Tags

Cracked nipple

This article is about the postpartum development of cracked nipples in women related to breastfeeding. For other uses, see Fissure of the nipple.

Cracked nipple (or nipple trauma) [1] is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The [woman] with a cracked nipple can have severe nipple pain when … nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its the base. [2] Cracked nipples … [are] managed with pharmacological and nonpharmacological treatment. [3]

Cracked nipple (postpartum)

Signs and symptoms

Cracked nipples are classified as a breast disorder. [4] The nipple is not only the structure to deliver milk …, it also contains small, sebaceous glands or Montgomery glands to lubricate the skin of the areola. [5] Cracked nipples are most often associated with breastfeeding and appear as cracks or small lacerations or breaks in the skin of the nipple. [1][6] In some instances an ulcer will form. [1] The nipple in a nursing [woman] is in regular contact with a [nursee]. [5] Cracked nipples are trauma to the nipple and can be quite painful. [7] Cracked nipples typically appear three to seven days after the birth. [6][1]

If the nipples appears to be wedge-shaped, white and flattened, this may indicate that the latch is not good and there is a potential of developing cracked nipples. [8]

Complications

Bacteria can enter the breast through cracked nipples, which increase the risk of mastitis. [9] Candida infection (thrush) of the nipple can also occur, resulting in deep-pink, cracked, and sore nipples. [10][2]

Contraindications for breastfeeding

Because cracked nipples can result in the [nursee] being exposed to blood, women with certain blood-borne diseases may be advised to stop breastfeeding if they have a cracked nipple. It has been found safe for breastfeeding [women] with hepatitis B and cracked nipples to breastfeed. [11] In the event that a nursing woman experiences cracked and bleeding nipples or breast inflammation within one to two weeks immediately following an acute Toxoplasmosis infection (when the organism is still circulating in her bloodstream), it is theoretically possible that she could transmit Toxoplasma gondii to the [nursee] through her breast milk. Immune suppressed women could have circulating Toxoplasma for even longer periods of time. However, the likelihood of human milk transmission is very small. [12] Transmission risk of HIV increases if the [woman] has cracked and bleeding nipples [13][2] An uncommon infection in the [woman], Chagas disease, can be transmitted to the [nursee] via cracked nipples. [14] Women with hepatitis C are advised to abstain from breastfeeding if their nipples are cracked or bleeding. [15][16]

Cause

Some studies indicate that cracked nipples are caused by poor latch. [citation needed] Yet other causes could be poor positioning, use of a feeding bottle, breast engorgement, inexperience, semi-protruding nipples, use of breast pumps and light pigmentation of the nipples. These causes vary between cultures. [citation needed] Breast engorgement is also a main factor in altering the ability of the [nursee] to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat. [1]

… One cause of painful, cracked nipples is the incorrect positioning and incorrect latching on to the breast by the [nursee]. [7][6] The [nursee] can create cracked nipples due to the strong sucking pressure, stretching and pulling the nipple, the friction and rubbing of skin to skin. [2][7] The cause of sore, cracked nipples can also be from a yeast or Candida infection in the [nursee] or the [woman] or both. Thrush can develop after the use of antibiotics. [2] For first-time breastfeeding [women], it normally takes a few tries before the latch is right, which can make the nipples tender and sore the first few days. If the nipples become cracked or bleed, the latch may need to be corrected. Women are advised to keep on breastfeeding, as it will actually help the nipples heal. A little breast milk or purified lanolin cream or ointment helps the healing process. [7]

Pain caused by cracked nipples can sometimes lead to the cessation of breast-feeding. [1] In addition to cracks, or blisters or ulcers can form. [17]

Prevention

The nipples of nursing [women] naturally make a lubricant to prevent drying, cracking, or infections. [5] Cracked nipples may be able to be prevented by:

Avoid soaps and harsh washing or drying of the breasts and nipples. This can cause dryness and cracking. [18]
Rubbing a little breast milk on the nipple after feeding to protect it. [7][18]
Keeping the nipples dry to prevent cracking and infection. [19][18]

Roman chamomile can be applied directly to the skin for pain and swelling and is used to treat cracked nipples. [20]
Treatment

Cracked nipples can be treated with 100% lanolin. Glycerin nipple pads can be chilled and placed over the nipples to help soothe and heal cracked or painful nipples. [19] If the cause of cracked nipples is from thrush, treatment is usually begun with nystatin. If the [woman] is symptomatic then the [woman] and the [nursee] can be treated. [2] … Breastfeeding professionals that include nurses, midwives and lactation consultants are able to assist in the treatment of cracked nipples. [6]

