A vasospasm is a sudden constriction (or narrowing) of the blood vessels. A nipple vasospasm may be triggered by a breastfeeding baby in a shallow latch and it can also be connected with Raynaud’s phenomenon (a condition affecting blood supply). Nipple vasospasm can also be associated with deep breast and muscle pain—a condition referred to as Mammary Constriction Syndrome. This article looks at the symptoms, causes and possible treatments for easing nipple vasospasm.
What are the symptoms of nipple vasospasm?
Symptoms of nipple vasospasm include:
- White nipples—nipple tips may look white (blanched) after a feed or mothers may notice other colour changes in their nipples
- Painful nipples—the pain is often described as burning, stabbing or itching and may be felt a short time after breastfeeding or in between feeds.
- Sore nipples—nipple vasospasm is associated with misshapen nipples and sore nipples.
- Deep breast pain—some mothers may also feel shooting pains deep in the breast.
Lactation consultant and author Nancy Mohrbacher explains:
Vasospasm is a constriction of the blood vessels in the nipple that causes the nipple to blanch, or turn white. Compression of the nipple is a common cause, either due to shallow breastfeeding or the baby compressing the nipple to slow fast milk flow. When the nipple is compressed, it may look misshapen after feedings—pointed or creased, like the tip of a new tube of lipstick. The blood flowing back to the nipple may cause a burning sensation, intense throbbing, or shooting pain.
Vasospasm? Or a bacterial or fungal infection?
Vasospasm symptoms such as burning pain and soreness can be very similar to those of a fungal infection (e.g. thrush) or a bacterial infection (e.g. a Staph infection). A misdiagnosis of thrush and resulting unnecessary prescription medication, may make symptoms worse 1.
What causes nipple vasospasm?
The risk factors for nipple vasospasm are set out in a useful patient handout from the Goldfarb Breastfeeding Clinic:
- Exposure to cold temperatures.
- Periods of severe emotional stress.
- Cigarette smoking or second-hand smoke.
- Poor latch or biting.
- Nipple cracks or trauma.
- Certain medical conditions such as Lupus, rheumatoid arthritis, and hypothyroidism.
- Certain medications such as Fluconazole/Diflucan (treatment for thrush) and the birth control pill.
How can I avoid vasospasm symptoms?
Minimising the risk factors can work very well to help prevent symptoms of nipple vasospasm, namely:
- Get help with positioning from an International Board Certified Lactation Consultant so that your baby’s latch is not triggering vasospasm. A baby needs to latch deeply on the breast with a big mouthful of breast as well as the nipple. See Breastfeeding Positioning for Newborns, Latching Tips and Why Does Breastfeeding Hurt? for more information.
- Keep warm; breastfeed in a warm room and cover the nipple as soon as a breastfeed ends. Keep breastpads dry, some mothers use woollen or fleecy breastpads for warmth. Try to avoid sudden temperature changes.
- Avoid the following triggers: cigarette smoke and smoking, nicotine, caffeine, alcohol, medications that promote vasoconstriction and avoid stress where possible.
- Keep active with aerobic exercise
Raynaud’s is a disorder of the tiny blood vessels of the extremities which reduces blood flow. In cold temperatures, the blood vessels go into spasms, which may cause pain, numbness, throbbing and tingling. Some women who have Raynaud’s in the fingers and toes may find they get Raynaud’s of the nipple when they start to breastfeed.
There is a helpful article from the Raynaud’s Association describing the reasons why breastfeeding mothers are at particular risk of nipple vasospasm. It has tips and suggestions to help mothers; such as never leaving nipples to air dry, and not latching their baby during a vasospasm event (instead it advises repeatedly squeezing the nipple to help blood flow back into this area before latching).
Treatments for nipple vasospasm
Treatment tips from Dr Jack Newman
Jack Newman, a Canadian paediatrician and breastfeeding expert, has a protocol for treating vasospasm which can be found in Vasospasm and Raynaud’s Phenomenon or his book Dr. Jack Newman’s Guide to Breastfeeding. In addition to a discussion of certain vitamin and mineral supplements (also referred to in the patient handout quoted below), Dr Newman advocates:
- Fix the latch. Find the original cause of the pain such as fixing a poor latch. A poorly latched baby, an ineffective suck or the baby clamping on the nipple can all cause nipple blanching. For help with positioning and latch contact your IBCLC lactation consultant and see Latching Tips and our associated articles on positioning.
- Treat thrush if it is present because thrush can cause vasospasm symptoms.
- All Purpose Nipple Ointment, a topical cream with antibacterial, antifungal and anti-inflammatory ingredients can help with soreness.
- Massaging warm olive oil into the nipples during burning episodes for instant relief.
- Treat deep breast pain for Mammary Constriction Syndrome.
If avoiding the risk factors and the above measures are not enough to deal with the symptoms of vasospasm there are other treatments and dietary supplements that can be considered:
- The use of Advil™ or Motrin™ (ibuprofen) and/or Tylenol™ (acetaminophen) may be very useful to treat the pain of nipple vasospasm. These medications are safe during breastfeeding.
- Your health professional may suggest high doses of calcium (1000 mg twice a day), magnesium (500 mg twice a day) and vitamin B6 (150-200 mg daily for 4 days, then 25-50 mg a day).
- Omega fatty acids may also help. Evening primrose oil (up to 12 capsules a day) and fish oil capsules are rich sources of omega fatty acids.
- Nifedipine (Adalat™), which are normally used for high blood pressure, can also be used for nipple vasospasm, and is safe for breastfeeding mothers and infants.
Refer to the full article online for precautions regarding nifedipine and share this with your health care professional. For places to find more information about the safety of nifedipine online see Medications and Breastfeeding. Always discuss medications or medicinal doses of supplements with your health care provider.
Anecdotal supplements that may help with relief of symptoms are mentioned in the following excerpt from a document on Gov.UK. Note this article isn’t specific to breastfeeding mothers. The latest findings on the compatibility of many supplements while breastfeeding can be checked online at e-Lactancia and should always be discussed with your health professional.
There are many reports of anecdotal response to a variety of herbal supplements including ginger extract, cayenne and extract of Ginkgo biloba. All treatments are aimed towards relief of symptoms of Raynaud’s rather than cure. As RP is a cold related disorder, Raynaud’s sufferers may only require drug therapy in colder weather when symptoms are usually worse.
Nipple vasospasm is a narrowing of blood vessels in the nipple. It can be triggered by a baby breastfeeding in a shallow latch and can cause burning, stabbing or itching pain in the nipples after a breastfeed. Nipple vasospasm can be associated with Raynaud’s phenomenon and can also cause Mammary Constriction Syndrome or deep breast pain. Treatment involves avoiding the triggers of nipple vasospasm and some medications may help.