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)
Many pumps are sold with 24oz flanges, but you might need bigger or smaller ones to be comfortable. 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. Here is a full review.)
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, 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 a few main breast issues that can cause nipple and breast pain – clogged ducts, mastitis, thrush, milk blisters, and vasospasms. 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 it 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.
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- 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.
- 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 in response to cold, and you may notice part of your nipple turning white.
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.
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.
- 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.
Not sure what’s causing your breast pain related to pumping? Here are six questions that can help you figure out the issue.
References- Medela. “Medela Breast shield sizing guide.” https://blog.medelabreastfeedingus.com/2015/05/medela-breastshield-sizing-guide/
- Newman, Jack, MD. “Sore nipples.” https://www.breastfeedinginc.ca/informations/sore-nipples/
Has anyone else gotten “blebs” on their nipples (as I have heard them termed)? Basically, I have almost like blood blisters on my nipples. At first, I just had one large one in the area where I used to have a wound that healed. So at first, I thought it was part of the healing process. Then, I developed more, even on the other nipple! They look horrible. They do not hurt. But I almost feel like the large one has covered over some openings, and my milk has had to “re-route” on that side, and it drains slower than my other side. Also, my nipples are constantly soggy! When I am in the shower, it is like I have to “exfoliate” them and get off white, dead skin cells. Gross, I know. It is almost like I do not know if they are soggy or dry! Just thought I would ask! To some degree, I think pumping is brutal on your nipples, regardless. Thanks as always for the info!
Ugh, Stephanie – the “blebs” sound horrible. When you said that it spread to the other nipple, I thought maybe it was thrush, but then the fact that it doesn’t hurt makes me think maybe not. Do they bleed at all or just look bad and cause issues with draining?
(Side note: once I had a cracked nipple and bled so much when I pumped that the bottle looked like it would have been perfect for the vampire baby – Renesmee -from Twilight.)
Ugh, the white stuff on the nipples is gross – I know exactly what you mean. I had that the entire year I pumped with my EPed baby and not at all for my nursed baby (even though I pumped for her all day with working). You are right, the pump is hard on your nipples!
Glad I am not the only one with the dead skin cells! 🙂 No, no bleeding, thank goodness. Your experience with the blood-tinged milk does not sound pleasant. Yes, the best way I can describe them is blood blisters…because it is not like they would “fall off” like a scab. Ok. Gross. Well, thanks for the reply! Happy Mother’s Day! Maybe someone else can pump for me today?
Is it normal for nipples to be hard and sore after pumping (been pumping for a month)? Thanks!
Hi Katherine – no, pumping shouldn’t hurt. 🙁 I see you asked about the flange size in a separate comment, I hope that changing the size fixes your issues!
If my nipple looks red while I’m pumping is my flange to large or to small? Trying to figure out why my nipples always hurt- so hard after I pump…
Hi Katherine – it could be either way. Do you feel like a lot of the nipple is getting pulled in? You could try getting one size up and one size down and figuring out which works? They run about $7-8.
I am getting so frustrated with pumping! My daughter is 3 months, And I’ve started getting engorged between feeds if my breasts are not fully emptied previously. Then, when I turn the pump on, that side won’t express milk! No nipple mobility with any flange size. Cold and warm compresses don’t seem to work. But not expressing milk is leading to further engorgement… Once I finally get one side going by manually expressing, the other side malfunctions next time. Help!
Mary – that sounds so frustrating. When you say no nipple mobility, what do you mean exactly? Do you mean that when it’s hooked up and you start the pump, your nipple doesn’t move in the flange? Or that you aren’t able to get a let down?
Today, at 3pm, just for fun as a self challenge (and I truly regret this), I had the idea of pumping using pump speed 10 (Using Spectra 9 and that’s the maximum speed). About 2 minutes later, I noticed that I’m pumping blood instead of milk. I immediately stopped pumping and decided not to pump.
At 11 pm, I tried pumping using only speed 3 (I normally pump using speed 5-7). However, my milk is mixed with blood at the first pump. So, I had to manually pump by pressing my breast. After getting 4 oz, blood started to come out again. What should I do? How to heal an internal bleeding? And how long will it take before I could start normal pumping again? I’m gonna start working next week and I need to start pumping for the stock a.s.a.p as I don’t wish to feed my baby formula milk at three months.
Please help me. Thanx!
Hi Ilyana! So sorry this happened – I know how painful it can be. So – you should just keep pumping normally and it should resolve itself within a day or two. If it’s painful, you should bring the speed down – if it’s not, you should keep it at the normal speed regardless of blood. I pumped a bottle that looked like it was 100% blood and fit for that baby from Twilight, and over the next few days the blood went away. Good luck!
