A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (see Milk Blister), or the obstruction may be further back in the ductal system see anatomy. A plugged duct usually comes on gradually and affects only one breast. Milk backs up behind the blockage and the duct and surrounding area usually get inflamed and very sore!

How would I recognise a blocked milk duct?

How will I know if its not Mastitis?

Local (Breast) Symptoms:
A plugged duct usually comes on gradually and affects only one breast. A hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened can appear. The location of the plug may alter through the course of the problem.
A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown.

Systemic symptoms
There are usually no systemic symptoms for a plugged duct, but a low grade temperature (less than 38.5°C) may occur.

Mastitis is an inflammation of the breast that can be caused by obstruction and/or infection of the breast ductal tissue.  The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is standard practice.
Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation.
Mastitis may come on abruptly, and usually affects only one breast.

Local symptoms:
As for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area.

Systemic symptoms:
Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness.

What causes a blocked milk duct?

Blocked ducts are usually caused by milk that hasn’t drained completely from the duct. Several things can cause a blocked duct:

• pressure on the breast, such as an ill-fitting bra, sling or handbag.
• A milk blister blocking the duct.
• Oversupply can lead to engorgement which can lead to blockages.
• A poor latch can lead to inefficient feeding and blocked ducts.
• Skipped feeds, perhaps your baby has just slept through the night.
• Pumping with a inefficient pump.
• Illness or stress.
• Or there can be no obvious reason!

Will it go away by itself?

Some blocked ducts will resolve within 48 hours but to be on the safe side you should always actively deal with any blocked ducts you discover. If left untreated, as well as getting sorer, blocked ducts can get infected and lead to mastitis. You can take Ibuprofen or Paracetamol to help with the inflammation and pain while you are treating it.

What should I do?

• Nurse, nurse, nurse and nurse again!
  The first course of action is to nurse, nurse, nurse and nurse some more. It may hurt but your baby’s sucking action is more efficient than a pump at emptying the breast and hopefully clearing the blockage.
  While nursing keep varying your position. Many experts suggest nursing with the baby’s chin pointing towards the blockage to assist in draining it.
  Let gravity help by nursing on all fours with your baby lying under you on the bed, it’s not dignified but it works!
• Use Heat pads & Massage the area
  Apply a heat pad between feeds to soothe the area. Many mothers find a disposable nappy soaked in hot water to be a very useful hot compress (don’t burn yourself!) Massage the breast frequently & firmly, working your way towards the nipple. This may be very sore, so the best way to do it is in the shower. Lather some shower gel on your breast and massage it. If you find using your fingers to be too sore, many women find using a big hairbrush with bobbles on the teeth to be much gentler.
• Get plenty of rest
  It is generally accepted among nursing mothers that blocked ducts are nature’s way of telling you to slow down. It’s difficult to rest with a new baby, near impossible if you also have a toddler to look after, but you must find a way to get some rest.
  Many mothers recommend a “nurse-in” to clear a blocked duct. This involves you, your baby, a few magazines and your bed for one day. Only get up if you have to and let your baby nurse all day!
  Loosen your bra or wear none at all and drink plenty of water.
  Blocked ducts can lead to mastitis so they are not something to be sneezed at. Treat them as seriously as you would treat a “real” illness and you should be well and happy in a couple of days. If you work outside the home, take a sick day. If you’re a stay-at-home mum, try and get someone to help for a few hours.

Will my baby be ok?

Yes, you may find that your baby is a little fussier on the blocked breast as the flow can be slower but as it clears up the flow will return to normal.

It’s not clearing up, is there anything else I can do?

If a blocked duct has not resolved with 48hrs, Dr. Jack Newman <link http://www.drjacknewman.com/help/Blocked%20Ducts%20&%20Mastitis.asp> recommends the use of therapeutic ultrasound which can be arranged at your local physiotherapy centre.

He suggests a dose of: 2 watts/cm², continuous, for five minutes to the affected area, once daily for up to two doses. He also suggests that if it is going to work, it will most likely work on the first dose.

It’s been 48 hrs and I feel worse, what should I do?

If you develop a fever, or feel like you have the flu with an all-over ache, you may be getting mastitis. Contact your healthcare provider at this stage as you may need medication to clear the mastitis.

Hurrah, it’s cleared up, now how can I prevent a recurrence?

Your breast may feel tender and look slightly reddened for up to a week after the duct has cleared. This is normal.

If you know what caused the blockage then take steps to prevent it from happening again.

Avoid long breaks between feeds, if your baby has recently started sleeping longer, you may need to wake yourself during the night to express off a little milk to avoid engorgement until your supply adjusts, only express a little, too much will encourage more milk production.

Remember feeding on demand is a two-way street, you need to take care of your own needs too. Your body can take a few days to catch up with your baby’s changing patterns so keep an eye out for any engorgement in the meantime.

Make sure your bra is well fitted <link to nursing bras>, your breast size can fluctuate quite a bit, especially in the first few months.

If you are concerned about your baby’s latch, contact a Lactation Consultant as an incorrect latch can lead to inefficient feeding which in turn can lead to blocked ducts.

Some women find taking lecithin supplements to be helpful, although care should be exercised if you have low blood pressure or are prone to depression.

What if it’s not a blocked duct?

Any lump you find in your breast that doesn’t go away after a few days should be investigated by your healthcare provider, they are usually benign cysts but it is always worth checking them out.

References:

WWW:

Blocked Ducts & Mastitis – Dr. Jack Newman

Plugged Ducts & Mastitis - Kellymom

Lecithin Treatment for recurrent Plugged Ducts – Kellymom

Blocked Ducts - Baby Centre

Blocked milk ducts - VHI:

Breast Lumpps & Cysts – Irish Health

Pubmed:

Campbell SH. Recurrent plugged ducts. J Hum Lact. 2006 Aug;22(3):340-3.

Scott CR. Lecithin: it isn't just for plugged milk ducts and mastitis anymore. Midwifery Today Int Midwife. 2005 Winter;(76):26-7.

Betzold CM. An update on the recognition and management of lactational breast inflammation. J Midwifery Womens Health. 2007 Nov-Dec;52(6):595-605.

Kinlay JR, O'Connell DL, Kinlay S. Risk factors for mastitis in breastfeeding women: results of a prospective cohort study. Aust N Z J Public Health. 2001 Apr;25(2):115-20.