78: Listener Question: I Think I Have a Plugged Duc

Cindy says, “I have been trying to wean from the last few breastfeeding feeds but I am experiencing some tenderness/breast pain. I think I have a plugged duct, what should I do?”

Cindy, that is a great question and I just want to give you credit for listening to your body and knowing that breast pain isn’t expected and I’m glad you are looking into this so you can avoid not only discomfort but other domino issues.

First, let's start by reviewing exactly what a plugged duct is. Plugged ducts are one type of inflammatory issue under the bigger umbrella of mastitis. So you have a big umbrella term, mastitis, that literally means inflammation of the breast (or mammary) gland. Then under that umbrella, types of mastitis are engorgement, plugged ducts, and unspecified mastitis. Plugged ducts, specifically occur when there is inflammation and narrowing in the milk ducts. You can think of this like a highway being the road or duct that the milk flows through to get to the nipple. When you have inflammation and narrowing it’s like having lane closures. This can create a backup of pressure behind the place where the roadside issue is because all the cars are slowing down and merging to fit through this more narrow part of the road.

Now, plugged ducts can have a bacteria infection component, but they can also happen with no infection. This is important because it means not all mastitis and plugged ducts require antibiotics. And even if they do, figuring out the cause of the plugged duct is important to fix the issue and to avoid reoccurance.

Some common causes to getting a plugged duct are, say when your baby or your pump are not properly removing milk for some reason. They can also happen for some women if their diet is highly inflammatory. (A good example of this might be, having a night out where you have a few drinks and your pumping isn’t adequate compared to your normal breastfeeding or pumping routine. Lot’s of moms wake up with breast inflammation and mastitis concerns after this type of experience). Having an oversupply of breastmilk can be a little known contributing factor to plugged ducts. Another sneaky cause is simply having pressure on the breast gland from a tight fitting bra, backpack or heavy bag strap as this puts physical pressure on the tissue. As a general rule, squeezing your lactating breast glands too tight is not ideal for breast health. A common but often overlooked cause is changing the feeding or pumping routine too quickly for your body to adjust. Cold turkey weaning is never really good for you or your baby.

In Cindy’s specific situation, she had already established breastfeeding and pumping without previous issues for over 9 months. Her baby was already taking and tolerating their next diet and bottle well. She hadn’t had any unusual nights out, diet changes, clothing changes, or breast trauma. So for her, one thing to consider is if her weaning was going too fast for her body.

Now, does Cindy have a plugged duct or just some engorgement? It’s hard to say without more information. If you are listening and think you may have a plugged duct then please avoid the following outdated and potentially damaging strategies: 

• Over massaging or using massage tools on your breast (your breast is a gland not a muscle)

• Ramping up milk removal to “remove the plug” (remember it’s not actually a clog to be sucked out and you may cause more damage or oversupply by over pumping)

• Epsom salt with suction is also an outdated recommendation for plugged ducts

• Heat or hot compresses are no longer recommended as heat can exacerbate inflammation

• And lastly, a one size fits all approach is also not recommended (because think of all those various causes that are situation specific)

Here are some updated strategies that are thought to be effective:

• The support of an anti Inflammatory diet

• Sunflower or soy lecithin is reported to help by some moms

• Some moms also find comfort with a cooling compress intermittently through the day

• But most importantly, identifying the possible cause and removing it

• And of course, if you have a bacterial infection then specified antibiotics may be necessary

So back to Cindy, remember she feels breast tenderness following trying to wean. But she has no other reported changes or risk factors and had a long established breastfeeding and pumping routine without previous issues. So what might she consider doing? Well one thing she can try is sticking to small changes, and then waiting at least a few days to adjust before making any further changes. This gives her a change to be sure her body is comfortable and has fully adjusted before weaning further. Especially since she has an older baby who may be trying to make up for those calories in less feedings. So for her, she may care for her breasts with anti-inflammatory comforts and slow the process down. Since she is already comfortable with pumping, instead of going cold turkey on an entire feeding, she could do a “half or partial” feeding with the pump for example- and stair step down every 3-7 days depending on how her body responds. Lastly, she could incorporate sage, parsley, or peppermint which some moms report to slow milk production. And of course, she could get a full lactation evaluation for support to dive in deeper and figure out what’s going on and have some hand holding during the process.

Sometimes it is difficult to know for sure that you have specifically a plugged duct when there is not a straightforward obvious change. Especially if breastfeeding or pumping has not been long established without previous issues since we often see plugged ducts early in the breastfeeding or pumping journey when there is an underlying problem. Your physical history including breast surgery or trauma can also be important clues for more involved cases. This is why it’s often helpful to have a lactation consultant’s support if you feel unsure or need a more detailed assessment and plan. This is especially true if you are in the beginning of your breastfeeding journey and suspect latch or pumping difficulty.

If you are interested in learning more about weaning safely at different ages and stages, check out my article linked in the show description. If you are possibly experiencing weaning challenges or plugged ducts, then I recommend reaching out for support because your breast health and comfort are well worth it. 

Cindy- thank you so much for your question!