Hey. Thanx for the reply. Since that day, I only do it manually. Turned out, I get more that way. Although it’s time consuming, I prefer not to use the breastpump anymore. Lol. ?
So my nipples are red and raised (Doctor says no thrush) are my flanges to big?
It’s possible – have you tried a different size?
Yes, I’ve tried the 24, 27,30 and they all hurt
Ugh, I’m so sorry. It’s really hard to tell without being able to see. I have two thoughts – first, I hate to suggest yet another flange purchase but you could try Pumpin’ Pals, as a lot of people find them more comfortable. Second, is there a lactation consultant that you could ask to watch you pump and see if there is a sizing issue with the flanges? Sometimes pediatricians have them on staff or you can see the one at the hospital where you gave birth.
This is a very helpful blog. I started expressing after my little one refused to breastfeed. Its now 1.5 months and I was beginning to experience painful nipples. Am glad to know there are a whole lot of people trying to express for the their babies.
DI’d anyone else have this problem, I pumped since birth and my nipples are now starting to hurt everytime I pump it kind of takes my breath away. I just fight through it but if there is something that can help I would prefer that. Also my nipples are permanently hard like when cold could it just be irritated from being hard and rubbing against bra always and is it normal for them to be permanently hard or could I be doing something wrong while pumping?
I have this same exact situation as Jen described.. What can I do? My nipples hurt initially but things got better.. now 4.5 months down the road left nipple started hurting again.. this pain is more sharp.. any tips on how i can remedy this?
My question is 3mpp I use to it have to pump for 20 minutes to get a bottle so 4oz nowy supply for a week now has been so up and down sometimes I pump for 45mins and only get 90ml and other times i pump I could possibly get 4oz??? How do I get my supply up my son drinks 130ml every 2-3 hours
I’ve been exclusively pumping for my 2 month old and at first I had no problem at all, I slowly start getting pain so I changed the size of the shield but now I’m not only getting nipple pain but also pain where the shields sit…. Please help its so painful
Hello:)
I have been pumping and breastfeeding for 2 months recently started getting s sharp pain on my left breast and my Nipple hurts on the top. Even just touching it.. Help? How can I ease the pain n what should I do so this does not happen again?
Hi Marie! That sounds awful! Does it hurt all the time or just when you’re pumping/touching it? It kind of sounds like thrush, given that the pain is sharp. Maybe you could get it checked at an urgent care type place?
Hey my question is I have a lower supply in my right breat is there any way to bring it up I’m producing about 5oz each session and have been exclusively pumping for 8weeks
It’s totally normal to have different output on the two breasts – you can try to increase it by pumping more just on the one side. But if it doesn’t work don’t worry, it’s normal!
I have been expressing for 2 & 1/2 weeks as my twins were born at 30 weeks. I started with the 24 which was slightly uncomfortable then LC at hospital suggesting larger so have tried 27 & 30. 30 was going well but according to the diagram had too much areolar going into the tunnel of the flange. LC said just use whatever is comfortable. Now i feel a callus type thickening which is sore (although it isn’t dry) on one side of each breast where nipple & areolar join where the flange rubs. It seems that the flange is going to rub somewhere no matter what the size, is that normal? Im worried my nipples will be so sore and thickened by the time my twins are ready to start breast feeding.
On the upside, my supply is great, getting 1200-1400ml per 24 hours (8 sessions of expressing per day)
I have been exclusively pumping for a year now, due to latch issues and nipple pain. I had a history of thrush with my older daughter, so when my nipple pain started when my baby was only a few weeks old I thought I had gotten another yeast infection. I spent the next several months doing everything I could to get rid of the Yeast infection. Everything. The nipple pain continued. Like I said it has now been a year and my nipples continue to ache, burn, and they are red, sore and irritated at all times. I have read that yeast infections are almost impossible to get rid of once it has taken hold, but I’m also wondering now if the pain is coming from my pump. I am using a Medela freestyle that is about eight years old. Even on the lowest setting it feels like it is literally ripping my nipples off. The pump was given to me because I did not have one. I have debated buying a new one and seeing if that helps, but that is like $300. And I know when I used the hospital pump it was better, but there was still pain. I am reaching out for help because I have finally reached my limit of pain, but my one-year-old who was born prematurely is still not eating enough for me to wean completely. I hate the thought of formula, but I do not know what else to do. Please help!
Hi Crystal! Are you sure that you have the right size flanges? Have you tried different ones to see if they are more comfortable?
Crystal,
I had the same issue- I’ve switched from the Medela pump in style to the Spectra S1 and it has made a world of difference. No more pain!
I did figure out early on that I needed bigger flanges, so I’ve been using 27’s. Maybe now that I am pumping less, I can go down a size. I did take your advice and purchase the set of three angled flanges so I can try those.
