Dealing with painful nipples while you’re exclusively pumping is really challenging, since you need to keep pumping on a schedule to keep your milk supply up – there’s no way to take a break. As a result, it’s important to get to the root cause of what’s causing your nipple pain. Below are some of the most common issues and how to resolve them.
Breast Shield Size (Also Called Flanges)
Pumps are usually sold with 24oz flanges, but you might need bigger or smaller ones to be comfortable. (Since you’re on your third baby, I’m guessing you have the correct size, but your breasts can change with each pregnancy so I thought I’d include it as a possibility.) Unfortunately, figuring out what size is best for you can often be an expensive exercise in trial and error where you order three different sizes and see which one fits the best. (That’s what I ended up having to do.) Here are a couple of guidelines to help figure out whether your flanges are too big or too small:
- If your nipple cannot move freely in the flange “tunnel,” the breast shield is too small. This can cause nipple pain because the fit is too tight.
- If the tissue around your nipple is being pulled into the tunnel, the breast shield is too large. Here, the cause of the nipple pain is that extra tissue that shouldn’t be pulled in is being pulled in. This agitation can bruise that tissue and cause pain and inflammation.
This graphic might help you visualize whether or not there is a problem.
One important thing to know that was not immediately obvious to me is that you can have large breasts and still need a small size breast shield, because the breast shield size is reflective of your nipple and not your breast.
(Updated to add: I tried Pumpin’ Pals for the first time about a year after writing this post, and they are very helpful for nipple pain caused by poor fitting breast shields – and they send you three sizes at once so you can skip the trial and error.)
Sometimes pumping at too high of a speed can cause nipple pain. If you think this might be your issue, start on the lowest setting and gradually increase it, but stop a notch or two before you feel start to feel uncomfortable.
(I have a Freestyle, which has numbered speeds from 1 to 9.When I started pumping with it for the first time when my baby was two days old, I wasn’t sure what number to set it at. I figured a higher number would mean more milk, and as my milk supply was at that point nonexistent, that’s what I wanted. I put it on 9 to start out with. BAD IDEA.)
A Pox on Your Breasts
There are three main breast issues that can cause nipple and breast pain – clogged ducts, mastitis, and thrush. How do you know if you have one of these? Here are the major symptoms:
- Clogged Duct – This will usually only affect one breast at a time, and you might be able to feel a hard, painful lump (this is where the milk flow is obstructed, or “clogged”). The area around the lump will be tender and sometimes red and warm if you touch it. The pain is at its worst before pumping/feeding, with some relief afterwards.
- Mastitis – Mastitis has the same symptoms as a clogged duct plus a whole slew more – fever, chills, general malaise, and flu-like aching. If your boob hurts and you also feel like you have the flu, you probably have mastitis.
- Thrush – The main symptoms of thrush are itchy, burning and/or cracked nipples, shooting pains in the breast during feedings, “intense nipple pain,” and deep breast pain. You may also see white patches in your baby’s mouth.
Clogged ducts can be treated at home, mostly by pumping the affected breast early and often. If you think you have mastitis or thrush, it’s a good idea to call your OB or primary care doctor. Mastitis might require antibiotics, while thrush usually calls for an oral fungal medication like Nystatin.
There are a few other possible culprits:
- “Squashed” breasts from sleeping your stomach, having a bra that doesn’t fit quite right, or having a bag with a strap (like a diaper bag or purse) that frequently rubs against your breast.
- Wearing breast pads but not changing them frequently enough. (I am definitely guilty of this.)
- A dry or chapped nipple that leads to cracking or bleeding. Lanolin and nipple cream can help with this.
What to Do About the Pain?
Keep in mind that once you’ve addressed the underlying cause of the nipple pain (such as getting a different size flange), it may take a week or two for the damage that was already done to heal. While you wait for your nipples to heal or recover from mastitis or thrush, there are a few things that you can do to make yourself more comfortable.
- Take Motrin or Tylenol. If it hurts more when you start pumping, make sure that you’ve taken something recently when it’s time to sit down and pump.
- If only one side is affected, start by pumping only the other side. Once you’ve let down, hook the affected side up to the pump. (Nipple pain is at its worst before let down.)
- Make sure your bra is comfortable. Even if it doesn’t provide the best support, a basic sports bra might be better than one that might irritate you.
- If your issue is a dry, cracked or bleeding nipple, and you’re sure you don’ t have thrush, try applying breast milk and/or nipple cream to your breast before and after pumping. Also, try to let your breasts “air out” if possible. Obviously, you can’t walk around topless all day, but if you can for 10 minutes at a time here and there, it will help.
- Try using a warm compress both before and after a pumping session.