Plugged Duct

By Krista Gray, IBCLC. Last updated February 13, 2013.

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What is a plugged duct?

A plugged duct is a milk duct that becomes blocked and prevents milk from draining well. This milk stasis can cause pressure and pain along the duct in the breast. If left untreated, it can turn into mastitis.

Sometimes, expressed milk from a plugged duct may look thicker, spaghetti-like, or stringy.  If you are nursing your baby, you won’t even notice this thicker milk but if you are expressing and see this, there’s no need to be alarmed.  It is the duct coming unplugged and the antibodies in breast milk will protect your baby from infection.

This milk is still completely safe for your baby.

Symptoms

Symptoms may include one or more of the following:

  • Tenderness
  • Breast lump
  • Pressure/pain build up
  • Skin may be red and/or warm
  • Mild fever (or none at all)
  • Usually in one breast only
  • Even after duct is drained can be sore and feel bruised for several days.

Causes

  • Scheduled nursing
  • Restrictive items on chest
    • tight-fitting bras (especially underwire bras), certain slings, tight-fitting tops, sleeping positions, holding a diaper bag or purse while shopping all day, etc.
  • Engorgement
  • Ineffective milk removal
  • Poor latch – which can lead to misshapen nipples, nipple pain, and/or ineffective milk removal
  • Nipple bleb
  • Cracked nipples
  • Stress
  • Missing feedings
  • Outside distractions (perhaps mom was busy and forget to nurse)
  • Rapid weaning (breasts are more prone to engorgement)
  • Overabundant milk supply
  • Previous plugged ducts
  • Breast anomalies – from prior breast surgeries, for example, where a duct may be blocked from scarring; or a lump that is already in the breast

Treatments

The most important thing you can do to resolve a plugged duct is to frequently and effectively remove milk from your breasts.

Therefore, it is important to breastfeed often! A plugged duct can easily turn into mastitis without diligence in unblocking the duct. Keeping the milk flowing can prevent a plugged duct from turning into mastitis or mastitis from turning into a breast abscess (though this is rare).  Along with frequent nursing, this is the time to get plenty of rest and apply heat to affected area before breastfeeding.

10 Strategies to Fight Plugged Ducts

  1. Drain your breasts often, at least every 2 hours – but don’t neglect the other breast.
  2. Get plenty of rest. Ideally, go to bed with your baby!
  3. Drink plenty of water and eat nutritious whole foods to boost your immune system.
  4. Use warm compresses before nursing – either take a shower, dip the breast in warm water, or use wet heat from a water bottle, etc. Gently remove any dried milk from the nipple before nursing.
  5. Use breast compressions while nursing.
  6. Applying cold compresses and/or chilled cabbage leaves after nursing can also bring comfort.
  7. Occasionally nurse your baby while he is on his back and your breast is dangling above so that gravity can help to unblock the duct.  Frequently nurse in different positions to make sure to drain all ducts effectively.
  8. Massage and hand express in warm water
  9. Hand express or pump if baby is not feeding effectively.
  10. For pain, taking either acetaminophen or ibuprofen as both are safe during lactation.  (Ibuprofen may be better as it has anti inflammatory properties.)

If the plugged duct turns into mastitis, and the symptoms continue to worsen after 24 hours, antibiotics will most likely need to be started as the inflammation can turn into bacterial mastitis.

Recurrence Rates

After having a plugged duct, will I be more prone to them in the future?  The good news is that plugged ducts and mastitis are most common in the early days of lactation and your chances decrease once nursing is well established.  However, once you have a plugged duct you may notice this ducts being a “trouble spot” as it may be a duct more prone to not draining effectively.

Being aware of this is half the battle.  You can then be on guard if there is a day when you didn’t nurse your baby is often as usual, you wore restrictive clothing, slept on your stomach, etc.  Remember the best way to treat a plugged duct is with frequent nursing, so once you realize there may be a plugged duct be extra diligent to nurse your baby frequently.

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