Breast engorgement

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Breast engorgement
Mature female breasts during nursing phase.jpg
Mature female breast engorged during nursing phase
Normal histology of the breast during lactation. Histology of lactating breast, annotated.png
Normal histology of the breast during lactation.

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis. [1]

Contents

Engorgement usually happens when the breasts switch from colostrum to mature milk (often referred to as when the milk "comes in"). However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts. It can be exacerbated by insufficient breastfeeding and/or blocked milk ducts. When engorged the breasts may swell, throb, and cause mild to extreme pain.

Engorgement may lead to mastitis (inflammation of the breast) and untreated engorgement puts pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in one part of the breast, and the skin in that area may be red and/or warm. If it continues unchecked, the plugged duct can become a breast infection, at which point she may have a fever or flu-like symptoms.

Signs and symptoms

Symptoms include the breasts being swollen and oedematous, and the skin appearing shiny and diffusely red. Usually the whole of both breasts are affected, and they are painful. The woman may have a fever that usually subsides in 24 hours. The nipples may become stretched tight and flat which makes it difficult for the baby to attach and remove the milk. The milk does not flow well. [2]

A fever may occur in 15 percent, but is typically less than 39 degrees C and lasts for less than one day. [3]

Causes

Failure to remove breast milk, especially in the first few days after delivery when the milk comes in and fills the breast, and at the same time blood flow to the breasts increases, causing congestion. The common reasons why milk is not removed adequately are delayed initiation of breastfeeding, infrequent feeds, poor attachment, ineffective suckling, [2] a sudden change in breastfeeding routine, suddenly stopping breastfeeding, or if a baby suddenly starts breastfeeding less than usual. [4]

Treatment

The mother must remove the breast milk. If the baby can attach well and suckle, then she should breastfeed as frequently as the baby is willing. If the baby is not able to attach and suckle effectively, she should express her milk by hand or with a pump a few times until the breasts are softer, so that the baby can attach better, [5] and then get them to breastfeed frequently. She can apply warm compresses to the breast or take a warm shower before expressing, which helps the milk to flow. She can use cold compresses after feeding or expressing, which helps to reduce the oedema. Engorgement occurs less often in baby-friendly hospitals which practise the Ten Steps and which help mothers to start breastfeeding soon after delivery. [2]

Regular breastfeeding can and should be continued. [6] The treatment for breast engorgement can be divided into non-medical and medical methods. The non-medical methods include hot/cold packs, Gua-Sha (scraping therapy), [7] acupuncture and drinking specialized herbal teas [8] whereas medical methods are proteolytic enzymes such as serrapeptase, protease, and subcutaneous oxytocin. Cabbage leaves are often cited as a possible treatment but studies have found they provide "no overall benefit" on breast engorgement. [6] Evidence from published clinical trials on the effectiveness of treatment options is of weak quality and is not strong enough to justify a clinical recommendation. [6]

See also

Related Research Articles

<span class="mw-page-title-main">Nipple</span> Part of the breast

The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along with the ductal system. Male mammals also have nipples but without the same level of function, and often surrounded by body hair.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Nipple discharge</span> Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. Pain that involves only one part of a breast is more concerning, particularly if a hard mass or nipple discharge is also present.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Erotic lactation</span> Sexual activity involving the stimulation of womans breast

Erotic lactation is sexual arousal by breastfeeding on a woman's breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.

Breast diseases make up a number of conditions. The most common symptoms are a breast mass, breast pain, and nipple discharge.

Overactive let-down (OALD) is the forceful ejection of milk from the breast during breastfeeding. In some women it occurs only with the first let-down in a feeding, occasionally women may have multiple strong letdowns during a feeding. OALD can make breastfeeding difficult and can be the source of some breastfeeding complications. It may also be known as hyper milk-ejection. A woman may have OALD in addition to an oversupply of breastmilk. The physical or medical cause of an overactive let-down is still unknown. Whether mothers with OALD have a higher overall milk volume – or a strong reaction to the hormone oxytocin also remains to be seen.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

Lactation suppression refers to the act of suppressing lactation by medication or other non pharmaceutical means. The breasts may become painful when engorged with milk if breastfeeding is ceased abruptly, or if never started. This may occur if a woman never initiates breastfeeding, or if she is weaning from breastfeeding abruptly. Historically women who did not plan to breastfeed were given diethylstilbestrol and other medications after birth to suppress lactation. However, its use was discontinued, and there are no medications currently approved for lactation suppression in the US and the UK. Dopamine agonists are routinely prescribed to women following a stillbirth in the UK under the NHS.

