In trying to find out the cause of bilateral breast pain, first realize that anytime there is skin breakdown (wounds, cracks, scabs), the nipples and/or breasts may be painful.
Even though the wounds may only be on the nipple tips, pain may be severe and radiate deep into the breasts, both during and/or between feeds.
Many women experience nipple cracking / wounds in the first days of nursing. Once the baby is consistently latching well, wounds should not persist or recur. See Nipple Wounds.
Once nipple wounds heal, if you are still experiencing pain, there may be another problem.
The most common causes of nipple soreness without open wounds include:
- Shallow latch
- Nipple compression due to baby’s anatomy (tongue tie, high palate)
- Nipple compression as a reaction to overactive letdown or high flow
- Yeast infection
- Inflamed ducts/ blebs milk blisters
- Pump trauma
- Vascular spasms
The most common causes of deep breast pain without open wounds are:
- Engorgement
- Inflamed ducts/ blebs milk blisters
- Vascular spasms
- Nipple compression due to baby’s anatomy (tongue tie, high palate)
- Nipple compression as a reaction to overactive letdown or high flow
- Pump Trauma
- Plugged Ducts
- Mastitis
- Let Down Discomfort
Latch: Ideally you want to get as much breast tissue in the baby’s mouth as possible. Aim the nipple at the baby’s nose so the baby opens wide. You then guide the baby on in a way that the nipple ends up closer to the roof of the baby’s mouth and more of the bottom part of the areole will be in the mouth. You want the tongue to compress the areolae and not the nipple. When open wide, the angle at the corner of the mouth should be 90º or more. Look at the nipple when the baby comes off the breast. If the nipple is round (without a crease or fold at the tip), the latch was probably good. If you need help latching your baby on comfortably, see a lactation consultant.
Nipple Compression: Sometimes, even with a good, deep latch, the baby may compress the nipple and cause pain. In this case, you will see a compression line, crease or fold on the nipple tip.This may happen if a baby has a tight frenulum (tongue tie) and/or a high palate.
Also, when the flow of milk is too fast, the baby may compress the nipple in order to slow down the flow.
Yeast infection:
- Sharp shooting pain, deep in both breasts between feeds is a later sign of yeast
- yeast that causes deep pain will also have:
- Pain on latch-on that usually improves during the feeding.
- Burning, stinging discomfort of the nipples and areolae between feeds.
- Sensitivity of nipples to anything that lightly brushes against them.
- Painful or uncomfortable letdown.
- Refer to complete Yeast article.
Inflamed duct / bleb/ milk blister:
- white dot, yellow scab, blood blister or bloody scab on nipple tip
- pain during nursing, after nursing or both
- usually only on one side, but can be on both
- Refer to complete Inflamed Duct article.
Pump Trauma:
- may occur if you are pumping for long periods of time
- or pumping at too high of a vacuum
- Refer to Pump Trauma article
Vascular spasms:
- When blood vessels clamp up and don’t allow enough blood and oxygen to the breast tissue, nipple and/or areolae.
- Stabbing, aching, throbbing or shooting pain.
- Can be severe, intense pain.
- Usually feels worse in the cold.
- Refer to Vascular Spasm article.
Engorgement:
- fullness or hardness of the entire breast
- may extend to breast tissue in the armpit
- Refer to Engorgement article
Plugged ducts:
- hard painful area in part of the breast
- may start with just a sore feeling in the breast
- if the blockage is very deep, you may only feel pain and not hardness
- may have redness over the skin
- Refer to Plugged Duct and Recurrent Plugged Ducts articles.
Mastitis:
- same symptoms as blocked duct but with fever
- Refer to Mastitis and Recurrent Mastitis articles
Let down:
- small stabbing or “electric shock” pains when the breast is filling
- lasts only a few seconds
- should not be very painful
- yeast infections and vascular spasms can make let down sensations more painful