Ruling Out Thrush
Very sore nipples can sometimes be caused by thrush, an overabundance of yeast that can manifest on your nipples or in your baby's mouth. Thrush can be easy to miss and can make nursing very painful, so it's always a good idea to rule it out if you're experiencing persistent or severe nipple soreness. If you have a thrush infection, your nipples may look shiny, puffy, pink, blistered, or flaky. Your baby's mouth may have small white spots in it, and he may cry and pull away when he nurses. Sometimes, though, thrush doesn't show any symptoms in a baby, and the only symptom you experience could be pain.
Essential
The pain of thrush is often described as burning, stabbing, or sharp, and may radiate through the milk ducts and even into your armpit. Generally, the pain is worst during latch-on but persists throughout the feeding. Garden-variety tender nipples usually get better by the end of the first week or so, but thrush tends to get worse, not better, with time.
If your water was broken or leaking for more than twenty-four hours before you went into labor, if you tested positive for group B strep bacteria late in your pregnancy, or if you experienced any symptoms of infection after your baby was born, there's a good chance you received antibiotic treatment, which can also increase your chances of developing thrush. Or, if your baby was given antibiotics, he could have developed thrush and then passed it back to you.
If you think you might have thrush, don't hesitate to start treatment. Once the “yeastie beasties” have a foothold, they usually won't go away without a nudge — and without treatment, the pain will just get worse. Or, the infection might spread to your baby, making it more difficult to nip the problem in the bud.
Prevention
Yeast grows best in warm, moist environments, so make sure you keep your nipples dry between feedings. Pat your nipples dry or expose them to the air after each feeding, and change your nursing pads or nursing bra often. Wash bras and reusable nursing pads daily in hot water, and dry them completely before putting them back on. If your nipples become cracked or blistered because of poor latch or other issues, it can create an environment that yeast can thrive in. Keep your nipples dry (when not in use) and moisturized.
Treatment
Your health-care provider can prescribe you an antifungal medication, like Diflucan or Nystatin. It can be difficult to diagnose nipple thrush, and women often have a hard time getting their doctor to prescribe the medication. Also, the drugs can be really expensive, especially if you don't have prescriptive insurance. If you can't get your doctor to prescribe you an antifungal, or if you're prescribed one that doesn't work, don't worry — you still have several treatment options.
Over-the-counter Antifungal Creams
Creams containing the active ingredient miconazole or clotrimazole can be used directly on your nipples after each feeding. Dr. Jack Newman, an internationally recognized breastfeeding expert, recommends asking your pharmacist to make up this “all-purpose nipple ointment” for the treatment of thrush and other causes of sore nipples:
15 grams 2 percent mupirocin ointment (not cream)
15 grams 0.1 percent betamethasone ointment (not cream)
If this is unavailable, mometasone ointment can be substituted. Don't mix ointments and creams together.
Add miconazole powder, so that the final concentration is 2 percent miconazole. If miconazole is unavailable, clotrimazole powder can be substituted. Apply this combination sparingly after each feeding, but not at the same time as gentian violet. Do not wash or wipe it off; according to Dr. Newman, this formula is safe for your baby to ingest.
Gentian Violet
You can still find this inexpensive, old-time remedy in many drugstores, but you might have to ask the pharmacist for help. Gentian violet is a dye with powerful antifungal properties and is sold in powder and liquid form. Dilute the gentian violet until you have a 0.25 to 0.5 percent solution, and apply it to your breasts once a day with a cotton swab before nursing your baby. That way, his mouth will get treated too (don't worry, a small amount of gentian violet is safe for your baby to swallow).
Treatment with gentian violet can be extremely messy, and gentian violet will stain your clothing and temporarily turn your baby's lips and mouth purple. To make cleanup easier, try rubbing a little olive oil on and around your baby's lips and cheeks before a feeding. The oil will provide a barrier between your baby's skin and the dye, and may reduce staining.
While health-care providers around the world recommend gentian violet regularly as a safe, effective treatment for thrush, some experts aren't convinced it's completely safe. Gentian violet should be a short-term, infrequent treatment. If your symptoms aren't better after treating with gentian violet for a few days, or if your thrush continues to recur, talk to your health-care provider about other options.
Acidopholus
Yeast and other microorganisms are always present in a healthy body, but usually, they keep one another in check. When “good” bacteria are wiped out of your system, the yeast can grow unchecked. Restoring the levels of healthy bacteria in your body is your first line of defense against thrush infections. Plus, regularly consuming lactobacillus acidopholus is good for your digestive system. As mentioned previously, you can take acidopholus in pill form or get it in yogurt containing live cultures. It works topically, too: open an acidopholus capsule or take a little plain yogurt and swab it on your nipples.
