Updated Research: Do I Have a Plugged Duct?
By Summer, RNC, BSN, Breastfeeding Educator, Reviewed and updated by Laura Silvas, RN, IBCLC 2023
Breast pain is a primary cause of early weaning among breastfeeding mothers. If pain persists, mothers are more likely to wean their babies earlier than intended. Early intervention and treatment of breast pain are vital to maintain the breastfeeding relationship and support continued breastfeeding.
Plugged ducts and mastitis are prevalent breastfeeding conditions affecting up to 20% of women. These conditions cause breast pain and discomfort, impacting long-term breastfeeding goals. Effective management and treatment of these conditions are essential to minimize pain and discomfort and maintain breastfeeding.
In this article, we will explore the causes, symptoms, and treatment options for plugged ducts, as well as tips for maintaining milk flow and preventing future occurrences. Whether you are a new or experienced mother, understanding the causes and management of plugged ducts can help you navigate breastfeeding challenges more effectively.
What is a plugged duct?
A plugged duct or a clogged duct is simply a plug or clog in the duct pathway. Although it is called this, it does not result from one single clogged duct. According to the Academy of Breastfeeding Medicine, “ Ducts in the breast are innumerable and interlacing, and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘’plug.”
This can occur when your breasts are not fully emptied or when there is an excess of lymph fluid. The residual milk can thicken, or the lymph fluid builds, which can both create a blockage. This backup creates inflammation and an unpleasant hardened spot in your breast. You may notice a tender, sometimes painful, warm, reddened, or even wedge-shaped area on your breast. Some women have even described this as feeling like a “rock or pebble” is in their breast. In the first early days of breastfeeding, engorgement can mimic clogged ducts. Inflammation, hardened areas, hormonal changes and discomfort are all a part of this process as well. Treatment is primarily the same. These pesky little areas can be common among breastfeeding women, so rest assured, mama, you’re not alone.
Anything that disrupts your nursing routine puts you at risk of developing a plugged duct. Did you just return to work? Did your baby finally start sleeping through the night? A plugged duct requires your immediate attention. Left untreated, it can quickly turn into an infection known as mastitis.
How do you know if you have a simple plugged duct or mastitis?
Mastitis causes more body-wide symptoms, such as flu-like symptoms, increased heart rate, and sometimes fever. If you are experiencing either of these, then you need to speak with your MD or Lactation Consultant immediately about treatment. Don’t wait! Mastitis can affect your milk supply permanently. Learning to recognize and treat plugged ducts or “plugs” helps you prevent them later in your breastfeeding journey.
Visualizing the milk duct system can help you to identify a plugged duct. The milk ducts run like grapevines in a star pattern extending from the nipple. A plugged duct may feel similar to frozen peas or grapes and may be accompanied by a pimple-like bump close to the opening on the areola.
How do I treat a plugged duct?
Previously, the recommendations were to empty the breast every 2-3 hours, heat and massage, massage, massage. Recent studies have led the ABM (Academy of Breastfeeding Medicine) to change how we treat plugged ducts, similar to mastitis.
Firstly, continue breastfeeding or pumping according to your normal schedule. Increasing pumping or feeding from the breast can increase your supply and demand, creating more milk and exacerbating the problem. It has even been suggested to feed off the less affected side first to not overstimulate the area. An increase in milk can mean an increase in inflammation. If needed, after feeding or pumping on that side, hand express to comfort.
According to the ABM, there is no evidence to support “dangle feeding”. The thought process is that gravity-specific positions help to drain the area. In addition, you aim the infant’s chin toward the affected area, increasing the strength or pull toward the clogged area.
Anti-inflammatories help by reducing inflammation and relaxing the duct system making it easier to release the blockage. They are most effective, taken 30-60 minutes before nursing. Check with your care provider for clearance. For example, 800mg of Ibuprofen is suggested every 8 hours.
Heat opens the duct system by increasing circulation. Studies now show that this can worsen inflammation because it brings more blood to the affected area. However, many women find the heat very comforting. Brief warm compresses may help to relax mothers and facilitate letdown, but ice packs on the area help with inflammation and discomfort between feeds.
Massage and vibration were previously key components. Many mothers used electric toothbrushes, fancy electric breast massagers, etc. But you guessed it, not anymore. While LIGHT massage can be helpful, studies found that deep massage created more inflammation and injury to the breast tissue.
Evidence still supports lymphatic drainage for the clearing of plugged ducts. Lymphatic drainage helps facilitate excess lymph fluid out of the area. With lymphatic drainage, you lightly move your hands up towards your collarbone across the breast and then massage it gently towards your lymph nodes.
How do you know when you have cleared the duct?
Many mothers report feeling immediate relief. However, you may feel a little residual tenderness from the inflammation. Also, you may see a toothpaste consistency blockage come out of your nipple. Don’t worry - it is safe for your baby to ingest.
Need an Extra Hand?
This is a great way to involve your partner in making cold compresses and helping with lymph drainage so they, too, can experience the joys of breastfeeding.
Remember, plugged ducts can be common, and the key to resolving one before it turns into mastitis is by recognizing the symptoms early. If you have any concerns or need assistance in treating, preventing and learning more, contact us at Leva!
+ References
Figure 1. Cancer Research UK, CC BY-SA 4.0, via Wikimedia Commons
Figure 2. https://www.medela.com/breastfeeding/mums-journey/breastfeeding-positions
Hale, T.W. (2017). Hale’s Medication & Mothers’ Milk. New York, NY: Springer Publishing Company LLC
La Leche League International. (n.d.) Retrieved from https://www.llli.org/breastfeedinginfo/mastitis/
Morell, S.F.& Cowan T.S. (2013, 2015). The Nourishing Traditions Book of Baby & Child Care. Washington, DC: New Trends Publishing, Inc.
