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Plugged Ducts

posted Jan 4, 2020, 4:57 PM by Carolyn Honea, IBCLC, CLC   [ updated Jan 11, 2020, 10:33 AM ]
What are plugged ducts?
Plugged ducts are usually a combination of congealed milk or milkfat, combined with inflammation and swelling of the surrounding tissues, causing the ducts to become swollen closed or blocked by the milk plug. When the milk making gland ("lobule" or "alveoli") does not have a way to release the milk though the duct it tends to build up, increasing the pressure and inflammation. Mothers notice specific, isolated areas of pain in their breast and often report the area feels hard or lumpy. Unlike acute mastitis, women do not experience fever or systemic symptoms with plugged ducts.
What causes plugged ducts?
Plugged ducts sometimes occur when milk is not emptied from the glands in a timely manner. This could be because of a longer than usual space between feeds or because baby did not remove as much milk as usual. Most of the time, this doesn't cause a problem, but occasionally the built up milk creates pressure, swelling and inflammation. Once swelling occurs it may squeeze the ducts and reduce the amount of space for milk to travel. During long spaces between breastfeeds (or pump sessions) the milkfat is also more likely to form clumps or plugs. Less common reasons for plugged ducts could be subacute mastitis (this is treated with specific strands of probiotics), a tight bra that compresses ducts and restricts emptying if worn while pumping or breastfeeding, or, women who sleep on their stomachs leading to compression and inflammation. 

Plugged Duct Protocol:
Step 1: Reduce the swelling and inflammation so that the ducts can dilate and flow freely, allowing the build up of milk to pass.
  • Ibuprofen and turmeric (curcumin) are anti-inflammatories that can be taken according to package directions. (Consult your doctor if you have other health conditions or take medications that might be contraindicated.)
  • Lay on your back for 30 minutes with cold packs applied to the painful areas. Cold reduces swelling and inflammation. Try Lansinoh's Breast Therapy Packs which can fit in your bra or around your pump flange.
Step 2: Liquify the milkfat so that it flows freely and is less likely to form clumps
  • Take Sunflower Lecithin according to package directions. It is an emulsifier that helps fat to mix evenly into liquids and makes it less likely to clump or separate  Some women continue to take a low dose of sunflower lecithin to prevent future recurrence of plugged ducts.
  • At the beginning of the next breastfeed/pump session, apply heat for 10 minutes. Heat helps to melt/liquify the milkfat and promotes relaxation and better milk flow. Do not use heat more than 10 minutes because it can increase swelling and inflammation if overused.
Step 3: Focus on frequent and thorough breast emptying. 
  • Pump or breastfeed frequently (every 1-2 hours) until the area no longer feels swollen or hard and the pain is improving. If baby has a good latch and suck, s/he may be more efficient at clearing a plugged duct than a pump. However, if baby isn't willing to nurse often or empty fully, follow breastfeeding with pumping.
  • Massage the area or use a vibrating electric toothbrush on the area to help break up the plug. Consider using a "dangling" position while pumping or nursing where you are leaning forward or on all fours so that gravity can aid in emptying.
Repeat throughout the day until you start to feel relief. Monitor for symptoms of mastitis (fever, flu-like symptoms) and discuss with your healthcare provider if you don't feel like you are getting better.