Still having breastfeeding pain at 2.5 months!

Vrinda - posted on 03/22/2016 ( 4 moms have responded )

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Hey everyone! I have been battling breastfeeding pain from day 1. I keep hearing it'll get better but it's still so painful. I have been working with a great lactation consultant and i think i may have even stumped her! Latch is looking pretty good. I was initially getting bruising around the areola. Then a week or two the pain started to go deep into my breast- I thought i had vasospasm. The nifedipine did help but I noticed that I also had some burning. So I figured I have ductal yeast though her mouth has always looked good. Well I started diflucan for a week and a half now, and the deep pain is getting better but I still have areola pain and some vasospasms. We have been giving her nystatin as well for 5 days, and i have been putting APNO ointment on my nipples alternating with probiotic paste after feeds. She may still have a latch issue (she's very strong and has quite a sucking reflex!). I noticed lying down with her to feed helps (I am not big breasted but apparently my milk sinuses are "deep"?). I am going to do gentian violet today because I can't keep "waiting and seeing." Someone please tell me it will get better! I am getting a bit discouraged

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Sarah - posted on 03/22/2016

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I had chronic blockages, and I think it was just my anatomy. I don't know, I went and read on vasospasm of the nipple and breast. I did not find much beyond what the IBC describes and it sounds like you've tried every treatment they advise. If your deep pain is better, at least tolerable and you have no other symptoms than the nipple pain. (I am not trying to minimize that pain. I had terrible latch issues and that pain was like no other pain in this world) Maybe consider doing nothing for a few days, except expressed milk and warm compresses, or pump and see if your pain improves. If pumping helps, then you know it is related to the latch or the physiology of the baby's mouth. I just know that for me even using lanolin ointment when my nipples were cracked and bleeding, actually made them worse. Granted this was 20 years ago, but maybe you have a sensitivity in one of the ingredients of the APNO? I wish I could help!

Vrinda - posted on 03/22/2016

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Hi Sarah- thanks for responding! I have been doing one thing at a time- the APNO just for the past 5 days or so and probiotics for the past 4 days or so. nothing else on the nipples. i do express milk and let the breast air dry before putting anything else on it. I am a physician myself (we really aren't trained well on this go figure) and I have read vasospasm can be deep in breast and go to the back even- usually there's an underlying cause of inflammation (yeast, mastitis or otherwise?) causing the vasospasm. i took nifedipine only a couple times when it was really bad (i have low blood pressure as it is so can't take it unless necessary). It did help but again I don't do it unless necessary. No cracks, no bleeding- just inflamed looking (the nipple tips which is where it is still sore despite her not sucking on the nipple tip itself for months). I have had 3 blocked ducts- so I am pretty familiar with what that feels like and it's nothing like that- no lumps. The pain will fluctuate in terms of location. The blocked ducts (recurring) is another reason why I wonder if there is an underlying infection of some sort. I do feel the diflucan helped the deep (in the breast tissue beyond the nipple and areola) significantly-- but it's still there a bit and the nipple and areola still have burning and pain. Thank you so much! I hope that is helpful

Sarah - posted on 03/22/2016

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Who diagnosed the vasospasm and prescribed nifedipine? Raynaud phenomenon, is generally of nipple or areola nt deep within the breast. If that were the case, then you'd possible have ischemia of your breast tissue.
Who diagnosed the yeast infection? If her mouth looks good, and the diflucan did not resolve your symptoms, then I'd think this is not yeast based. Have you consider a blocked duct? I had this with my first child at 4 weeks and it was very painful. I had three more kids after that and i had issue with blocked ducts each time. Where is the pain? I know you said deep, but where? Is there redness or warmth at the area of pain? Does it hurt all the time, or only during nursing? I would not use gentian violet

Sarah - posted on 03/22/2016

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Who is doing the diagnoses and prescribing treatment? Raynaud phenomenon, or vasospasm related to lactation is almost always in the nipple or areola. If it were deep within your breast, it could cause ischemia to your breast tissue. If the diflucan did not help your symptoms and her mouth never looked like she had thrush, then I'd not continue to treat for yeast. I'd not use genitian violet, personally, especially if your did not respond to the diflucan or nystatin. Also if the APNO did not help, there is something else at play; as that ointment treats bacteria, yeast, and has a steroid in the ingredients. Maybe your nipple are so sore because you are over medicating them? Have you tried expressing milk onto your nipples and letting it dry rather than using paste and ointment? Is your nipple or areola, cracked, bleeding or swollen? The pain deep in your breast, where is it? Is there any sign of infection? Can you feel a mass or thickening? Does it hurt all the time or only during nursing? what you describe sound more like a blocked milk duct than infection.

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