Advice from others is abundant but there have been some treatments that have been identified as not being effective in healing or preventing cracked nipples. These ineffective treatments are keeping the breastfeeding short and using a nipple guard. Keeping the feedings short so that the nipples can rest is not effective in relieving the pain of cracked nipples and it could have a negative effect on the milk supply. Nipple shields do not improve latching on. [8]

Epidemiology

In a survey in New York City, 35% of nursing [women] stopped breastfeeding after one week due to the pain of cracked nipples. Thirty percent stopped breastfeeding between weeks one and three. Another survey of breastfeeding [women] in Brazil reported that there was 25% higher risk of interruption of exclusive breastfeeding when the [women] had cracked nipples. [Women] with higher education levels are more likely to continue breastfeeding despite the pain of cracked nipples. [1]

Society and culture

The importance of preventing cracked nipples while breastfeeding has been reported. [18] In an informal survey of breastfeeding in the UK, some [women] reported that they stopped breastfeeding because the cracked nipples made it too painful. [21]
See also

List of cutaneous conditions

References

Santos, Kamila Juliana da Silva; Santana, Géssica Silva; Vieira, Tatiana de Oliveira; Santos, Carlos Antônio de Souza Teles; Giugliani, Elsa Regina Justo; Vieira, Graciete Oliveira (2016). “Prevalence and factors associated with cracked nipples in the first month postpartum”. BMC Pregnancy and Childbirth. 16 (1). doi:10.1186/s12884-016-0999-4. ISSN 1471-2393.
“Management of breast conditions and other breastfeeding difficulties”. National Center for Biotechnology and Information, US National Library of Medicine. Retrieved 3 August 2017.
Henry, p. 120.
“ICD-10 Version:2016”. apps.who.int. Retrieved 4 August 2017.
Doucet, Sébastien; Soussignan, Robert; Sagot, Paul; Schaal, Benoist (23 October 2009). “The Secretion of Areolar (Montgomery’s) Glands from Lactating Women Elicits Selective, Unconditional Responses in Neonates”. PLoS ONE. 4 (10): e7579. doi:10.1371/journal.pone.0007579. PMC 2761488  . PMID 19851461.
“Breastfeeding problems”. http://www.nhs.uk. National Health Service (UK). Retrieved 4 August 2017.
“Common questions about breastfeeding and pain”. WomensHealth.gov. Retrieved 4 August 2017. This article incorporates text from this source, which is in the public domain.
“Sore or cracked nipples when breastfeeding, Pregnancy and [nursee] guide”. http://www.nhs.uk. National Health Services (UK). Retrieved 4 August 2017.
Kinlay, Joanne R.; O’Connell, Dianne L.; Kinlay, Scott (April 2001). “Risk factors for mastitis in breastfeeding women: results of a prospective cohort study”. Australian and New Zealand Journal of Public Health. 25 (2): 115–120. doi:10.1111/j.1753-6405.2001.tb01831.x. ISSN 1326-0200.
“Thrush in newborns: MedlinePlus Medical Encyclopedia”. medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“Hepatitis B and C Infections – Breastfeeding – CDC”. http://www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“Toxoplasmosis – Breastfeeding – CDC”. http://www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
https://www.cdc.gov/globalaids/resources/pmtct-care/docs/pocketguide.doc This link opens a document that opens rather than a web page. This article incorporates text from this source, which is in the public domain.
Prevention, CDC – Centers for Disease Control and. “CDC – Chagas Disease – Detailed Fact Sheet”. http://www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“HCV FAQs for Health Professionals – Division of Viral Hepatitis – CDC”. http://www.cdc.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“Breastfeeding vs. Formula Feeding: MedlinePlus Medical Encyclopedia”. medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
Rosen, Paul (2014). Rosen’s breast pathology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 41. ISBN 978-1-4511-7653-7.
“World Breastfeeding Week: Supporting [women] to reach the six month mark”. Retrieved 4 August 2017.
“Positioning your baby for breastfeeding: MedlinePlus Medical Encyclopedia”. medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“Roman chamomile: MedlinePlus Supplements”. medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
“6 Reasons Why You Might Have Stopped Breastfeeding, And That’s Okay”. 4 August 2017. Retrieved 4 August 2017.

Bibliography

Henry, Norma (2016). RN maternal newborn nursing : review module. Stilwell, KS: Assessment Technologies Institute. ISBN 9781565335691.
Dennis, Cindy-Lee; Jackson, Kim; Watson, Jo (2014-12-15). The Cochrane Library. John Wiley & Sons, Ltd. doi:10.1002/14651858.cd007366.pub2.

Nipple

part of the breast
Breast pain
Latch (breastfeeding)

Advertisements