Physical Therapist Marianne Ryan explains what causes blocked or clogged milk ducts and mastitis, and offers advice on how nursing mothers can deal with it.
A normal part of nursing is experiencing fullness in the breasts, which occurs as the breasts fill up with milk. This can be uncomfortable, but serves as a sign that it is time to empty your breasts. If your baby is not nursing enough or you are not pumping enough your breasts can fill up with too much milk and engorgement can set in causing tenderness and pain and sometimes even a fever. These symptoms are often relieved when the milk is emptied by nursing your baby or by pumping. However, if the milk supply builds up and the engorgement is not relieved then the breasts will become even more swollen and problems can arise. When there is too much swelling the excess weight of the breast tissue can press on the milk ducts and block the normal flow of milk. As time goes on, if the milk remains in the blocked duct it can form a “plug” and a painful lump in the breast. In severe cases, moms run the risk of developing a bacterial infection, called mastitis.
What can you do if you have a blocked milk duct?
First of all, don’t stop breastfeeding! Sometimes women avoid nursing when the breasts are sore and this increases the likelihood of developing a blocked duct. Instead, try to completely empty your breasts of milk each time you breastfeed. Prior to each nursing session apply moist heat by taking a warm shower or placing a heating pad on your breast for about 15 minutes while bending over to assist drainage. You can try this while lying face down with a few pillows under your tummy which will allow the breast to hang downwards.
Start each nursing session on the side of the blocked or clogged duct first and position the baby so their tongue and lower jaw are facing the blocked duct to encourage better drainage.
The best way to deal with a blocked or plugged milk duct is to:
1. Use moist heat prior to nursing
2. Start each nursing section on the side of the blocked duct
3. Position the baby's chin so that is is touching the clogged milk duct.
Some women also find self-massage helpful. There are loads of videos on how to do this on YouTube if you want to learn some massage techniques. When massaging, try not to press too hard on top of the duct. Apply pressure above the painful area in your breast and press in the direction towards your nipple. You might get better drainage if you massage as the baby is nursing or you are pumping.
If a mother is unable to clear a blocked duct on her own, physical therapy intervention has proven to be very helpful1. “We generally start treatment within twenty-four hours of a duct becoming blocked in order to clear it before mastitis develops. We also emphasize patient education so each woman learns how to clear any future blockages," says Barbara Cooper, PT, of Physical Therapy for Women, in Trumbull, Connecticut.
Cooper has been treating women with blocked milk ducts for over a decade and studied the efficacy of physical therapy treatment for this condition in conjunction with Quinnipiac University. A very specific massage technique and therapeutic ultrasound is used to help pump the milk out and unblock the duct. This type of treatment can help prevent mastitis developing if it is done early enough, so timely treatment is important.
Note: If you do try to find a therapist for treatment make sure to ask if they have advanced training in women’s health issues and whether they have experience in treating blocked milk ducts.
Yes, I really did say cabbage leaves! But is it a myth that they can can help relieve the pain caused by blocked milk ducts?
Many nursing moms have told me a best-kept secret: they use a compress of fresh cabbage leaves and place it on their breasts to help relieve the pain of engorgement.
I never tried this myself so I thought I would do a little research and share the information I found with you.
A study done by the Cochrane Pregnancy and Childbirth Group showed that cabbage leaves can indeed help relieve the discomfort and pain many women experience during the engorgement phase, although researchers are not absolutely sure why Mothers who do this boil the cabbage then let it cool down to room temperature (or chill it). Then they crush the leaves to break the veins and release the cabbage juice. Finally, they place a few crushed leaves on the breast for about twenty minutes. They apply this compress three to four times a day during the engorgement.
This is probably safe to try unless you are allergic to sulfa drugs because the cabbage leaves contain sulfa. So if you have a sulfa drug allergy, steer clear (if you are not sure whether you can tolerate sulfa, try doing a “skin patch test” by putting a piece of boiled cabbage on your forearm, held in place with a band aid, for twenty-four hours first.)
Note: Remember that cabbage leaf compresses can help relieve the pain of engorgement so that it is easier to empty your breasts, but will not unblock a blocked milk duct.
The Physical Therapists at Marianne Ryan Physical Therapy have advanced training in a wide range of women’s health issues, including the treatment of blocked milk ducts. We offer hands-on treatment for pain relief along with safe and effective exercise programs. If you would like to make an appointment for physical therapy treatment or get one-to-one advice on how to get your body back in shape after childbirth please fill out the contact us form here.
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1. Barbara B Cooper PT, MS and Donald Kowalsky, PT, EtD. Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women; Journal of Women's Health Physical Therapy, September/ December 2015 - Volume 39 – Number 3 Issue 2 - p 115-125
2. Renfrew MJ, Lang S. Do cabbage leaves prevent breast engorgement? A randomized, controlled study. Birth. 1993;20:2. doi: 10.1111/j.1523-536X.1993.tb00418.x.
3. Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. Journal of Human Lactation. 1995. 11(3): 191-4. doi: 10.1177/089033449501100319
MARIANNE RYAN PT, OCS is a physical therapist and board-certified orthopedic clinical specialist. She is the owner and Clinical Director of MRPT Physical Therapy, and a spokesperson for the American Physical Therapy Association Media Corps. With more than 30 years' experience, she specializes in the treatment of the spine, pelvis and jaw, with particular emphasis on the treatment of prenatal and postpartum patients. She has taught physical therapy treatment and exercises for prenatal and postpartum women on the nurse midwifery program at Columbia University School of Nursing, and has also taught at the TMJ clinic at New York University Dental School. A much sought-after media guest, Marianne has appeared on dozens of national TV and radio shows, and has also been featured in Red Book, Fitness Magazine, USA Today, Shape Magazine and the Wall Street Journal. She was also featured in the film Drifting, a documentary about movement produced by the Tribeca Film Institute. Passionate about helping women to restore their stomachs after pregnancy and childbirth, Marianne is author of the book Baby Bod® - Turn Flab to Fab in 12 Weeks Flat.