Plugged Ducts, Mastitis, and Blebs…Oh My!

How to recognize and solve these common breastfeeding challenges…

Plugged duct or mastitis – what’s the difference?

Generally speaking, a plugged duct is a lump of milk “stuck” in the breast, sometimes caused by going too long between nursing sessions.  It can appear quickly and shouldn’t be painful, though the lump may be a little tender when pressed.  Mastitis is inflammation or infection in the tissues of the breast (not the milk itself).  It usually involves a fever and the affected area of the breast is warm, red and very tender.

What do you do about a plugged duct?

Plugged ducts are not harmful, but they can turn into mastitis, so it’s important to clear them as soon as possible.

  • Keep nursing or pumping frequently. Babies are usually much better at removing milk from a breast, so try to nurse rather than pump whenever possible. However, if baby can’t or won’t nurse, use a pump or hand expression to keep the milk flowing. Hand expression is sometimes less painful than pumping –Stanford University has a great video of hand expression of breastmilk. You may also want to hand express or pump after nursing if your breast still feels firm and lumpy.
  • While baby is nursing (or pumping if baby isn’t around), massage the lump gently but firmly towards the nipple until the lump has softened or disappeared.
  • Let gravity help. Try lying baby on his or her back in the middle of the bed, get on your hands and knees, and dangle the breast over baby to nurse.
  • Try warm water. In the shower, massage the lump while warm water runs over your back or breasts, or you can try leaning over a basin of warm water.
  • Use warm compresses. Try putting rice in a sock, warming it in the microwave and applying it to your breast before massaging and/or nursing.
  • Get moving. It may also help to massage all over your breast with your knuckles and finger tips, then lift and move the breast around to encourage fluid and milk drainage.
  • Try lethicin. If plugged ducts continually recur, you could try taking soy lethicin, a natural supplement that helps move fat through the body.
  • Avoid triggers. Tight, ill-fitting or underwire bras, heavy purse straps or seat belts can all contribute to plugged ducts, so be careful with anything that puts pressure on your breasts.

Once you get milk flowing, you may notice strings or grains of thickened milk.  These are normal and not harmful to the baby, so don’t let them worry you.  It’s good news – the plug is moving out!


What if you think it may be mastitis?

If you start feeling achy, feverish and “fluey,” especially if you have a warm, red, sensitive are of your breast, you may have mastitis.

·         If your fever is under 100.4, you can try home care for 24 hours…

Lots of rest, drinking fluids, and draining the breast regularly is critical to overcoming mastitis. Babies can and should continue to breastfeed (although pumping and/or hand expression is a good second choice if baby is not available). Going without a bra, breast massage (including all the tips above for plugged ducts), anti-inflammatory medications (ibuprofen is compatible with breastfeeding) and cold compresses can also help. Many times, mild mastitis will clear up on its own if mom simply goes to bed with baby and nurses frequently for 24 hours.

·         If your fever is about 100.4 or symptoms don’t clear up after 24 hours of good care…

If you still feel sick after a day in bed, you may have a breast infection, so call your doctor about an antibiotic. Probiotics, taken in between doses of the antibiotic and continuing for several weeks afterwards, can help prevent mastitis from coming back. Be sure to also keep any cracked or damaged nipples clean with soap and water to prevent bacteria from entering the breast.


So what is a bleb?

A “bleb”, or milk blister, is a small white spot on the nipple. This is a clog of milk right where the duct exits the breast and can be very painful.

  • Soak it. Try soaking the nipple in warm water with a little Epsom salts (one trick is to lean over a shot glass, then press into the breast gently and sit up) right before nursing – the warmth will often open the duct and the baby can suck out the clog.
  • Dissolve it. Soak a cotton ball in vinegar and wear it inside your bra over the bleb – sometimes the vinegar will help dissolve the hardened milk. Alternatively, use olive oil on the cotton ball to soften the bleb.
  • Massage it. Massaging behind the nipple and rubbing gently with a washcloth after any of these treatments can also help.
  • See your doctor. A stubborn bleb may need to be opened using a sterile needle by a healthcare provider.
  • Keep it clean. When dealing with a bleb, be sure to wash the area at least once a day with soap and water. Apply antibiotic ointment for a few days after it clears.


No matter what you’re dealing with, if you have questions at any time, if symptoms get worse, not better, or if you feel like something’s just not right, give us a call and ask to speak with one of the Lactation Consultants.  We’re here for you!


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