Plugged Ducts

What are plugged ducts?

Plugged ducts are usually congealed milk or clumps of white blood cells, combined with inflammation and swelling of the surrounding tissues, causing the ducts to become swollen closed or blocked by the 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 improperly fit pump flanges, longer than usual space between feeds, oversupply 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. Another common reason for plugged ducts is breast dysbiosis (sometimes called subacute mastitis) which causes clumps of white blood cells and bacterial films to block ducts. Mothers are at higher risk for this if they were exposed to antibiotics in the past year (including delivery). Less common causes include 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 or turmeric (curcumin) are anti-inflammatories that can be taken regularly according to package directions until symptoms resolve. (Consult your doctor if you have other health conditions or take medications that might be contraindicated.)

  • After each feed, apply cold packs 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. Laying on your back with cold compresses applied can be extra helpful as it encourages lymph drainage as well.

Step 2: Encourage milk to flow freely without blockages from plugs/clogs

  • 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. We recommend only taking lecithin for one week at a time due to concern that long term use may affect gut health.

  • Take a women's probiotic containing L. salivarius and L. gasseri to reduce plugs that are sometimes caused by white blood cells in response to breast dysbiosis.

  • 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. Discontinue this practice once plug is resolved to avoid triggering oversupply.

  • Use appropriate fit pump flanges (nipple diameter plus 0-2 mm)

  • Gently massage the area or use a heated breast massager 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. Schedule an appointment with us to help troubleshoot the cause of your plugged duct and strategies for preventing recurrence.

Mamas in the north Charlotte and Lake Norman area, we encourage you to setup a home visit so we can help you address these issues. If you are out of our travel area, you can setup a virtual consult with us or google "lactation consultant near me" to find local help.