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How to manage clogged milk ducts and mastitis when breastfeeding

Get the latest expert advice for identifying, treating and preventing a plugged milk duct and mastitis in breastfeeding parents.

How to manage clogged milk ducts and mastitis when breastfeeding

If you are breastfeeding, chances are you will experience a clogged milk duct at one time or another — about 20% of breastfeeding parents do. Clogged ducts are an “inflammatory condition that can cause breast pain, swelling and problems with breastfeeding,” explains Dr. Jessica Madden, pediatrician, neonatologist, lactation consultant and the medical director of Aeroflow Breastpumps.

If clogged ducts aren’t treated, they can lead to a condition called mastitis, which causes more widespread breast pain and can make you feel like you’re coming down with the flu. Pain during breastfeeding is one of the top reasons that parents call it quits, but there’s hope: clogged ducts and mastitis are treatable. Plus, there are measures you can take to prevent them from happening in the first place.

Clogged milk duct vs. mastitis

If you are confused about the difference between clogged ducts and mastitis, you are not alone. The two conditions share similar symptoms and causes, and sometimes people who have clogged ducts go on to have mastitis.

Both clogged ducts and mastitis are inflammatory conditions, says Madden, but clogged ducts are more localized. “The tenderness and swelling with plugged milk ducts are typically found in just one area of the breast,” she explains. With mastitis, inflammation and swelling spread from the milk ducts into the alveoli sacs (the tiny, hollow sacs where milk is produced and stored), and then into the deeper breast tissue,  says Madden.

And how do clogged ducts turn into mastitis? “Plugged milk ducts cause mastitis when the associated swelling and inflammation lead to leakage of fluid into the surrounding breast tissue,” says Madden. However, she adds, the reverse isn’t true: mastitis doesn’t cause clogged ducts. 

Causes of clogged milk ducts

Erin Artfitch, mom of two from Charlotte, North Carolina, and owner of the blog, Blunders in Babyland, shares that she had multiple clogged ducts during the years she breastfed her daughters. “Our breastfeeding journey was rough,” she says. Artfitch believes the reasons for the clogs were a combination of the fact that she had milk oversupply and that her daughters were tongue tied, a condition that can make it difficult for infants to suckle the breast effectively. “The girls had trouble latching properly and could not drain my milk effectively,” she adds.

Indeed, poor latching can, in fact, lead to inadequate removal of milk in the breast, which can be a contributing factor in developing clogged ducts. According to the Academy of Breastfeeding Medicine (ABM), hyperlactation, where you overproduce milk, is also a main cause of clogged ducts. Leaving excess milk in the breast can lead to engorgement, swelling and inflammation, all of which are factors in clogged ducts.

Another common cause of clogged milk ducts, according to ABM, is something called mammary dysbiosis. “This is basically when the microbiome specific to the breasts becomes disrupted,” explains Katie Prezas, private practice lactation consultant and owner of Empowering Lactation. “This disruption can be caused by many things like your genes or health conditions, but some of the other common culprits are a recent round of antibiotics, probiotics use or breast pump usage.”

Common symptoms of clogged milk ducts

One thing is almost certain: If you have a clogged duct, you will have noticeable symptoms. Artfitch remembers when her youngest weaned from night feeding and her breasts became overfull, leading to clog. “A large lump formed on the side of my breast,” she describes. “It became red, uncomfortably warm and very, very painful.”

Prezas says that it’s normal for lactation breasts to feel lumpy and bumpy at times, but clogs are usually much more uncomfortable and usually quite painful. “A plugged duct often feels like a small lump, bump or knot within the breast that might be tender to the touch,” she describes. Plugged ducts usually just affect one breast at a time and are localized to one particular spot on the breast.

Signs mastitis may have started

So how do you know if your clogged milk duct has turned into mastitis? First, mastitis affects more of the breast, says Madden. “Mastitis causes the affected breast to have a large area of redness, swelling and tenderness, which is easily visible from the outside,” she describes. Mastitis will also cause more systemic symptoms, like fever, chills, and fatigue, says Madden.

Treatment for a clogged milk duct

The common treatment for clogged ducts used to focus on breastfeeding or pumping more frequently to get the milk out and “release” the plug. It was also recommended that you apply heat to the clogged breast and massage the area vigorously. However, in 2022, ABM revised their clogged ducts and mastitis protocol and no longer recommends these types of treatment.

So how do you unclog a milk duct? “The new recommendations from the ABM for treating plugged ducts are to breastfeed and pump in a normal manner, says Madden, adding, “not trying to fully ‘empty’ the breasts each time,” says Madden. 

Additional treatment measures Madden recommends include:

  • Taking over-the-counter pain medications, such as ibuprofen or acetaminophen.
  • Using ice (instead of heat) for pain and tenderness.
  • Asking your doctor or midwife about taking sunflower or soy lecithin (5-10 grams daily).
  • Treating oversupply, which may include taking care not to pump more than your baby needs, and trying “block feeding,” where you nurse from the same breast a few times a row to help downregulate your milk supply.
  • Using therapeutic ultrasound (TUS), which is performed at a doctor’s office and uses thermal energy to reduce swelling and inflammation in the breasts.

Many parents find massage soothing for clogged ducts, but Prezas cautions against aggressive massage. “A plugged duct is not a pimple that needs to be popped,” she says. “If you massage too deeply, you will further inflame the area, which will promote more swelling when your body sends more fluid and blood to the area, ultimately causing more harm than good.”

Treatment of mastitis

The recommended treatment for mastitis is similar to the treatment for a clogged duct, but sometimes antibiotics are necessary. “Not all cases of mastitis need to be treated with antibiotics, and, in many cases, mastitis will resolve without antibiotic treatment,” says Madden. “The ABM recommends using antibiotics for suspected or confirmed bacterial mastitis, and there is an increasing utilization of breast milk cultures to help clinicians determine which antibiotics should be used.”

If you suspect that you have mastitis, you should contact your OB-GYN or midwife, who can help diagnose you and prescribe antibiotics, if needed.

Prevention of plugged ducts and mastitis

Clogged ducts can be a pain (literally!), but there are some simple measures you can take to prevent them from happening in the first place, and from recurring. Adrian Fear, a private practice lactation consultant from Michigan, says that having a routine for breastfeeding or pumping on a regular schedule is a good place to start.

“Frequent milk removal is the best way to prevent these problems from developing,” Fear says. So that means you shouldn’t skip breastfeeding or pumping sessions, when possible. You also shouldn’t limit your baby’s feeding time. If you need to wean your baby or space out your breastfeeding sessions, do it as gradually as possible, she recommends.

Other ways to prevent clogged ducts is to wear nursing bras that fit well, Fear says, since tight or ill-fitting bras can increase the likelihood of developing clogs. Making sure that your baby is latched on well during breastfeeding and is able to empty the breast is also important because overfull breasts can lead to mastitis. This may mean reaching out to a lactation consultant or breastfeeding counselor for some hands-on latching help.

The bottom line 

Breastfeeding a baby can be hard enough, and dealing with a clogged duct on top of that can be extremely overwhelming. But it’s important that you be proactive as soon as you notice signs and symptoms of clogged ducts or mastitis. According to ABM, the sooner you treat the problem, the better changes it has to resolve.

Most importantly, remember that you don’t have to do this on your own. “When in doubt, reach out to an International Board Certified Lactation Consultant (IBCLC), your primary care doctor, OB-GYN or midwife for additional care and treatment options,” Prezas recommends.