Ask Anne...

Question: My nipples are cracked and terribly sore - HELP!!!
I am currently breastfeeding my fourth child and he is four weeks old. I have cracks around the base of my nipples and when he latches on to eat it causes me GREAT pain. I breastfed my other children and never had this problem. I need to know how I can get this healed up as quickly as possible. I bought a tube of lanolin because I was told it would work wonders. That was a week ago and sometimes it hurts just to stretch my arms up!!! HELP!!!!

Answer:

 Based on your symptoms, it sounds like you might have a really bad yeast infection. Symptoms include just what you are describing: horrible pain no matter what you try (lanolin, different positions, etc.), tender nipples that are reddish and cracked, and dreading each feeding because the pain is so bad. I find that probably nine times out of ten, severe soreness that persists after the first couple of week of nursing is due to yeast (especially when the mother is experienced at nursing and knows the basics of proper positioning). Although lanolin can be very helpful in dealing with soreness due to other causes, it will not be helpful in treating a yeast infection.

I would recommend several things: 1) Gentian violet - it contains anti-infective as well as anti-fungal properties and is available over the counter. 2) Nizoral cream - it requires a prescription, but is a very effective anti-fungal. 3) If your doctor will prescribe it and your pharmacist will mix it up for you, Dr. Jack Newman's nipple ointment is excellent. It is a mixture of an anti-fungal cream (I recommend Nizoral, but you can also use a combination of Nystatin (100,000 units/ml, 15 gms) and Clotrimazole (10% cream, 15 gms). These are anti-fungals to treat the candida, or yeast. In addition, the cream contains Mupricon (antibiotic - 2% ointment, 15 gms) and Betamethasone (cortocosteroid to decrease inflammation -0.1% ointment. 15 gms). In his new book, Dr. Jack Newman's Guide to Breastfeeding, pp.108-109, he recommends applying the ointment after each feeding and not washing it off. You gradually cut back on the applications as the pain disappears. 3) Breast shells (with large hole for sore nipples, not small hole for inverted ones) can help air dry the nipples and keep clothes and pads from rubbing against the raw area. If you use pads, use disposable ones and change them often - try to expose the nipple to air as much as possible. 4) Use a pump while the nipple heals - sometimes breastfeeding is just too stressful on the damaged nipples, and if you use a good pump for a couple of days, it can give the tissue a chance to heal - you can control the suction with a good pump, but not with the baby. 5) If the yeast is in the ducts (symptoms are deep, burning, stabbing pain inside the breast, especially with let-down and immediately after feedings), then Diflucan (oral medication) seems to work better than anything else. Make sure you take enough of the Diflucan - it rarely works unless you take at least 7-14 days of treatment, and with the severity of your symptoms, it may take up to a month or more. The recommended dosage is 400 mg the first day and 150-200 mg daily for the duration of treatment. 6) Make sure you treat the baby at the same time you are treating yourself, even if you don't see anything in his mouth - otherwise, you may just keep trading the yeast back and forth.

There is also an article on my website called "Information Sheet and Care Plan for Yeast" that may be helpful. Please look it over carefully and then let me know if you have any more questions.

The key is to treat the yeast aggressively in both you and your baby, because once it is in your system, it doesn't tend to go away by itself. It feeds on moisture in the tissues and the sugar in the milk, so it has a perfect environment to multiply, whether in your milk ducts, in your vagina, in your baby's mouth, on his diaper area, or on your nipples. Please get the help you need promptly, and let me know if I can help in any way.

View Past "Ask Anne" Columns