What is subacute mastitis? We are often contacted by women who, for days or weeks (or even months!), have had a stinging feeling in their nipple, especially at the beginning of the feed and right after it. Sometimes, there is also pain in the breast and a prickling feeling that moves towards the ribs. The nipples are often pinker than usual, and, in some cases, milk blisters or wounds appear that don’t heal or that come and go.

All these sensations could be mainly related to poor latch, and in fact, if you have one or any of these problems, the first thing to do is to check if your baby’s latch is ok.

However, in the last few years, and after working a lot on the subject of the latch and seeing that there were mothers who still had pain and discomfort despite a good latch, research began to be done. Now, we know a little bit more about the bacteria in breast milk. New types of mastitis appeared from those further investigations, which are different from the well-known acute mastitis. The first one we want to discuss is the so-called subacute mastitis. Here we answer the most common questions you may have:

What causes the discomfort or pain associated with subacute mastitis?

A breastfeeding woman’s milk is full of “good” bacteria that are beneficial to both mother and baby. For different reasons, some of them can increase in quantity and start to deposit in the ducts where the milk comes out, which together with other substances, can cause these ducts to narrow and the milk to flow more slowly. Sometimes, they even obstruct the milk duct completely, causing the so-called milk blisters or blebs.

So milk won’t come out anymore?

Breastmilk will come out, but it may flow slower, making your baby more irritable when feeding at the breast. You might have the feeling that your baby is more nervous and pulls more on the nipple, which makes the feed even more painful than it already is.

I have been told that I have thrush in my breast, and my baby has thrush as well

For a long time, it was thought that thrush (a fungal infection also called candida) in the nipple caused these symptoms. Then, it was recommended that antimycotics (antifungal creams) be applied to the nipple and areola. On many occasions, the mother’s pain in the breast came with the appearance of fungus or thrush in the baby’s mouth.

However, research on microorganisms in the mammary gland has now ruled out the presence of candida: the nipple and areola are not places where they can easily reproduce, and neither are the ducts. These studies found that, in fact, it was bacteria and not fungi that caused pain or discomfort in the nipple and breast, and these bacteria can also favor the growth of fungi in the baby’s mouth.

What should I do now?

First of all, you have to look for the cause of this mastitis. If you don’t treat the cause, even if you follow the following recommendations, it’s possible that within a short time, you will be back in the same situation. So, review your breastfeeding technique. Remember that your breasts should never hurt, neither at the time of latching on nor afterward. If repositioning your baby is not enough, find help and have an expert healthcare professional assess your baby’s mouth to see how mobile your baby’s tongue is. Often, if you improve your technique and reduce the pain during the feed, the discomfort will improve within a few days, and you may not need further treatment.

I also have sore nipples; what should I do?

If you have sore nipples and wounds, you should wash them two or three times a day with water and neutral body soap, dry them with disposable paper towels, and keep them clean during the day. It’s important that you take care of them as they are a way of entry for harmful germs.

If you have one or more milk blisters, it is not recommended to touch or prick them, as the whole duct may be clogged with bacteria. If they are not touched much, the discomfort improves, and, on the other hand, there may be a greater possibility of overinfection if you touch them often.

If it continues to hurt, there are two lines of treatment, which should be supervised by a healthcare professional: probiotics or antibiotics.

What about probiotics? Are they helpful?

Probiotics are live microorganisms that are intended to improve the bacterial flora of a certain place in the body. Specifically, for the breast, studies show that two types of probiotics could help when there are symptoms of subacute mastitis: lactobacillus fermentum and lactobacillus salivarius. It seems that they could improve between 60 and 80% of the cases, although there are still only a few studies on the subject. They can be a good choice because they have little side effects.

I have already tried probiotics, and they have not worked; what else can I do?

As mentioned above, probiotics do not work in all cases. If the discomfort does not go away after a while of using them, and you still feel a lot of pain, or if you have had a milk culture lab test that tells you which antibiotic to take, antibiotic treatment may be recommended. These antibiotics need to be prescribed by a doctor.

I have had many cases of mastitis during these months of breastfeeding. What should I do?

If you can get a quantitative lab culture test with an antibiogram for your breast milk sample, go ahead. This would be an essential tool to understand which bacteria are causing the problem and, therefore, also be able to treat it better. The difficulty here is that you get a lab to do these tests according to specific protocols because the way to make the test and count bacteria in breast milk is different from the one used for blood or urine tests, for example.

We also provide a link to a recent protocol by the Academy of Breastfeeding Medicine for the treatment and approach to these types of problems: https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf.

If you are in pain, make sure you ask for help. Breastfeeding pain is never normal, and it always indicates that something can be improved. We know that this is a controversial topic, with many people having different points of view. However, we need more research on issues related to breastfeeding in order to shed light on common problems mothers have during this time.

If you have any more questions, please download the LactApp app for your Android or iPhone. There, you can find a consultation channel where our experts will help you with your individual consultations.