A vasospasm is a sudden constriction (or narrowing) of the blood vessels. Nipple vasospasm may be triggered by a shallow latch and it can also be connected with Raynaud’s phenomenon (a condition affecting blood supply). Vasospasm can also cause deep breast and muscle pain (Mammary Constriction Syndrome).
White nipples and other vasospasm symptoms
Nipple tips may look white (blanched) after a feed and vasospasm may be extremely painful and a Cause of Sore Nipples. The pain (burning, stabbing or itching) may be felt a short time after breastfeeding or in between feeds and some mothers may also feel shooting pains deep in the breast or notice other colour changes in their nipples. Vasospasm symptoms are very similar to those of Thrush on Nipples. A misdiagnosis of thrush and resulting unnecessary prescription medication, may make symptoms worse. Breastfeeding Answers Made Simple 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 (Wilson-Clay & Hoover, 2008, p. 49). The blood flowing back to the nipple may cause a burning sensation, intense throbbing, or shooting pain.
What causes nipple vasospasm?
The risk factors for nipple vasospasm are set out in a 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:
- Get help with positioning from an International Board Certified Lactation Consultant so that your baby’s latch is not triggering vasospasm and see Breastfeeding Positioning for Newborns and Latching Tips.
- 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. Avoid sudden temperature changes.
- Avoid the following triggers: cigarette smoke/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
If 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 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.
Fix the latch
Jack Newman’s1 protocol for treating vasospasm is very similar to the above and can be found in the following linked article and his book Dr. Jack Newman’s Guide to Breastfeeding. In addition to the above treatments, Dr Newman stresses the importance of finding the original cause of the pain such as fixing a poor latch or treating thrush if it is present (thrush can cause vasospasm symptoms). 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 and see our collection of Breastfeeding Videos and the articles Breastfeeding Positions for Newborns and Latching Tips. Newman also advocates All Purpose Nipple Ointment, massaging warm olive oil into the nipples during burning episodes for instant relief, and treating for Mammary Constriction Syndrome.
Anecdotal supplements that may help 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 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.