Using the wrong size or type of pump flange can cause a lot of pain. But not all pain is caused by pump flanges. If there are any breaks in the skin on your nipple, like from latching or pumping issues, a bacterial or fungal (yeast) infection can set in, causing even more pain. Then breastfeeding and pumping repeatedly pull the edges of the wound making it more difficult to heal, and giving the bacteria or fungus more chance to grow. Milk production is often somewhat decreased when there's an infection but it usually rebounds after the infection heals.
There may not be an obvious wound on the nipple but signs of an infection are white or yellow discharge or crusting (milk doesn't dry on the nipple), red or pink inflammation, shininess, swelling, and flaking. If your healthcare provider doesn't see any signs of infection despite the symptoms, it may only mean they are not familiar with how infections look on nipples during lactation.
Most nipple infections during lactation won't heal easily on their own and require targeted treatment. Delaying treatment increases the risk of the infection spreading inside the breast, which can lead to mastitis, milk-filled cysts (galactoceles), and an abscess. So we urge treatment as soon as possible to relieve your pain, avoid spreading into the breast, and maximizing your milk production.
Oral antibiotics and antifungals generally are not as effective for treating nipple infections because it takes at least a week for the antibiotic to reach the dermal layers. The treatment recommended by most experienced lactation consultants for both bacterial and fungal infections is topical treatment with Medihoney (around $7-10 US on Amazon, usually more expensive elsewhere). Even if you're not sure there's an infection, Medihoney is so safe that it's worth trying it on painful areas just in case or as a preventative.
Medihoney is medical-grade (sterile) highly refined manuka honey in a thick paste for easy application on nipples. It starts working immediately (initial relief usually felt in 24-48 hours), it's highly effective in treating both staph bacteria and yeast fungus, safe for you, your baby (see the attached handout), and the milk (it can be removed completely and easily with water before pumping), inexpensive, and doesn't require a prescription. (If you have an allergy to honey, let us know and we'll recommend an alternative).
Medihoney is "Manuka honey" from New Zealand where the
bees get their pollen from the tea tree oil plant. This is what gives it an antimicrobial quality that is stronger than most topical antibiotics and known to work exceptionally well for both bacterial and fungal (yeast) nipple infections.
The honey has been reduced down to the active ingredients and sterilized so it's safe for your baby. It's used in hospitals throughout the world for effective wound healing and doesn't require a prescription.
Apply it after pumping or nursing (you might find it helps to warm it between your fingers for a minute before spread it on your nipples and areolae. Then just wipe it off with a warm wet washcloth or baby wipe before pumping or nursing. Witch hazel (without glycerin or other ingredients other than water) can also be used to wipe it off and also remove any other lingering oils.
You may feel a slight "tingle" when the active ingredients start working but it only lasts a bit and probably isn't much compared to the pain you've been having. You should feel less pain within one day and it should be mostly cleared in 3-4 days. You'll need a breast pad to keep it from getting on your bra. Disposable are best to avoid recontamination.
To help infected tissue heal more quickly, it will also help to wash your nipples 2-3 times a day with warm water and a mild soap because soap breaks the bacterial biofilm that it needs to survive. One of those times might be your daily(ish) shower and the others could be at the kitchen sink with the faucet sprayer if you have one or a cup of water to rinse. Try not to touch them to avoid adding new microbes and avoid antibacterial soap because it can be irritating and may leave a film that's lubricating.
Feel free to reach out if you're not sure if you have an infection or you'd like to talk it over with our inhouse lactation consultants.
Reviewed by Diana West, IBCLC
June 10, 2021