How to treat a blocked milk duct

So, you’ve woken up experiencing the tell-tale signs of a blocked duct. Apart from freaking out, what do you do next?

Having a blocked duct always unleashed something primal within me. Of course it impacted my baby feeding, but experiencing pain and swelling in such an intimate and sensitive part of my body made me extra weepy too. As a new Mama, I felt terribly protective towards my boobs.

Once you’ve allowed your emotions to settle, (and it’s ok to have a good cry, I did, on countless occasions); you need to act fast. Ignoring a blocked duct and hoping it goes away by itself isn’t the wisest thing to do; there is a very small percentage that do, but it never happened that way with me.

What might start off as a small lump with mild discomfort could within hours take over half the boob, sometimes branching into multiple lumps, leaving everything solid and very painful to the touch.  In my case, the longer the blockage was there, the worse I would feel. Pain would move up my neck, my glands would swell, and I would feel tired, fluey and irritable. Not to mention the panic that mastitis was waiting to grab me.

Feeding is your best chance to get rid of a blocked duct. Because I couldn’t whip out my boobs and carry out my complex unblocking routine (complete with hot compresses and vibrators – more on that below!) in public, as soon as I had the slightest inkling of a blockage coming on, I’d drop everything and start treating it with a combination of the following:

Feed, feed like a maniac! This might seem obvious, but the very best way to cure a blocked duct is to breastfeed. Take every opportunity you can; your baby is a master at feeding, and no one is going to clear the block more effectively, or efficiently than them. If you can’t feed, use a pump. A blocked duct is usually easiest to clear in the first few hours, as the area isn’t so inflamed, and the milk isn’t so sticky. The longer the milk stays clogged, the stickier it becomes, making it more difficult to unplug. Even if your marathon feeding sessions aren’t clearing the blockage itself, they will keep the milk flowing through the rest of the ducts, reducing the risk of the inflammation and infection spreading. It’ll also help keep your milk supply up, which is great because blockages usually cause a dip in the days after they have cleared. Baba’s sucking is strongest at the start of a feed (once they get full they become a bit lazy), so be sure to start feeding on the affected boob first, even though it might be very painful.

Hot wet compresses: Applying moist heat to the area promotes milk flow, so before you feed, bathe the affected boob in a hot wet compress. One of your baby’s (clean) nappies is the most effective way of doing this. Fill it with hot water, and it will maintain its warmth and moisture far longer than a wet cloth, and with a lot less mess. I found the cheaper supermarket own brands to be best as they weren’t as good at wicking the water away, and kept skin clammier (not as good for baba’s bum, but great for this purpose!). The cheaper ones also make sense because eventually the heat does run out and you might need to use quite a few before you get results.

Hot soak: This works on a similar premise to the hot wet compresses, promoting milk flow. I had read a lot of good things about soaking in a warm bath of Epsom salts. We didn’t have a bath so I had to improvise with bowls of water, which can get a bit messy and didn’t work too well. Instead I often stood under a hot shower, directing the shower head to the point of the blockage. Go as hot as you can stand, and then follow with a breastfeed.

Baby feeding positions: A baby’s suck is usually strongest around their chin, so when you are feeding, try to position baba’s chin in the direction of the blockage. You might need to perform some interesting acrobatics to achieve this, and don’t stress if it’s just not possible. Most of my blockages used to happen in the upper half of my left boob, which meant I had to try to feed baba upside down in order to get her chin in the right place. The only way I managed was by lying on my bed and I could never really get the position right even at that. Kneeling on all fours and leaning over your baby, so your boobs hang down, is also meant to be a great feeding position, with lots of women swearing that gravity helps. Be prepared to look completely ridiculous, but in fairness, if you get to this point, you really won’t care. Unless you have amazing arm and abs muscles, you’ll need to pop baba on an elevated surface, like a foot stool so you’re not bending down too low. I used the couch and had success with this method many times so it’s definitely worth a try.

Massage: This is biggie, and along with feeding, I found it was one of the most effective ways at clearing blockages. There are a few ways to doing it, depending on how tired you are.

The stroke massage: Press firmly down at the site of the blockage, pushing towards the nipple in even strokes. You can do this before a feed, after applying moist heat to the area. I found it worked best if done whilst baba was feeding though. I ought to include a little disclaimer here, because if done properly, this can be really, really sore. It’s as if you are pushing down with all your might on a bad bruise. I often did it through gritted teeth, and would break a sweat, my heart racing by the time I was finished. But there’s no denying that this technique got great results for me so is definitely worth a shot if you can bare it.

The circular massage: If my boob was so swollen I couldn’t figure out exactly where the point of the blockage was, massaging the general area in a circular motion was a great way of getting things moving. It helped release some milk and break the blockage into smaller lumps, which I found baba was able to suck out easier. I usually did this by applying firm pressure with my first and middle finger, but often used a vibrator (see below), moving it in circular motions too.

The ‘personal massager’: I was so delighted to receive one of these from my husband at Christmas, but not for the reasons you would obviously think! It wasn’t long after I started getting blockages that I figured out vibrators were really good for massaging the area when I was too exhausted to do it myself. In between feeds I would point them at the blockage while applying a hot compress. When baba got used to the noise I would sometimes use them while she was feeding too. They were also great at preventing blockages; as soon as I felt the slightest inkling of one coming on, I took out my favourite vibrator.

Ibuprofen: This is safe to use when breastfeeding, and good for managing the pain if you have a really bad blockage. I found it really useful for reducing inflammation, which buys you time in delaying a mastitis infection developing. It is good as a preventative measure too, and I would take them for a day or two after any bad blockages had cleared, to reduce inflammation and the likelihood of another blockage. A word of caution though, it might not be as addictive as some medications, but during my worst blockages I relied on it, and became quite irritable when I forced myself to stop – you’ve been warned!

Therapeutic ultrasound: You’ll be delighted to hear that I’ve saved the best till last. As a chronic blocked sufferer, therapeutic ultrasound was for me, the king of all treatments, and dare I say it, made all my other efforts seem like DIY disasters. It’s not for every Mama, but if you have a really stubborn blocked duct that won’t shift no matter what you try, or like me, you’re getting them every couple of days, it can be an absolute lifesaver.

The treatment is typically used by physiotherapists to promote healing and to break down scar tissue in other parts of the body. When used for blocked ducts, a combination of heat and magnetic pulses help to reduce areas of inflammation and increase blood flow. It generally isn’t painful, as the probe is kept in motion the entire time.  This treatment can be expensive, I paid €60 per 30 minute session in Ireland, which I found would keep me block-free for about 2-3 weeks. For lots of women one treatment is all they need. Gradually the length of time between my own sessions increased until I didn’t need to attend anymore. Because the treatment increases blood flow, it’s best to feed your baby within the hour to help drain milk from the affected area.

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