When Breastfeeding Hurts: Nipple Blebs

Will breastfeeding hurt?

That is a concern many parents have as they come closer to the day they embark on their breastfeeding journey. In an attempt to alleviate these concerns, we often reassure families that breastfeeding is not supposed to hurt and if it does, to seek lactation support immediately.

And it's true, breastfeeding in and of itself shouldn't be painful. There shouldn't be pain during latching, while nursing nor should there be pain after or between nursing sessions. ( If any of these are true for you, click here to schedule a consult ;) )

But imagine you wake up after a restful night of dream feeding your little one, take a quick shower, grab a coffee (or your beverage of choice) and head back to scoop your babe up for an early morning nursing session. Your baby recently turned four months old, and as you take a minute to soak in how cute they are, the thought crosses your mind at how nice breastfeeding has become now that you all have pretty much mastered the latching game.

After scooping baby squish into your arms and settling into your favorite nursing position, you successfully latch baby onto your breast and are rewarded instantly with the excruciating discomfort that can bed best described as a shard of hot glass being shoved through your nipple. No amount of latching and positioning changes reduces the intense, toe-curling discomfort you are feeling.

You grit through the pain while your adorable baby nurses for what seems like the longest nursing session of their entire life. Baby finally unlatches, and you quickly look down to inspect your nipple to find a tiny, inconspicuous white dot on your nipple face.

That, my friend, is a nipple bleb. Also known as a nipple blister or milk blister. How such a tiny white spot can cause such unimaginable pain is beyond me, but if you've never experienced it first hand, believe me, nipple blebs are the devil.

What are nipple blebs?

Nipple blebs are essentially blocked nipple pores caused by an overgrowth of nipple skin. They can also be due to dried breast milk clogging up the nipple pore, but in either case, the key is that the nipple pore is blocked and breast milk cannot freely flow out of it.

What causes nipple blebs?

Many times blebs occur after a session of poor latching. Tongue tie, poor oral function, or improper nursing positions can all contribute to an increased possibility of bleb formation.

For many bed-sharing folks, they may see blebs after "middle of the night" feeding sessions when babies self attach or parents are too groggy to ensure proper latching posture. The poor latching in of itself doesn't cause the bleb, but friction may cause an inflammatory response that increases the production of skin cells.

For some unlucky souls, they may be prone to blebs due to rapid skin cell formation on their nips or due to issues with desquamation (shedding of the top layer of skin). As new skin is formed, it moves up through the layers of skin, eventually reaching the outer most layer (stratum corneum) where it is flaked off. If this process takes longer than usual or the skin becomes tougher to slough off, blebs may result.

I have no proof that this is the cause of cyclical, recurrent blebs, but if you get blebs frequently without an apparent latching cause, tracking when they show up may show a pattern consistent with the life cycle of skin cells.

In some cases, thrush is to blame for the blebs, as thrush can block the ducts or pores of the nipple preventing milk from flowing. If you have more than one bleb on the same nipple face, the cause is most likely thrush, whether or not you have other "traditional" thrush symptoms.

Other causes may be due to oversupply, inadequate draining, or restrictive/friction causing clothing. "Sticky milk" may also cause blebs, especially if plugged ducts are a common issue despite proper breast drainage.

Why are blebs so painful?

Surprisingly your nipple is NOT the most sensitive part of your breast, but that little trivia fact does not matter when you're dealing with a nipple bleb.

I haven't found out an exact explanation of why blebs cause such severe pain, but it's not hard to consider how the dilation of nipple pore could cause discomfort. Nipple pores are made to expand but not stay dilated for an extended amount of time. Additionally, the inflammatory process that created the bleb initially may play a role in the discomfort. Often there's redness all over the nipple face, which points to irritation possibly being a factor.

How do I make a bleb go away?

Resolving nipple blebs is straightforward in principle. Remove the layer of skin blocking the nipple pore or get out the clump of milk blocking it and no more bleb.

A care plan for blebs may look like this:

- Rinse nipple with warm water and a saline solution

- Apply an oil-soaked pad to your nipple face for roughly 20 minutes

- Gently exfoliate with a clean washcloth to attempt to remove the moistened skin.

- Nurse baby to extract milk from that breast.

Repeat till gone.

Executing the action plan is a bit more challenging. First off, pain is almost always a barrier. Who wants to exfoliate their nipple or nurse when any contact with it causes unbearable pain? Secondly, because the process may take a few iterations, it can become very discouraging. (See point above).

In any case, some version of the Clean, Moisten, Exfoliate, Suck process should clear the nipple bleb reasonably quickly, and the discomfort should resolve soon after. You may find that you need to keep up with the process for a couple of days after the bleb disappears to prevent the skin from reforming over the nipple pore.

Always keep the nipple clean and ensure good breast drainage. Both will help prevent any bacteria present on the nipple face from causing issues.

In the event of mastitis type symptoms due to a bleb that refuses to go away, it may be necessary to get the bleb lanced with a sterile needle at the doctor's office. It's a quick procedure that many parents choose to do at home, but any time an object is used to puncture the nipple , there's an increased risk for infection. I like to keep the doctor responsible for managing and preventing that in situations like these.

How can I prevent milk blebs?

How you can prevent milk blebs from forming will depend on what is causing them in the first place.

If poor breastfeeding (to include latch, position, & suck) is the culprit, resolving that should get rid of your nipple bleb problem. Blocked nipple pores caused by night time nursing may take a more active latching approach.

If oversupply or milk transfer issues are responsible for the nipple clogs, ensuring adequate draining can help reduce the likelihood of blebs. Naturally, oversupply needs a bit more management, but the principle for preventing blebs is the same.

Treat thrush if thrush is the cause. Stop wearing tight or restrictive clothing if you feel that is the cause.

You get the picture.

For those who have "sticky milk" lecithin (Here's good brands of soy or sunflower) can help your milk flow a bit easier. It's worth checking out the benefits and risks of Lecithin if you're considering it. I'll probably make a post about it in the future ...

Blebs are a painful but generally uncomplicated breastfeeding occurrence that resolves fairly quickly when identified. With all breastfeeding things, prevent is always easier so if you need another reason to get your kids poor latching issues sorted out, here it is. I promise it's not something you will be happy to experience.

As always I would love to hear your thoughts. Do you have a bleb experience you want to share?

And speaking of sharing, make sure you share this with your friends. That way, if it does happen to them, they can already be familiar with what to expect and what to do. It's no fun trying to figure out what is going on when it feels like your nipple is on fire!

-Shondra.