Help needed - nipple and breast pain

[@llli*mom2000]

I began breastfeeding my baby a few days after birth and she had difficulty latching initially but was fine afterwards. A couple of weeks in, I developed a white blister on the left nipple which my lactation consultant called a milk blister or bleb. I was advised to use a wet compress before nursing in the hope that the blister would burst - I did this for some days. I didnt have any accompanying milk duct blockage that I could detect. I also got the Newman all purpose ointment and used it a few times when I was worried about infection.
The blister persisted and was painful when the baby was nursing. A few days later, the whole breast became painful during and after nursing for quite some time. As I was told that my ob/gyn could burst the blister with a needle and that would start the healing, I went in to see my doctor but was told that this could make the area infected. They also said that the blister was actually over 2-3 ducts and did not seem to be a blister. My doctor thought that I possibly had fungal mastitis and gave me a two week course of anti-fungal medication. My baby's ped also added a suspension to put on her mouth several times a day, which I used for a few days and then stopped.
Since then the blister kind of reduced to one white point and over the original blister area, I have pink skin underneath which the doctor says is regular nipple surface without the pigmentation. The pain on the breast after nursing continues and I hav recently tried to reduce the ibuprofen I was taking for the pain throughout the day. A couple of days back, the nipple started bleeding one night when I went to pump (I have continued to both pump and nurse) and since then the pain has become worse after nursing. The nipple has also bled a few times in terms of there being a dried point of blood on the nipple (I have not seen any drops flow like the first time).
I am now wondering how this will heal/ get better. The pain on and around the nipple during and after nursing has become worse and for the last day I cannot bear to have anything touch the nipple, including clothes.
I hope someone out there has experienced something similar and can help!
thanks

[@llli*lllmeg]

Jeepers. This sounds awful. My first thought is someone needs to look at your breast and also watch your baby nurse and try to see what is going on. Can you go back to see the lactation consultant? Or see another? Is the LC board certified (an IBCLC?) I am not sure who was right here, but blebs are pertty obvious and lansing blebs is pretty common, moms even do it themselves, and as far as I know as long as it is done with a sterile instrument its fine. Also having a block in the milk duct would be extremely hard to detect and as far as I know is not neccesarily going to be a bleb symptom. Also th bleeding is not consitent with thush. Are your nipples cracked and bleeding or is it only bleeding from the spot where the maybe-bleb was?

Thrush is unlikely to occur in one breast although it is possible, and it is neccesary to treat mom and baby if it is thrush. Why did you stop treatment? Did you think that it's not thrush?

Does it hurt during and after nursing or only after? Pain esp. after nursing sounds like vasospam, which also causes the nipple itself to turn white or get a white tip when it is compressed by a poor latch and can cause extreme pain right after nursing.

Thrush typically presents as shiny or flaky nipple/areola skin, with pain, during nursing and often between nursing as well. I am not sure it would look like a bleb.

here is info on blebs: http://www.llli.org/docs/00000000000...plugsblebs.pdf

You can try using as breast shell under your clothes to protect the nipple while it heals. http://www.askdrsears.com/topics/bre.../breast-shells Are you still using APNO or lanolin, anything to speed healing?

Can you nurse comfortably on the other side, and maybe pump (if its comfortable) or hand express on the injured side for a day or two in order to heal?

[@llli*mommal]

Welcome, mama, and congratulations on the new baby and on nursing her succesfully despite what sounds like some significant discomfort! What you describe sounds very much like a bleb/blister, but there are some elements in your story which suggest fungal/bacterial infection may have played a part in your experience.

When an LC says she sees a blister/bleb, I am inclined to believe her. Generally LCs know a lot more about breastfeeding than doctors. You did pursue the proper course of action in treating it- the wet compresses, the APNO, the request to have the doc pop the blister. (FYI, your doc did not give you the best advice about breaking a blister. It is safe to do so, provided you use hygienic precautions like using a sterile needle and washing your hands. And your doc should have told you that the best person to pop a blister is the person with the blister. You can feel when you have gone too far with the needle. The doctor can't!)

That being said, some of what you experienced does suggest a thrush or bacterial infection. Soreness that persists in the breast after feedings is classic thrush, and if your doc saw what appeared to be thrush I am inclined to agree. It's possible that what you had started with a blister, and then infection took root in the damaged area.

At this point, I think you might want to see the doc and the LC again. It sounds to me like you might have both a blister and thrush, and that the thrush treatment you were given just didn't do the trick in terms of wiping out the yeast. But you might also want to get a bacterial culture done.

[@llli*joe.s.mom]

You've gotten good advice here. I would keep looking for answers, because breastfeeding does not need to be this painful! The open wound caused by a bleb bursting is very vulnerable to either bacterial or fungal infection. I would go back to the LC first, because they have "seen it all" when it comes to breastfeeding issues, whereas your GP will probably see a proportionately smaller amount of breastfeeding women. Get her thoughts, and then take them to your doctor. I really hope you start getting some relief soon! For what it's worth, I also seemed to get every possible thing for the first couple months of breastfeeding and it wasn't pain-free for a long time. Mastitis, thrush, blebs, you name it, I had it. It was HARD, but I am so glad I pushed through it. I went on to have a long and PAINFREE breastfeeding relationship. You can do it too!