<span class="mw-page-title-main">Human–animal breastfeeding</span>

Human to animal breastfeeding has been practiced in some different cultures during various time periods. The practice of breastfeeding or suckling between humans and other species occurred in both directions: women sometimes breastfed young animals, and animals were used to suckle babies and children. Animals were used as substitute wet nurses for infants, particularly after the rise of syphilis increased the health risks of wet nursing. Goats and donkeys were widely used to feed abandoned babies in foundling hospitals in 18th- and 19th-century Europe. Breastfeeding animals has also been practised, whether for perceived health reasons – such as to toughen the nipples and improve the flow of milk – or for religious and cultural purposes. A wide variety of animals have been used for this purpose, including puppies, kittens, piglets and monkeys.

Cracked nipple is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.

A blocked milk duct is a blockage of one or more ducts carrying milk to the nipple for the purpose of breastfeeding an infant that can cause mastitis. The symptoms are a tender, localised lump in one breast, with redness in the skin over the lump. The cause of a blocked milk duct is the failure to remove milk from part of the breast. This may be due to infrequent breastfeeding, poor attachment, tight clothing or trauma to the breast. Sometimes the duct to one part of the breast is blocked by thickened milk. A blocked milk duct can be managed by improving the removal of milk and correcting the underlying cause.

A nipple bleb is a blister on the nipple that can be filled with serous or other fluid. It may be pink or light yellow. It is thin-walled and may appear as a small blister, more than 5 mm in diameter. It can also be referred to as a bulla. Some clinicians may also include milk blisters as a type of bleb. In addition, a blocked Montgomery gland may also be called a nipple bleb though its cause is different than a milk or serous-filled bleb on the nipple. In some cases the bleb may be associated with an adjacent blocked sebaceous cyst.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

Hyperlactation syndrome is a condition where breast milk overflow occurs because of increased milk production. The milk may come out fast and forcibly, making it difficult for the baby to nurse well.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

<span class="mw-page-title-main">Establishment of breastfeeding</span>

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organisation(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

<span class="mw-page-title-main">Hand expression of breast milk</span>

Hand expression of breast milk is a technique used by lactating mothers to express milk using their hands. It is an ancient practice that has been used by women across the world for centuries. Hand expression has gained renewed interest in recent years due to its affordability, portability, and effectiveness. It is an important tool for breastfeeding mothers, especially those who are unable to afford or access breast pumps.

References

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  2. 1 2 3 "Management of breast conditions and other breastfeeding difficulties". National Center for Biotechnology Information US National Library of Medicine. Retrieved 4 August 2017.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  3. "37". Williams obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN   978-0-07-179893-8.
  4. "What is Engorgement? What Causes It?".
  5. "Warning Signs of Breastfeeding Problems". HealthyChildren.org. Retrieved 29 October 2020.
  6. 1 2 3 Zakarija-Grkovic, Irena; Stewart, Fiona (18 September 2020). "Treatments for breast engorgement during lactation". The Cochrane Database of Systematic Reviews. 2020 (9): CD006946. doi:10.1002/14651858.CD006946.pub4. ISSN   1469-493X. PMC   8094412 . PMID   32944940.
  7. Chiu, Jin-Yu; Gau, Meei-Ling; Kuo, Shu-Yu; Chang, Yung-Hsien; Kuo, Su-Chen; Tu, Hui-Chuan (March 2010). "Effects of Gua-Sha Therapy on Breast Engorgement: A Randomized Controlled Trial". Journal of Nursing Research. 18 (1): 1–10. doi: 10.1097/JNR.0b013e3181ce4f8e . ISSN   1682-3141. PMID   20220605. S2CID   18329014.
  8. "Tackling engorgement and mastitis: an all-in-one guide". www.meandqi.com. Retrieved 26 March 2019.