Are you experiencing intense pain in your nipple or breast? Does this pain come on after a feed or in between feeds? If so, you may be experiencing nipple vasospasm.
Vasospasm is the term used when blood vessels constrict or go into spasm, impairing blood flow to an area. This can occur in any part of the body and can result in intense pain. Some mothers may experience vasospasm in the breast (sometimes referred to as Mammary Constriction Syndrome) or in the nipple (nipple vasospasm); these are related conditions and treated similarly. This blog will go through the symptoms, causes and treatment for nipple vasospasm, a painful condition which can affect breastfeeding mothers and can be misdiagnosed.
What is nipple vasospasm?
Nipple vasospasm occurs when the blood vessels supplying the nipple go into spasm, decreasing the blood flow to this area. This can be extremely painful and colour changes to the nipple may be noticeable, depending on your skin tone.
Imagine having been outdoors on a cold, snowy day and then coming inside; your hands are ice cold and have become numb as the blood flow to them is reduced. If you then run your hands under warm water to 'wake them up', the blood flows back into your hands, which can cause a tingling, stabbing, throbbing or burning pain. This is how vasospasm may feel.
What triggers nipple vasospasm?
There are two main causes of nipple vasospasm, your baby pinching or compressing your nipple during a feed and the other being Raynaud's phenomenon.
Your baby compressing your nipple
Nipple vasospasm can be brought on by your baby pinching or compressing your nipple during a feed. This pinching can restrict blood flow to the nipple during feeds, leaving the nipple discoloured. Mothers with a lighter skin tone, may notice that their nipple turns white with the feed. It is when your baby comes off the breast and the blood flow is being restored to the nipple, that a mother may experience a tingling, stabbing, throbbing or burning pain deep in the breast tissue.
If you think you are experiencing symptoms of nipple vasospasm, the first thing you should do is have someone check that your baby is latching onto your breast properly. If your nipple looks flattened or pinched when your baby comes off the breast, this is a tell tale sign that the latch needs fixing.
Vasospasm occurring in any part of the body is always exacerbated by cold so warmth is key to alleviating symptoms.
Raynaud's phenomenon
Raynaud's phenomenon is a circulatory disorder, affecting blood flow to the extremities, most commonly the fingers and toes, but the nose, ears and even the nipples can be affected too. The vessels supplying blood to these extremities go into a spasm, when the person affected is exposed to cold or is feeling stressed. The lack of blood flow will lead to numbness in the affected body part and then to a tingling, stabbing, throbbing or burning pain as the blood flow returns and the nerves react to the renewed circulation.
A person who suffers with Raynaud's may experience discoloured extremities and pain when getting out of a warm shower, leaving a warm house on a cool day or even walking past a frozen food aisle in a supermarket. For some sufferers, the temperature change does not have to be that extreme to trigger a vasospasm. It may be that you are cuddled up with your baby or partner in a warm bed at night and as soon as you get up to go to the kitchen etc, a vasospasm is triggered due to the room not being as warm.
If you have Raynaud's, you may get nipple vasospasm if you are breastfeeding, as the nipple is exposed to cold air before and after a feed. This may be exacerbated if your baby is learning to feed and taking more time to fix onto the breast (nipple exposed to cold air for longer), potentially triggering a vasospasm before your baby even latches on. If this happens, treat the nipple vasospasm before continuing with a breastfeed.
More often with Raynaud's, nipple vasospasm occurs when the baby comes off the breast. As the baby's warm mouth leaves the breast, the nipple is then exposed to cold air triggering a vasospasm, resulting in decreased blood flow to the nipple area. It may take time for the blood flow to be restored to the nipple, which is why the tingling, stabbing, throbbing or burning pain can be felt sometime after the feed has finished.
Symptoms of nipple vasospasm
Tingling, stabbing, burning or throbbing pain to nipple and/or breast
This pain tends to occur after breastfeeds
If nipple vasospasm is associated with Raynaud's phenomenon, the pain can also occur separate from breastfeeding and affect both nipples at the same time.
