This can be one of the greatest sources of frustration – you feel like everything should be going well – in theory. You’ve had your latch checked and your midwife and health visitor are happy. There are plenty of wet nappies, and your baby is happy. But your nipples are not – you find that breastfeeding hurts even with good latch and more than that – it’s excruciating every time your baby nurses. What is going on?
There can be several possible factors at play in this scenario, and while I’m not a GP, I wanted to give you some ides explore (the NHS covers some breast pain issues here, but this post looks specifically at nipple pain). Because I’ve been where you are and it’s miserable. Especially when you’re determined to continue nursing.
Why Breastfeeding Hurts Even With Good Latch
Firstly, something I’ve mentioned before but just want to reiterate: adapting to breastfeeding usually causes some soreness to begin with. That’s normal; granted it doesn’t seem to be the message we generally hear, but it’s the truth I’m afraid.
While our nipples may see some action in the bedroom before we ever have children, for most of us their new use, along with its frequency, cause irritation to occur. If you have a good latch then it’s usually short-lived, just while your nipples adapt to the friction they’re not used to. But some soreness during this period is to be expected.
But what might be the culprit when the pain is unbearable and it’s not easing with time? There are a few issues to consider…
- Pain or discomfort
- Open sores and bleeding
- Dry or flaky nipples
Cracked nipples are generally a result of a poor latch. To make things more complicated, a poor latch can have a few causes in itself:
The good news is that these issues can usually be corrected. If you have concerns see your GP or health visitor as soon as possible.
It may be necessary to fix the root cause of your cracked nipples, and the solution will vary according to the exact problem. In the meantime, lots of nipple cream and possibly nipple shields and nipple shells can help to heal the areas. I’ve also found nipple compresses to be very soothing.
- Sore or cracked nipples,
- Sharp shooting pain lasting up to an hour after nursing,
- Shiny red or pink areola,
- Itchy and flaky nipples.
Thrush of the nipples is caused by a candida fungus infection.
The infection can also be present in your baby’s mouth (look for a white film on lips, and white spots or patches on the gums, tongue, rook of mouth, and inside cheeks which cannot be wiped away). You may pass it back and forth between you, so it’s important to identify and treat both you and your baby simultaneously.
An overgrowth of yeast can be triggered by a course of antibiotics in either you or your baby.
You and your baby will require anti-fungal treatment. Your baby will have an oral gel or liquid and you will have a cream to spread on your nipples after feeds, and may also require anti-fungal tablets.
It’s safe to continue nursing during treatment for thrush.
Symptoms should ease 2-3 days after beginning treatment.
Vasospasm and Raynaud’s Syndrome
Vasospasm is when an artery suddenly constricts and can happen anywhere in the body, causing pain and discomfort. One of the most common sites for vasospasm to occur is in the nipple of breastfeeding women, shortly after nursing or in between feeds. Pain is caused by the blood rushing back to the nipple when the vasospasm ceases.
- Sharp pain
- When baby is not firmly latched,
- Severe stress,
- Nipple trauma,
- Exposure to tobacco smoke.
How Vasospasm With Raynaud’s Presents Differently
Vasospasm differs slightly in women suffering from Raynaud’s Syndrome:
- It usually affects both nipples in a woman with Raynaud’s,
- The nipples change colour in a woman with Raynaud’s,
- Vasospasms occur randomly rather than being connected to breastfeeding,
- Vasospasms also occur in the hands and feet.
Symptoms otherwise remain the same.
Cause in Raynaud’s
Vasospasm in Raynaud’s Syndrome usually happens when the nipple becomes cold.
Treatment will depend on the cause, but may include medications, oil massage, and/or supplements.
All of these options are safe during breastfeeding.
Nipple Eczema or Nipple Dermatitis
- Sore, cracked nipples
- Flaky areola
- Red ring around the nipple
This is the one that inspired me to write this post. When breastfeeding my first daughter, out of the blue I started to suffer excruciating pain when nursing, and my nipples looks horrendous. Cracked nipples made no sense, and I initially visited my GP convinced I had thrush. Sadly, that’s also what I was given treatment for, and of course it did nothing to help me.
My pain continued and nothing improved.
Eventually I returned and saw a different doctor. This time she took one look at me and told me I had eczema. I couldn’t quite believe it, as it was restricted to my areola only and having suffered with eczema on and off in the past I hadn’t thought it appeared the same. But the steroid cream treatment started to work almost immediately.
The same issue recurred with my second daughter, but thankfully this time I knew the issue and was able to get on top of it quickly.
What’s interesting and the reason for writing this post, is that a couple of years later, I’ve unearthed the root cause of my spontaneous dermatitis flare ups:
I’m allergic to lanolin!
And what’s the key ingredient in the most widely used breastfeeding nipple cream? Lanolin. I was slathering the stuff on to provide relief, and what was actually happening was I was causing my poor nipples to have an allergic reaction!
So how did I figure this out? My husband cleared our car out as we decided we no longer need a pushchair and a baby bag to live in the boot, and when I emptied it out I found half a tube of lanolin. I told my husband it’s an excellent lip balm so I was keeping it, and I put some on my lips there and then. The next morning I’d developed the same allergic reaction I had to a lipstick a few years ago, and I put two and two together. I couldn’t believe it – I’d finally discovered my issues were the result of an allergy – six months after I stopped breastfeeding!
So that’s really the inspiration behind this post – the hope that I might just save one or two others who also happen to be allergic to lanolin from suffering the same agonising fate.
I’ll just add that, providing you do not have a lanolin allergy, then it’s an excellent product for sore and cracked nipples! I’ve long recommended it and you’ll likely find such recommendations all over this blog. I won’t remove them since my discovery, because lanolin allergies are pretty rare (estimated to be 1-2% of people) – I just happen to be one of the lucky few…
This is unlikely to be the cause of pain during breastfeeding, but having discussed nipple eczema it’s important to mention this rare disease too.
Paget’s disease can present similarly to eczema of psoriasis of the nipple and is linked to breast cancer.
- Red, scaly rash starting in the nipple and possibly extending to the areola
- Sore and inflamed skin
- May cause itching and burning sensations
- Around half of women with Paget’s disease also have a lump behind the nipple.
If you experience burning, bleeding, or itchiness but the nipple is not red or scaly then it’s unlikely to be Paget’s disease.
If you’re experiencing any pain or discomfort in your nipples, see your GP.