Clogged Ducts

Authored by Sabrina Granniss, IBCLC. 

Getting a clogged duct can be a literal pain in the boob. Sometimes they seem to come out of nowhere. Luckily, they are often able to be taken care of at home so you can continue happily on your nursing/pumping journey. Other times, a plugged duct may be a little more tricky to resolve. Either way, in addition to treating the plugged duct, it is important to do some detective work to uncover why it happened in the first place and treat the root of the problem to avoid more clogged ducts in the future.

What exactly is a plugged duct?

Plugged ducts are also called clogged ducts. Inside each breast is a network for making, storing and carrying milk. There are about 15-20 sections called lobes of glandular tissue where milk is produced in each breast.(1) When the nipple is stimulated by your baby sucking, pumping or other stimulus, the milk begins to flow.  Milk travels through the mammary ducts towards the nipple. 

A clog or plugged duct is when milk becomes backed up in the milk duct and is unable to flow freely and out through the nipple. Sometimes this happens closer to the surface at the pore as a milk blister which looks like a white spot on the nipple or areola that doesn’t seem to go away. Other times, it happens further back in the ductal system where it is not seen but can be felt.

Plugged ducts will typically only be on one breast at a time. A clog can happen on any part of the breast tissue from close to the areola or much farther up even into the armpit area.

Symptoms of a plugged duct

• An area that feels tender and sore
• A hard pea sized lump you can feel 
• Swelling or pain near the lump
• Pain during a letdown
• Decreased milk flow from that side

What causes a plugged duct?

• Engorgement - In the beginning of breastfeeding, milk transitions from colostrum to mature milk and the volume of milk increases significantly. The larger amount of milk and other fluid can cause swelling putting pressure on the ducts. This makes the diameter of the duct to become more narrow, making it hard for the milk to travel through the duct in that spot. If milk is not removed regularly and frequently, the breasts become overfull. Also, if you had fluids during the birth, this can contribute to the pressure on the ducts.(7) Engorgement can happen anytime during your nursing journey. By keeping your baby skin to skin and nursing often 24 hours a day, it keeps milk flowing and prevents severe engorgement. 

• Infrequent nursing or pumping - Babies sometimes change their patterns when we do not expect it. A common time this might happen is a spontaneous night that your baby decides to sleep longer than usual and you sleep too because let’s face it, that extra sleep is rare and most welcome. Next, you wake up and feel overfull from the missed milk removals. Whether nursing directly at the breast or pumping, milk can get clogged in the duct if the time between nursing or pumping is too long during either the day or night. 

• Timed feedings - if you are watching the clock instead of your baby for feeding cues, you may end up stretching time too long between feedings. It is normal for babies to nurse every 2-3 hours and sometimes grab a snack in between. As babies get older, they still come to the breast often for comfort as well as food. Those small snacks make breasts less full. Allowing your baby to follow their natural feeding pattern means your breasts never become overfull from too much time between some milk removal. Nursing a distracted older baby in a sling is great for giving them a new and exciting view of the world as you walk with them while they can nurse at the same time.

• Nighttime - It is biologically normal for babies to nurse overnight and your breasts need to have milk removed to avoid getting overfull as well as maintain your supply. Going too long during the night without nursing or pumping will create more pressure on the ducts and milk can back up in the ducts, increasing the risk of waking up with a plugged duct. When babies stay in close contact with you, they will wake frequently to eat during the night.(2) When separation or barriers to close contact with you are introduced, including swaddles or sleeping in a separate room, your baby’s natural waking pattern can become delayed and a skipped feed is more likely.(3)(4) This can not only leave you susceptible to plugged ducts but may reduce your milk supply. 

• Improper flange fit - Proper flange fit makes pumping comfortable as well as effective. When your flange is too small or too big, less milk is able to flow and be removed. Compression on the areola from a flange that isn’t the right fit can inhibit milk flow from the ducts and create a clog.