Thanks for the tip about the other type of pump. I hate to purchase a new one so late in the game, but I think it may be my only option at this point.
I am so happy to find this forum is still active. Thank you for answering questions so quickly!
So, I’m a bit of an unusual case. I am currently in the process of using a surrogate and our due date is August 20th! I am trying to stimulate lactation so that I can breastfeed my baby myself. I have had one miscarriage in the past, but have never produced milk on my own.
I’m using a manual pump to help stimulate and am only 3 days in, but I’m experiencing nipple soreness and am unsure if its normal when you start pumping or if maybe I’m using the wrong size shield? One nipple is more sore than the other and remains sore to the touch between pumps. I’m pumping around 4 times a day for 20 minutes each side with some hand stimulation as well.
Any suggestions or help is welcome.
Hi Tabitha! Congratulations on your impending arrival! I’m so excited for you.
It is totally normal to have some degree of nipple soreness when you first start breastfeeding – I’ve had it with all three of my kids. It takes some time for the nipples to “toughen up.” In the meantime, I would suggest using some kind of lubrication (like olive oil, coconut oil, lanolin). It shouldn’t take too long.
Having said that, the flange size still could be an issue. Can you buy one size up and one size down and see if either of them are more comfortable?
Are you working with a lactation consultant at all? If so, she might be able to watch you pump and see if you have the right size.
You’re doing such an amazing thing!
My problem isnt when I am pumping so much so that when I am not pumping i feel like pin pricks in my nipples when i breath in deeply or yawn I feel it in my nipples I think i need smaller flanges but are there any ideas as to what can be going on my baby is a week old and i pump anout five ounces at a time. I have tried the nipple cream, airing them out, and switching the breast in intervals. I am using a manual pump right now but my insirance just okayd me for an electric pump that i should be getting soon.
I have been doing this for 7 weeks so I am still new to it comparitively. Here is what I find helps with pain:
Olive oil on your nipples helps with pump burn and callouses.
When it gets really bad I use an olive oil based cream-mothers love nipple cream. Tiny jar, costs about 10 bucks off amazon, but totally worth it. Nipple pain is incredibly discouraging and we all know the commitment it takes to pump regularly. I found lanolin was too sticky and increased the friction instead of relieving it.
To increase supply, which is probably a thread elsewhere I found that a regular hamburger from Wendy’s, like 3 times a week made about a 3 oz difference per day. I must be normally iron deficient or something. But it did really help. When I stopped because I wanted to start watching my weight…my supply dipped! I also eat oatmeal daily and I drink an alcoholic root beer a few days a week for the malt. I hate it, the taste of beer, but I do it for the baby?
If anyone needs to increase supply, because you have low milk production or because you’re needing more milk than you were originally making you, I urge you to try Pumpin pals breast shields and/or Lactiful supplement. I started taking the Lactiful one pill three times today for two days, then two pills three times a day for two days, and so on until yesterday when I had my first full dose of five pills three times a day. My breasts have felt heavy, tingling, and slightly engorged throughout the day today. I’ve already seen my supply increase by 1 ounce per pumping session, and my baby also nurses and I have seen a huge increase in Seedy breast milk poo’s in the last 24 hours. (We have been supplementing with Nutramigen since my supply was low). I know this is an exclusive pumping blog, but my experience can still help some of you mamas out there who can’t breast-feed. Both products can be returned easily if they don’t work for you. I also use a LactaMed Simplicity Hands Free pumping bra. I have tubular shaped breasts and I find the pumpin pal shields I respond too better than standard ones like Medela’s, especially since I have large nipples as well as downward pointing, tuberous breasts that tend toward sagging. The lactamed bra really has helped as well because it keeps the shields held higher and closer to my breasts whereas the other hands-free bras don’t give much support for my sagging, downward pointed breasts.
so i have been pumping for the past 3 weeks, 3 times a day. baby gets formula to make up for what i can;t get. i produce most of the milk from my left breast, & only a tiny bit from the right one. lately, about 5 – 10 minutes after i pump, i start getting these extreme shooting pains in my right breast, the one that barely produces any milk. it will last about an hour. i will be stopping from pumping on this side since the pain has become unbearable. But what is this? Does anyone know?
This afternoon, around 2pm, while I was pumping, my husband decided to turn my pump up all the way. He did this a few times before he decided it was dangerous for him to mess with me. My next pump session at 5pm was fine. However, my 8pm resulted in a pain in my left breast. It felt like it was right on the outside of the shield and only lasted for a few seconds, each time in the same area. This happened a few times in the 20 minutes I was pumping, especially if I moved. I am worried something may have happened or is starting to happen. Any advice or ideas on what I can do if it keeps happening? I have my 8 week, postpartum check up in a week.
