Question: I’m nursing my 3 month old and haven’t had any nipple soreness since the first few days after she was born.
However, for the past week my right nipple has been very sore.
At the end of every feeding, the tissue at the center of my nipple is white. There isn’t any pus or discharge, but it is very painful. Do you have any ideas about why this is happening?
Answer: It’s very difficult to diagnose breastfeeding problems without a one on one evaluation, but I can tell you what might be going on based on what you’ve described. You may need to see your doctor if the problems continue or become worse.Unfortunately, many doctors know very little about breastfeeding, so it helps to have as much information as possible that you can share with him/her.
Nipple soreness due to improper latch or flat nipples will occur with newborn infants who haven’t gotten the hang of nursing yet. Once babies pass the newborn stage, they have mastered latching on, so if pain suddenly develops, you need to look at other cases. Any time you have been nursing for several months and suddenly it becomes painful, the cause is often a yeast infection.
There aren’t any tests to definitely diagnose yeast infections in nursing moms, so you have to go by the symptoms. Yeast on the nipples can cause soreness, which is much easier to treat if it’s a topical infection rather than one that has made its way inside the milk ducts.
With topical infections, the nipples typically don’t look inflamed or sore, but nursing or pumping is painful, and the nipples are sensitive when anything touches them, including water from showers, and wearing bras or nursing pads. The pain is often described as stinging or burning.
If left untreated, the yeast fungus can move from the surface of the nipples to the ducts inside the breast, where it’s harder to treat, and may require the use of a systemic prescription medication like Diflucan (fluconazole) taken orally by mouth. Intraductal yeast infections may cause sharp pain inside the breasts, and the pain is most intense directly after nursing, and may persist between feedings. Yeast in the milk ducts can cause swelling and inflammation, and may develop into mastitis.
As far as the nipple turning white, there are several conditions that can cause nipple blanching, also called ‘vasospasm’. This happens when the blood vessels are cramp or compressed, keeping the blood from circulating to the nipple, and turning the tip of it white.
In most cases, nipple blanching occurs when the baby clamps down while nursing so that the blood doesn’t flow to the tip of the nipples. If the baby is positioned correctly, with the nipple pulled far back in the mouth, it’s hard for her to clamp down and compress it hard enough to restrict the blood flow to the nipple.
When the nipple suddenly appears white in an older baby who has a good latch, it may be related to thrush on the nipple, oversupply of milk (the baby clamps down to slow the milk flow), or – in a few cases – a condition called Raynaud’s Syndrome.
With Raynaud’s Syndrome, the nipple will be white after feedings when the baby comes off the breast. It usually affects both breasts, and may last for several minutes after the feeding.
After the baby finishes the feeding and the nipple is exposed to cold air, it will be its normal pinkish color when at first, but will turn white over the next several minutes. As the blood flow gradually returns, the nipple will change color from white to blue to back to their original color, and it may throb and burn.
The first step in treating vasospasm (nipple blanching) is to figure out what’s causing it. Usually it’s a poor latch, but in your case, the cause more likely stems from Candida, the fungus that causes yeast infections. Once that is successfully treated, the blanching is much less likely to occur.
Here are some things you can do that may help with the nipple blanching and pain:
- Keep cold air from reaching the nipple when your baby comes off the breast, or when you get out of the shower
- Apply dry heat from a compress or heating pad before nursing, and as soon as your baby comes off the breast, put your hand or a warm cloth over the nipple until it turns from white back to pink.
- Gently massage warm olive oil into the nipples.
- Your doctor may prescribe an oral medication called Nifedipine to provide relief from the symptoms. Nifedipine is used for hypertension, but it can also treat the pain caused by vasospasm. The most common side effect is headache, but most moms respond very well to this drug. Ask your doctor for more information.
Anne Smith, IBCLC