• Baby’s latch -   Your baby uses their whole body to feed. They have to be comfortable in order to be able to latch deeply. If there is tightness or restriction in any of the muscles they use to latch and breastfeed, it can make feeding hard. They may end up compressing an area of breast tissue. It may mean they are not able to latch deeply and effectively empty the breast (although your breasts are never completely empty). There can be several reasons for tightness, a shallow latch or difficulties at efficient milk removal including how they were positioned in utero, their birth and oral restrictions. Meeting with a skilled SACLC/IBCLC who can evaluate your baby’s oral function and positioning at the breast can help you decide how to best help them be more comfortable and capable of a deep latch.

How to get rid of a plugged duct:

• Nurse your baby. Grab your bottle of water, and spend time skin to skin with your baby nursing on the affected side.
• Take a warm shower and let the heat and gravity help release the clog. The warmth can get milk flowing and leaning forward uses gravity to encourage milk flow. Very gentle massage and hand expression can be used to loosen the congested area.
• Massage by gently stroking the breast behind the clog in the direction toward your armpit before and during nursing, pumping or hand expressing to move fluid behind the clog and allow for milk to flow.(8)
• Breast compressions while nursing can help move the stickier fat molecules through the ducts and may assist in more thorough milk removal.
• Heat packs before pumping or nursing encourage milk to flow and cold packs after nursing or pumping can help reduce swelling and inflammation
• Some moms find it helpful to dangle feed which is another way to use gravity. Lay your baby on a blanket on the floor and you can nurse them while on your hands and knees to encourage gravity to help release the clog. 
• Nurse in a different position so your baby is compressing your breast tissue in a different area than usual helping to drain the milk ducts. Nurse with your baby’s lower lip toward the clog.
• Check your flange size to make sure you have the best fit possible. Try this free nipple ruler to guide you in the right direction: https://legendairymilk.co.za/pages/free-nipple-ruler
• Kinesio taping can help reduce swelling and inflammation. It helps to move fluid away from the congested area.(5)
• Therapeutic ultrasound is a therapy for hard to treat plugged ducts. It uses ultrasonic sound waves causing vibration at a cellular level.(6)
• The bacterial strain L. fermentum can help get rid of plugged ducts as well as help avoid getting them in the future.

As the clog begins to resolve, you may notice thicker, stringy milk coming out when pumping or hand expressing. It is important to treat plugged ducts as soon as you notice them. If they are left untreated, you are at a higher risk for it turning into mastitis. If you have any flu-like symptoms or notice a red area on the affected breast, those are symptoms that the plugged duct has progressed to mastitis and you should contact your SACLC/IBCLC and health care provider right away.

Finding the root cause of an issue is always the best way to prevent reoccurrence. If you experience plugged ducts more than on one rare occasion, get in touch with a SACLC/IBCLC who is able to take a complete health history for you and your baby’s nursing journey, pumping and assess your baby’s latch to offer techniques and tips to avoid future plugged ducts.

Footnotes:

1. https://my.clevelandclinic.org/health/articles/8330-breast-anatomy
2. https://cosleeping.nd.edu/
3. https://www.psychologytoday.com/us/blog/moral-landscapes/201302/normal-human-infant-sleep-feeding-method-and-development
4. https://www.academia.edu/33881630/Mother_infant_synchrony_during_infant_feeding
5. https://www.researchgate.net/publication/272138203_Does_Kinesio_Elastic_Therapeutic_Taping_Decrease_Breast_Engorgement_in_Postpartum_Women
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437340/
7. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf 
8. https://bfmedneo.com/Services/Breast-Massage 
9. https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-020-00996-6?fbclid=IwAR1nvtZaGf0MQMwCcbqfleuZ5quPwmjyNBZzq2iB_AajDWRz9fEj5TEF3-s 

Resources:

https://www.healthline.com/health/breastfeeding/clogged-milk-duct#symptoms

https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Clogged-Milk-Ducts.aspx

https://kellymom.com/bf/concerns/mother/mastitis/

https://www.bsim.org.in/breastfeeding-information-plugged-clogged-ducts/

https://ibconline.ca/information-sheets/blocked-ducts-mastitis/

https://exclusivepumping.com/clogged-ducts/

https://www.verywellfamily.com/plugged-milk-ducts-causes-treatments-and-prevention-431586

https://vitalphysiotherapy.com/blog/therapeutic-ultrasound-for-blocked-ducts