Colour changes to the nipple e.g. from white to blue to red/purple may be seen with lighter skin tones (typical of Raynaud's).
Nipple pain is exacerbated or triggered by the cold
Treatment of nipple vasospasm
It is important to have your primary healthcare provider rule out other causes for breast and nipple pain.
Note: Vasospasm can be mistaken for a yeast infection (e.g. thrush) because of the similarities in how mothers describe the pain. A misdiagnosis of thrush and resulting prescription medication, may make vasospasm symptoms worse.
The aim of treatment is to get more blood flowing into the breast and nipple area. Here are some self help measures to do just that.
Fix the latch
Get support with correcting the latch if this is the cause. Please be aware that if your nipples have been damaged, they may not heal as quickly if you are suffering with nipple vasospasm as the blood flow to the nipple will be impaired.
If you experience nipple vasospasm while trying to latch your baby onto the breast (as maybe the case with Raynaud's), try warming your breast and repeatedly squeezing the nipple to help blood flow back into this area before reattempting to latch your baby on.
Keep your breast warm
Choose a warm place to breastfeed your baby. It is important to cover your breast immediately after feeds so as to avoid cold air on the nipple. Air drying your nipples should be avoided if you are experiencing nipple vasospasm.
Keep your breast pads dry, some mothers use knitted or bamboo breast pads to provide extra warmth. You can buy bamboo breast pads from www.littlelamb.co.uk and www.mamadesigns.co.uk. Both brands are super soft and as they are woven they really do help with milk absorbency. You can also apply dry heat to the nipples / breasts by using a heating pad or hot water bottle over your clothes.
Other tips include warming your bathroom before undressing for a shower and wrapping a warm towel around your breasts before stepping out of the shower. The key is to minimise exposure to cold.
Gentle massage
Gently massaging olive oil into the nipple and areola after a breastfeed can help to stop a nipple vasospasm.
Stretching
If there is pain in the breast, stretching the muscles around the breast can help keep blood flowing more easily. Dr Jack Newman, a Canadian paediatrician and breastfeeding expert, describes how to perform these stretches as follows:
"Lift one arm to shoulder height or slightly lower and press it back/behind you. Hold the stretch while taking a couple of deep breaths. Do the stretch twice with each arm - once with your palm facing forward and once with it facing back." https://ibconline.ca/information-sheets/vasospasm
Avoid
Avoid stimulants such as cigarettes and caffeine or any medications that promote vasoconstriction e.g. some decongestants and avoid stress where possible.
Severe cases of nipple vasospasm
If you are doubled up in pain despite the latch being corrected and trying the above self help measures, you primary care provider may consider other treatment options for vasospasm including taking dietary supplements and medications. Treatments include pain relief, dietary supplements (vitamin B6 complex, Magnesium, calcium), omega fatty acids and prescription medication including nifedipine. Wendy Jones (pharmacist for the breastfeeding network) discusses this in more detail. https://breastfeeding-and-medication.co.uk/fact-sheet/february-is-raynaud-s-awareness-month-www-sruk-co-uk
Summary
As I have covered in this blog, vasospasm can affect any part of the body but in the context of breastfeeding, we are most interested in how it affects the breast and nipple. Nipple vasospasm is a painful condition, which can be brought on by nipple compression during a breastfeed or by Raynaud's phenomenon. The self help measures mentioned above can really help if you are suffering with nipple vasospasm, however, in some cases medication may be necessary.
If you are experiencing any of the symptoms described in this blog, please speak with an International Board Certified Lactation Consultant or your primary health care provider to establish the cause of your pain and get the right treatment plan for you. Getting the right treatment will hopefully allow you to enjoy and continue breastfeeding.
The information in this blog is general and not a substitute for personalised advice from an International Board Certified Lactation Consultant (IBCLC) or your primary health care provider.
