Nipple Vasospasm and Breastfeeding

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:

  • 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.
  • White nipples—nipple tips may look white (blanched) after a feed or mothers may notice other colour changes in their nipples e.g. blue or dark red (associated with Raynaud’s Phenomenon—see below)
  • Deep breast pain—some mothers may also feel shooting pains deep in the breast.
  • Cold temperatures may worsen the pain or trigger it.

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.

Bacterial or fungal infection may have similar symptoms

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 vasospasm symptoms worse 1.

What causes nipple vasospasm?

For breastfeeding mothers, the main cause of nipple vasospasm is likely to be a poor latch (the way a baby attaches to the breast). A range of 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.
  • Migraines.
  • Certain medical conditions such as Lupus, rheumatoid arthritis, and hypothyroidism.
  • Certain medications such as Fluconazole/Diflucan (thrush treatment) or 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 poorly latched baby, an ineffective suck or the baby clamping on the nipple can all cause nipple blanching. A baby needs to attach to the breast deeply 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 and see your breastfeeding specialist for one to one help.
  • Rule out thrush or a bacterial infection—check with your health professional that you don’t have any other causes of burning pain and sore nipples.
  • Keep warm; breastfeed in a warm room and cover the nipple as soon as a breastfeed ends. Don’t leave nipples to air dry as they will get colder that way. Keep breastpads dry, some mothers use woollen or fleecy breastpads for warmth. Try to avoid sudden temperature changes.
  • Gentle massage. Try massaging the nipples with warm oil after a breastfeed to stop a nipple vasospasm 2.
  • Avoid the following triggers: cigarette smoke and smoking, nicotinecaffeine, or any medications that promote vasoconstriction e.g. some decongestants3 and avoid stress where possible.
  • Keep active with aerobic exercise.

Raynaud’s phenomenon

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. This might be because breastfeeding affords lots of opportunities for nipples to get cold e.g. just before and after latching. Raynaud’s is often misdiagnosed as thrush or a poor latch 4.

Diagnosis of Raynaud’s

Raynaud’s can usually be distinguished from nipple vasospasm due to a poor latch by:

  • Symptoms can be triggered by cold and tend to occur in both nipples and can happen separately from breastfeeding.
  • Several colour changes of the nipples e.g. from white to blue to red/purple.
  • Raynaud’s may be linked with a history of migraines or a history of poor circulation 5.
  • May be associated with previous breast surgery 6.

Breastfeeding tips for Raynaud’s sufferers

Help for Pregnant & Breastfeeding Moms from the Raynaud’s Association, has specific tips for Raynaud’s sufferers such as:

  • Never latch a baby while the nipple is having a vasospasm, try warming the breast and repeatedly squeezing the nipple to help blood flow back into this area before latching.
  • Pumping may be less painful than direct breastfeeding for some mothers.
  • Keep warm, never leave nipples to air dry after a breastfeed (as above). Try warm compresses after a breastfeed. Use woollen breast pads and warm layers of clothing to keep warm.

Treatments for nipple vasospasm

In addition to using the above ideas to avoid getting vasospasm symptoms, there are a number of treatment options for vasospasm that persists after a poor latch has been corrected and other infections ruled out. Treatments include pain relief, dietary supplements (calcium, magnesium and vitamin B6), omega fatty acids and prescription medication. The Goldfarb Clinic discusses these in more detail:

  • 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 and magnesium and vitamin B6 (200 mg daily for 4 days, then 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™) […] normally used for high blood pressure, can also be used for nipple vasospasm, and is safe for breastfeeding mothers and infants.

Nifedipine

Refer to the full Goldfarb article online for precautions regarding nifedipine and share this with your health care professional. The Breastfeeding Network discusses doses and side effects of nifedipine in their fact sheet Raynaud’s Phenomenon in Breastfeeding Mothers and for more places to find information about the safety of nifedipine online see Medications and Breastfeeding. Always discuss medications or medicinal doses of supplements with your health care provider.

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 above), Dr Newman advocates:

Complimentary medicine

Scleroderma and Raynaud’s UK (SRUD) discuss natural and over the counter complimentary medicine for scleroderma and Raynaud’s in Natural Therapies.  They discuss doses of vitamin C, vitamin E, gamolenic acid (GLA), ginkgo bilboa and ginger and more.  The latest recommendations on the compatibility of many supplements while breastfeeding can be checked online at e-Lactancia and should always be discussed with your health professional.

  • Gingko Biloba Up to 240mg daily in three doses. Some people find that this produces a significant reduction in their Raynaud’s symptoms.
  • Ginger 2000mg–4000mg daily.

The Breastfeeding Network fact sheet for Raynaud’s adds that it may be helpful to include ginger in the mother’s diet e.g. drink ginger tea, or even add a spoonful of ground ginger to bath water.

Summary

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 also 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.