Sore nipples during breastfeeding - is this normal?

Sore nipples are such a common experience for new mothers that many women think it is a normal part of the whole breastfeeding experience and they just put up with it. Sore nipples can make breastfeeding a miserable experience for you and your baby and may affect your decision about whether to continue or not. It is really important that you don’t ignore the problem.

Some women may not notice soreness at first, especially if they have taken painkillers during the days or weeks following delivery. It is important to be vigilant and get help at the first sign of nipple pain or discomfort. If you ignore pain, your nipples may become damaged. They can crack and bleed which may make breastfeeding intolerably painful. Damaged nipple tissue can also lead to more serious problems.

Breast and nipple pain indicates to midwives and lactation specialists that something isn’t quite right. Experts agree that you shouldn’t put up with pain and there is a great deal you can do to avoid it.

What causes nipple soreness during breastfeeding?

Problems with latching on. A poor latch is the most common cause of breastfeeding pain and discomfort. If it hurts when your baby is latching on, something is wrong. If your baby is not latching on correctly, you are very likely to develop sore nipples in the first few days or weeks of breastfeeding. A shallow latch, when your baby does not have enough of the breast in his or her mouth, causes the baby to suck on the nipple rather than the breast. This causes pain and damages the nipple. The complete nipple area (areola) should be covered by your baby’s mouth. Achieving a good latch is important, so don’t hesitate to get expert advice and support. A midwife or lactation consultant can help you position your baby correctly to achieve a proper, deep latch.

Tongue-tie. If the skin connecting your baby’s tongue to the floor of his or her mouth (the frenulum) is too short or extends too far to the front of the tongue, movement of the tongue will be restricted. This can cause nursing problems, including sore nipples. Your physician or lactation consultant should examine your baby's tongue. Tongue-tie is very easily fixed with a minor procedure. If it is the reason for a poor, shallow latch and your sore nipples, you’ll find breastfeeding so much easier after the problem has been sorted out.

Hygiene. Avoid using shower gels, soap or other detergents on your breasts and nipples. These products can dry out the skin and lead to irritated, cracked nipples. Simply rinsing your breasts with warm water in the shower is best. After showering or nursing, let your nipples air dry. You can use a nipple balm to replace lost moisture. Choose a balm that does not need to be rinsed off before feeding. This way you’ll have more lubrication and protection if your baby tugs or pulls at the breast. Synthetic, non-breathable bra pads should be avoided as they can create the perfect breeding ground for bacteria and other harmful microbes. Change pads frequently to maintain good hygiene and avoid microbial problems.

Nipple thrush. If your baby has an oral yeast infection, this can be easily passed on to you during breastfeeding. Thrush can cause nipple pain and damage, including cracking and bleeding. Symptoms include itch, soreness and red, shiny nipples. Pain is usually felt in both breasts during or after feeding. Eczema can present with similar symptoms to a yeast infection, so it is important to check with your physician to ensure the correct treatment.

A milk blister or ‘bleb’. A milk blister, also known as a milk bleb, is caused when a thin layer of skin grows over a milk duct opening and traps milk, or when a small amount of dried milk simply clogs the opening of the duct. A milk blister may be a white or yellow dot on the nipple and may cause pinpointed pain at that spot and just behind it. Sometimes a gentle rub with a towel after showering can clear the blister or it clears easily the next time you express milk. If the milk blister does not go away quickly on its own, your lactation consultant or physician can treat it by peeling the skin away from the area or popping it.

Nipple blister. A nipple blister is a clear, yellow, or blood blister on the nipple that causes intense nipple pain while you breastfeed. Friction or suction from a poor latch is most common cause of this type of painful blister. Poorly fitting nursing bras and or using a breast pump that is set too high are other common causes of friction blisters.

Breast pump trauma. Incorrect use of a breast pump can damage your nipples. If the breast shields that come with your pump are too small for your nipples, this will cause problems. If the suction level is too high, this could also cause problems. If you are unsure about how to use a pump or which type of pump to choose, a lactation expert or midwife can advise and help you get started.

Occasionally, an underlying condition like Raynaud's disease causes nipple vasospasms and pain. With this condition the nipple turns white or ‘blanches’ after feeding and it is painful as the blood flows back. Pain is commonly felt in both nipples and is triggered by exposure to cold or sudden temperature changes. Your physician or lactation consultant will be able to advise you on how to manage your breastfeeding with this condition.

The most important thing to remember is that sore nipples indicate that something isn’t quite right. You should not put up with pain and the most likely causes of your pain are easily resolved with the right advice and support. You may want to increase the time in between feeds if you are enduring nipple pain. However, if it is possible, try to continue with your regular feeds. If it is unbearable, then take advice from a lactation consultant about expressing for a short 12-24 hour period while your nipples recover.