Sore nipples and how to soothe them

by | Aug 18, 2020

Many breastfeeding mothers believe that nipple pain is normal, but registered dietician and certified lactation consultant Deidre Smith says breastfeeding shouldn’t hurt.

“Nipple pain is normal …” or is it? While nipple pain may be common, and one of the main reasons women stop breastfeeding, it is not normal. Sadly though, many mothers are often told that it is normal, that their nipples need to “toughen up” and that they should just feed through the pain.

Some are even advised on ways to toughen up their nipples in preparation, which in turn leads to pain and trauma. Breastfeeding should not hurt! Sensitivity and some mild discomfort during the first two weeks after your baby’s birth can be expected, but any of the following are warning signs that something is not right and should be investigated:

  • Continued pain and discomfort (either for an entire feed or past the two-week mark)
  • Severe pain at any time
  • Pain between feeds
  • Nipple trauma such as cracks, bruising or bleeding.

Why does it hurt?

When it comes to nipple pain and trauma, there are a number of potential causes such as:

  1. An incorrect or poor latch: This is possibly the most common cause of nipple pain and is generally easily corrected by adjusting your or baby’s position or finding ways to help baby get a better or deeper latch.
  2. Mechanical damage: Are you using a breastpump? A poorly fitting flange (the part of the pump that fits over your breast) or cranking the suction up too high can cause pain and damage to your nipples.
  3. Hormonal changes: Nipple pain after months of pain-free breastfeeding could be as a result of hormonal changes, and you may suddenly experience some discomfort during ovulation or before menstruation. Sudden onset of nipple pain may also be an early sign of pregnancy.
  4. Vasospasms: A vasospasm is the sudden narrowing of a blood vessel, and can cause severe pain. Vasospasms in the nipple can be caused, for example, by a poor latch or thrush, but also by something known as Raynaud’s Phenomenon. The pain caused by Raynaud’s can be fairly intense and is often mistaken for thrush.
  5. Torticollis: If you only experience pain on one side, while feeding on the other side is pain-free, your baby may have torticollis ‒ a condition where tight neck muscles cause the head to tilt to one side and make turning the head difficult.
  6. Tongue ties: This is a condition where the frenulum (the membrane that joins the bottom of the tongue to the floor of the mouth) is too short or tight, affecting or restricting the movement of the tongue and potentially causing severe nipple pain.

Other possible causes include engorgement, blocked ducts, breast/nipple thrush or eczema, allergic reactions to soaps or creams (including nipple creams) and even teething, since the saliva and enzymes in your baby’s mouth may irritate your nipples.

How to treat sore or damaged nipples

Treatment would depend on the cause, but includes:

  • Improving your baby’s latch or helping him to get a deeper latch, as mentioned. Experiment with different breastfeeding positions to find what works best for you and your baby.
  • Breastmilk has great anti-infective properties and applying a little expressed breastmilk to your damaged nipples could work wonders.
  • Applying lanolin or coconut oil to your nipples to soothe and moisturise.
  • Discontinuing the use of soaps, creams or washing powders that may be causing a skin irritation or allergy.
  • Making sure that your breast pump fits well, and not cranking up the suction in an attempt to get more milk.
  • Using heat to treat and prevent a vasospasm.
  • Chiropractic assessment and treatment of torticollis.
  • A referral to an ENT for assessment and possible surgical release of the tongue tie.
  • Visiting a physiotherapist who offers laser treatment to assist with healing your nipples.
  • Medical advice and treatment for bacterial and fungal (thrush) infections.

Though nipple pain is treatable, prevention is better than cure, and finding the cause of the pain is very important! Avoid harmful practices such as “toughening” of nipples and get to know your body – what feels and looks normal and what doesn’t, and don’t ignore the warning signs it is giving you, no matter what anybody says.

Contact a Certified Lactation Consultant, either International Board (IBCLC) or South African (SACLC) certified, as soon as you experience any severe or abnormal pain or discomfort, or if you notice any signs of trauma or nipple damage, which includes any changes to your nipple shape during or after a feed.

An IBCLC or SACLC can help you get the bottom of the problem, by identifying the cause and giving you advice on how to treat and prevent the pain specific to your problem.

Remember, breastfeeding should not hurt!