Exclusively Pumping and Nipple Pain

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.

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Below are some common causes of nipple pain while pumping breastmilk.

Incorrect Breast Shield Size

Many breast pumps are sold with standard 24oz flanges, but you might need bigger or smaller ones to be comfortable. Here are a couple of guidelines to help you 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.

One important thing that was not immediately obvious to me is that you can have large breasts and still need a small size breast shield, because breast shield size is reflective of your nipple, and not your breast.

This post might help you visualize whether or not there is a problem – it has a measurement guide that you can download, cut out, and measure to your nipple. You should measure after you pump.

(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.)

Alternatives to Standard Breast Shields

If you’ve tried a few different breast shield sizes and are still having discomfort, there are some alternatives that might work better.

Pumpin Pals – Pumpin Pals are a differently shaped flange – instead of a ring at the base of the funnel, the Pumpin Pal flange tapers into the tunnel. A lot of women find this more comfortable, especially those with elastic nipples (where the nipple is pulled to the end of the breast shield).
BeauGen Breast Pump Cushions – BeauGen inserts go inside your breast shield and make pumping more comfortable for some women. They reduce the size of breast shields by about 2mm, so they can also be useful if you are between sizes.
LacTeck – LacTeck breast shields are made to mimic a baby’s latch more closely. They are softer and more flexible than traditional plastic breast shields. (Note: I have a 10% off discount code for their products: Use EPUMP2.)

More information on alternative breast shields here.

Breast Shield Placement

Nipple damage – like a cracked nipple – is often caused by pumping with breast shields that aren’t centered correctly on the nipple.

If this is something you struggle with – especially at night – Lactalites can be a good solution. They are a light that you clip onto your flanges, which allows you to see your nipple move more clearly.

Pump Speed

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, until you feel a bit of discomfort. Then dial it back a notch.

(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. This was a bad idea.)

Lack of Lubrication

Some women find pumping is more comfortable with some kind of lubrication. Coconut oil is a popular choice, and safe for baby.

To use it, just dip your finger in the oil and apply it to the flanges and the tunnel. (Some moms find CoBoo Spray less messy and easier to use.)

Breast Health Issues

There are a few main breast issues that can cause nipple and breast pain – clogged ducts, mastitis, thrush, milk blisters, vasospasms, and galactoceles. 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. (A milk blister is similar, but is right on top of the nipple.)
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 skin changes such as shiny or flaky nipples. You may also see white patches in your baby’s mouth.
Milk Blisters – These are also called blebs or nipple blisters, and they are similar to a clogged duct but occur on the tip of your nipple. Milk blisters occur when nipple skin closes over a milk duct opening.
Nipple Vasospasms – Vasospasms are a sudden narrowing of the blood vessels in the nipple and can be very painful. They often occur after pumping, in response to cold, and you may notice part of your nipple turning white.
Galactoceles – A galactocele is a cyst filled with breast milk. It may or may not be painful, and is often mistaken for a clogged duct or for possible breast cancer. See your doctor if you have a persistent lump that doesn’t go away within a few days.

Clogged ducts can be treated at home, mostly by pumping the affected breast early and often. If you get recurrent clogged ducts, you may want to consider taking lecithin.

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.

Miscellaneous Causes

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.
A dry or chapped nipple that leads to cracking or bleeding. Lanolin or other types of nipple cream can help with this. (You can find reviews of different nipple creams here.)

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. (They are safe for breastfeeding.)
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 often at its worst before letdown.)
Make sure your bra is comfortable and fits. Most nursing bras don’t have seams or wires and are constructed for lactating breasts, so these are ideal.
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 may help.
Try using a warm compress both before and after a pumping session.

Not sure what’s causing your breast pain related to pumping? Here are six questions that can help you figure out the issue.

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