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Breastfeeding Complications - Mastitis, Engorgement and Blocked Ducts.

“Breastfeeding is natural but it is not always easy” (Bergmann et al., 2014). Your physiotherapist can help you succeed with breastfeeding and help manage complications if they arise.

What are some conditions that effect the breast?


Between days 2 and 6 after your baby is born your milk ‘comes in’. You may find your breasts become larger and feel heavy, warmer and slightly uncomfortable. This is normal and will settle down as you and your baby adjust to breast feeding.

In some cases, a mother’s breasts can become hard, swollen/tight and tender and her nipples become flattened. This is engorgement and is caused by a build-up of milk, blood and other tissues in the breast. It can be painful for the mother and also make it difficult for the baby to attach.

Blocked Duct

Ducts bring the milk to the nipple openings. These ducts can get compressed and cause a blockage; the milk then accumulates behind the blockage. A lump forms and it may be tender to touch, your breast may also have some redness. Bruising, swelling, hurried feeds, poor positioning, poor attachment, nipple soreness, tight or poor fitting bra and finger compression can cause a blocked duct.


Mastitis is an inflammation of the breast tissue. This may or may not be accompanied by infection (WHO 2000).

Non infective mastitis is often a result of engorgement or a blocked duct that hasn’t cleared. This banked up milk leads to an inflammatory response (red, swollen, hard, painful breasts) and then becomes an immune response – feeling unwell, fever, muscle aches.

Infective mastitis is often caused by staphylococcus aureus (MRSA). The infection results in pain, swelling, redness and fever/flu-like symptoms. It is often associated with cracked and fissured nipples, allowing bacteria to enter the breast from the nipple.

It is important to see your GP if you have any flu like symptoms.

Physiotherapy Management:

1) THERAPEUTIC ULTRASOUND: Engorgement, blocked ducts and Mastitis can be assisted with therapeutic ultrasound. You need to feed straight after ultrasound, so it is helpful to bring your baby with you for your appointment so you can feed straight after treatment.

2) HEAT AND COLD: Try to ensure on demand and uninterrupted feeding. Using heat before the feed to help the milk flow and cold packs between feeds to reduce swelling is helpful. A wet flannel in a zip lock bag kept in the fridge or cabbage leaves are helpful. You can also try gentle stroking of the breast towards the nipple before feeding to encourage the let down reflex.

3) AVOID: Avoid wearing restrictive clothing or tight bras. Be gentle with handling your breast. Ensure you are in a well supported and comfortable position to feed and baby is well positioned on your breast.

Your physiotherapist can show you different ways to hold baby to help empty your breast – some woman can only feed using the cradle hold – but other options can include the football hold or side lying. Get to know your breast and self assess your after feeding to check for blocked ducts.

Picture: Therapeutic Ultrasound (Embrace Physiotherapy)

Contact us today if you need any assistance with feeding. Mumma's we are here to help!

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