Update. At my 11pm I only felt the pain when I moved. I skipped my 2am as I’ve been so tired my husband felt I needed sleep more. So now it’s 5am and I’m pumping. Currently no pain but I am using a lower than normal setting on my pump and trying not to move around too much
I have tried every size flange on the market and I am still in intense pain. I’ve tried all speeds on the pump and lining myself and the flanges with cream. I have the pumping pals flanges as well as the factory medela ones. I don’t know what to do! I hurt so bad. Anything touches my nipples and I want to cry.
Have you tried using the Medela SoftShells? Those didn’t fully fix my issues but have made me comfortable enough to continue pumping!
I currently have a blood blister, rather large one on my “good breast” and I’m wondering if it’s safe to pump and give to my 3 month old with possible blood in it? Should I pump and dump? I’m not in any pain. I only got the blister because I was pumping and feeding my LO at the same time and didn’t notice the placement of my nipple was wrong until it was to late. Please and thank you for the advise!
Totally fine to give it to your baby. If you were nursing you’d have no choice and not even know either way. I usually didn’t freeze or keep the bloody milk for long but rather fed it asap – not for any real reason just because it felt weird to keep it in the fridge.
Hi there,
I have been exclusively pumping since my little was was born (5 weeks now), and I have already suffered Mastitis and I am now starting to experience severe nipple pain.
I have cracks all over, and water blisters that are forming over each of my nipples that very in size every time I pump. Not sure if this is due to the prescribed “all purpose nipple ointment” cream my Dr. gave me, or from just pumping 6-8 times/day.
The flange size doesn’t seem to be the issue, since the same blisters are appearing when I use various sizes (24,25,27 and 30).
I have not been able to locate any info or relation to this issue elsewhere, so I’m hoping maybe to find some advice here.
Any help would be much appreciated!
Thanks much 🙂
Hi Amanda! Are you switching the flange sizes around a lot? If so, my theory is that one size is damaging your nipples and there isn’t enough time for the damage to heal when you try the others. Maybe try Pumpin’ Pals and see if that helps? So sorry you’re dealing with this!
I’ve been pumping now for a month and I’ve used the wrong flange one the right side and have almost a cut on my nipple. I think I now have the right flange size but it’s painful because of the previous injury how long will that take to heal? I can’t stop pumping or else my supple will drop.
So sorry you’re dealing with this, Georgia! I would say it would take anywhere from a day or two to a week. Take tylenol or advil to help in the meantime. Good luck!
Hi, my wife has been pumping for about 10 days and her nipples have blood blisters, cuts and are extremly painful. Could thi be because the flange is too big or something else? Thank you
Yes, they could be either too big or too small. I would buy both, try them different size and see if one is more comfortable.
Hi all,
I’m having severe pain around my right nipple only before, during and after pumping. The worst part is during pumping. They fitted me for the correct size shield at the hospital and I’m already using the biggest size so I don’t think it’s that. It’s not mastitis beause I’ve had that before. I have under the skin nodules around the nipple they seem to pop out more than the left boob not sure what else it could be. I don’t have cracking or bleeding and I’ve been using ice packs and nipple cream. Help :(!!
Do think it might be thrush? I would maybe go see your OB. So sorry you’re dealing with this!
I have been doing exclusive pumping since my Lo wont latch and start loosing weight.It has been three weeks since i started pumping and i tried 21mm 25 27 mm and pumping pals large set flanges.all of them are hurting my nipples and nipples are rubbed against the tunnels.tomorrow i am planning to try 30 mm medela flange.i already hve low milk and i am not able to pump properly for the past week.i think because of nipple pain i am not even getting letdown for 20 min anf i end pumping 40 min to atleast partially empty my breasts and too much pumping is aggravating pain.My other worry is that because of improper pumping will my milk supply reduce permanently?Is there any other solution for flange fitting?
Hi! I’m so sorry that you’re dealing with this. A few suggestions – 1) can you call pumpin pals customer support and see if they can help you? 2) are you using any lubrication at all? Coconut oil works well 3) maybe try hand expression and see if that is easier for you until you can get the flange size worked out 4) can you ask a lactation consultant to help fit you for the right size flanges?
So my nipples are always hard, which makes them tender. They also have white (what looks like milk) stuff in the crevices of my nipples which then turns yellowish after is dry. Even having the shower water hit my nipples hurts so trying to get all of that white stuff out hurts too!
That milk stuff doesn’t go away until after you wean. Nothing I did could ever get it out!
Please help, my flanges look like the right size before pumping (if anything maybe slightly big) but while pumping my nipples get that much bigger they get quite red and rub on one side of the flange… would the flanges be too big or too small..?? Very confused
Hi Jay! I would try a bigger size and see if that feels better. I would go based on the “while pumping” size.