the nipple inside the areola area, and release. Too much compression without proper release, be it due to improper bra fitting or tight, shallow latching, can cause buildup to occur. Poor suction from latching or pumping can also prevent proper drainage which leaves behind the fattier part of the milk and may lead to the same problem.
This “network” is also designed to be tapped into frequently. If milk is allowed to sit and settle for too long, say during block feeding versus feeding frequently and on demand, the risk for blockage to occur drastically increases.
Some of the most common reasons behind clogs are:
- Poor latching – shallow, weak, uncomfortable
- Restrictive clothing and bras
- Block feeding/feeding schedules
- Incorrect flange fit or pumping technique, if pumping
- Nipple damage/blebs- secondary issues from poor latching
- Abrupt weaning
- Long stretches in between pumping, 4+ hours
- Fibroids in the breast tissue pushing on ducts/channels
- Lowered immune system
- High stress
- Thrush or bacterial infections
Most women can feel the backed-up milk occurring with a clog. Clogs can be anything from a tender knot in the deep tissue to a blocked outlet on the nipple, also known as a bleb. Pain may also occur while hand expressing or having a letdown, as other channels push up against it. While a small fever may occur due to localized inflammation, clogged ducts are mostly a nuisance and a pain more than anything else. Symptoms beyond these are more in line with mastitis, which is an infection of the breast tissue, and need immediate attention. Expressed milk may show strings or a grainy appearance. While this may look unappetizing, it’s completely safe to give to your baby.
Treating clogged milk ducts involves a combination of strategies to alleviate discomfort and restore milk flow. Effective methods include frequent nursing or pumping sessions to empty the breast, using warm compresses before feeding to encourage milk flow, gentle massage towards the nipple during feeds, and ensuring proper latch and positioning. Rest, hydration, and over-the-counter pain relievers can aid in reducing inflammation. If symptoms persist or worsen, seeking guidance from a healthcare professional is recommended to prevent complications like Mastitis.
The most common forms of treatment involve warm compression, massage and nursing through it while massaging the area during the feed, however, other methods have also been shown to be effective:
- Epsom soaks – dangling the breasts in a tub of warm water with epsom salt can
encourage release of the clog.
- Dangle feeding – lying baby down on a safe surface and dangling over to feed.
- Vibration and gently shaking the breast are both ways to break up a clog.
- Lecithin – a fat constituent found in foods and supplement form, such as sunflower and
soy, known to help emulsify fatty milk for easier release.
- Pump – if the baby does not feed well or has already fed, pump immediately after a feed
to encourage more thorough emptying and clog removal.
- Stay hydrated – this is important in flushing out potential infectious tendencies.
- Rest- really prioritize rest and recovery.
- Pain relievers can be used, just check with your care provider and utilize resources, like
LactMed, for safety while breastfeeding.
- Antibiotics are NOT needed unless it progresses into mastitis.
Another important note – while massage is a primary go-to for dealing with clogs, it’s crucial to realize that the clog is in FRONT of the backed-up milk, which is the knot most feel. Massaging in front of the knot will release the clog faster, while pushing behind it may be adding to the milk back-up.
While clogs may happen regardless of effort, there are ways to help prevent them.
- Avoid block feeding or strict schedule regimens that space out expression opportunities
more than 4 hours apart
- Don’t pressure “sleeping through the night,” neither mom’s supply or the baby is
designed for that
- Ensure proper latching, so as to tap into all of the milk stores
Preventing clogged milk ducts involves maintaining a consistent breastfeeding or pumping routine, ensuring proper latch and positioning to facilitate efficient milk drainage, and avoiding tight-fitting clothing that might impede milk flow. Adequate hydration and proper self-care, including managing stress levels, also play crucial roles in preventing duct blockages. Being attuned to your body and seeking assistance from a lactation consultant if issues arise can further help in proactively preventing clogged milk ducts. Addressing latching issues as quickly as possible will not only help with frequently-occurring clogs, but help prevent them from happening again. If clogged ducts are a common occurrence, rule out latching and mechanical feeding problems.
If pumping, take time to learn proper handling and technique, and just as important, flange-sizing. Just like with a shallow latch or too much compression, a flange that is too big or too small will cause the same problems. Adjust strength settings to a comfortable level to avoid compression of the ducts.
Ashley Georgakopoulos is the Lactation Director at Motif Medical and an IBCLC. Her focus is in the clinical management of breastfeeding and pumping. Ashley is also a mother who has dealt with the obstacles and joys of breastfeeding. She educates families, connects them to resources, and helps the next generation be as healthy as possible: nutritionally and sustainably.