[@llli*mom2000]

Thanks so much for the ideas and advice.
Some further clarifications and questions - The doctor said he hadnt seen symptoms of bacterial mastitis which inlcude fever and chills, and my treatment has been for fungal mastitis, which is different. He has mentioned a couple of times that there is no definitive diagnosis for fungal mastitis but this was his best estimate.
I kind of believe this is not thrush as I hadnt seen anything white in my baby's mouth (nor did the pediatrician or LC) and I didnt have this in both breasts. Though I think you are right in suggesting this started as a blister and the morphed into an infection even though I was using the APNO. I was using lanolin for some time but stopped that a little after the blister happened.
On the vasospam - I did come across that in my online research but I dont have the white nipple tip which seems to be the norm there.
I asked my doctor for follow up medication last week but he wanted to avoid that as the fungal medication course was very strong. I spoke on this Monday with him about the bleeding (it is not across my nipples but just at that spot) and he did not think he wanted to give any further medication. He still felt it was healing. He did mention that bacterial infections have symptoms such as fever and chills and therefore he did not think that I had one. I am thinking I will go back and request a bacterial culture perhaps based on your suggestion if that can help diagnose clearly.
I have anipple shield at home and will put that on - thanks for the awesome idea. The pain seems to be there irrespective of whether I nurse or pump but I think the shield will help enormously for post nursing/ pumping.
This has been SO helpful. Please do let me know if you have further thoughts.

[@llli*lllmeg]

The doctor said he hadnt seen symptoms of bacterial mastitis which inlcude fever and chills, and my treatment has been for fungal mastitis, which is different. He has mentioned a couple of times that there is no definitive diagnosis for fungal mastitis but this was his best estimate.

Well, I am a bit confused by the terminology, so I pulled out the big breastfeeding text Breastfeeding Answers Made Simple (Mohrbacher, 2010) to do some research. So the following basically comes from there: OK, so yes, there is mastitis, which is an infection inside the breast, often accompanied by a lump and/or red streaks on the breast, that causes flu like symptoms and often (but not always) needs oral antibiotic use to cure. Nothing you have mentioned here sounds like that typical mastitis to me.

Then there is thrush, which is caused by the fungus Candida albicans, which is a yeast infection (similar to a vaginal yeast infection) on the nipple(s) and in baby’s mouth. Please note, a mom can have thrush symptoms and baby be asymptomatic, but baby still needs to be treated along with mom since it is passed back and forth. (also clothing, any other nipples used like pacifiers, etc, also have to be cleaned regularly during treatment.) A common prescription treatment is Nystatin but studies show that other prescription treatments are much more effective, specifically fluconazole.

Then there are bacterial infections of the nipple area, which are often confused with thrush. These usually present as nipple cracks, fissures, ulcers and/or visible pus and pain. These are not commonly referred to as mastitis, although they also may require oral anti-biotics. I guess this is what you could have your nipple cultured for and look for the bacteria.

I am not sure what your healthcare provider means by "fungal mastitis" unless he means thrush, or he means a fungal infection that has gone deeper inside the breast due to the nipple injury. According to Mohrbacher, such secondary fungal infections were once thought to be the cause of deep, shooting or burning breast pain but research has found otherwise, and suggests that rather such pain is usually due to either a bacterial infection or Raynauds Phenomenon (a condition that causes moms to be prone to vasospasm.)

So, how does this help you? Not much I am afraid but anyway-I think, from what you have said, that mommal has it right and what likely started as a bleb related injury developed into either: 1) Yeast infection of the nipple. 2) Bacterial infection of the nipple or 3) no infection, but rather a very damaged nipple that is causing you pain simply because it is so damaged.

Also you want to make sure the bleb (if that is what it is) is gone, as that will continue to cause pain.

OK, does this make sense, or am I missing something guys?

[@llli*joe.s.mom]

Could he mean that the thrush has gotten inside the milk ducts? Inside the breast? I've never heard the term "fungal mastitis" either.

Thrush can get in the breast (it did for me, or at least, that's what I thought it was, and it seemed to respond to treatment?) where it can cause burning shooting pains at letdown. Not fun. ETA: Reading Meg's description that this is usually Raynaud's or bacterial, but I don't think I had either of those. I guess it's hard to say, but my issue resolved with treatment for thrush.

[@llli*mom2000]

Ok - so here is what I think after reading through the last but one post (Meg's, perhaps?) - that my ob/gyn meant this was possibly thrush/ just a blister and had caused a deeper fungal infection in the breast. He gave me fluconazole though my baby's ped gave Nystatin for her after seeing his prescription so not sure the two were consistent. I was not regular with the Nystatin primarly because I felt the baby was swallowing the large quantities of N (2 ml four times a day) without any clear signs of infection on her in terms of thrush.
Now quite unsure about what my best options would be. I keep thinking some medication to address the infection but not sure now which one it needs to be!

[@llli*mom2000]

Thank you again to everyone who responded - both with advice and encouragement!

the pain feels distinctly better with using the nipple shield to protect the nipple from clothes and direct touch after feeding, and I hope this will provide some room for it to heal. The nipple now seems to have a small white blister again at the site - this was beginning to form a few days back but I think was held back by the bleeding. I am hopeful that the blister will heal quickly with the warm compresses (planning to restart those today) and things will get better.

I am still worried that there is an underlying infection that needs to be treated with medication - does anyone have ideas on what we should explore now?

thank you! After 5+ weeks of living with these problems, it has been a BIG relief to get the advice on this forum! I especially appreciate the words of support and encouragement.

[@llli*mommal]

If you're still concerned about infection, I would take a 2-pronged approach:
1. Monitor yourself for thrush symptoms (burning pain, itching, skin that appears dry, flaky, or shiny, nipples that appear more pink or red than normal) and the baby for thrush symptoms (white, pearly patches in the mouth) while taking in increased hygienic precautions (wash all clothes and towels on hot, change bras daily), reducing yeast-promoting foods in your diet (simple starches and sugars), and taking a good probiotic supplement.
2. Get a culture done. It's the best way to find out if this is bacterial.

Have you tried varying your nursing position on the problematic side? If this is a persistent blister, changing the nursing position might stop the friction that is causing the blister to form and reform.