Topic Overview
What is breast engorgement, and what causes it?
Breast engorgement is the painful overfilling of the breasts with milk. This is
usually caused by an imbalance between milk supply and infant demand. This
condition is a common reason that mothers stop breast-feeding sooner than they
had planned.
Engorgement can happen:
- When milk first "comes in" to your breasts,
during the first few days after birth.
- When you normally have a
regular breast-feeding routine but cannot nurse or pump as much as
usual.
- If you and your baby suddenly stop
breast-feeding.
- When your baby's breast-feeding suddenly drops,
either when your baby is starting or increasing solid foods or when the baby is
ill with a poor appetite.
As you get close to your due date, your breasts make colostrum. Colostrum is a yellowish liquid that contains important nutrients and antibodies that a baby needs right after birth. About 2 to 5 days after your baby is born, your breasts start making milk for your baby. When your milk comes in, your breasts will most
likely feel warm and heavy. Some women feel only slight swelling. Others feel
uncomfortably swollen.
Early breast fullness is completely
normal. It occurs as your milk supply develops and while your newborn has an
irregular breast-feeding routine. The normal fullness is caused by the milk you
make and extra blood and fluids in your breasts. Your body uses the extra
fluids to make more breast milk for your baby.
If you don't
breast-feed after your baby is born, you will have several days of mild to
moderate breast engorgement. This gradually goes away when the breasts are not
stimulated to make more milk.
Overfilled breasts can easily become
very swollen and painful, leading to severe engorgement.
Common causes of severe engorgement are:
- Waiting too long to begin breast-feeding your
newborn.
- Not feeding often enough.
- Small feedings that
do not empty the breast well. Babies who are fed formula or water are less
likely to breast-feed well.
Severe engorgement can make it difficult for your baby
to latch on to the breast properly and feed well. This can make the problem
worse. As a result:
- Your baby may not receive enough
milk.
- Your breasts may not empty completely.
- Your
nipples may become sore and cracked. This is caused by your baby's attempts to
latch on to your overfull breasts. If you then breast-feed less because your
nipples are sore, the engorgement will increase.
Without treatment, severe engorgement can lead to blocked
milk ducts and breast infection, which is called
mastitis.
What are common symptoms of breast engorgement?
Engorged breasts:
- Are swollen, firm, and painful. If severely
engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the
touch.
- May have flattened-out nipples. The dark area around the
nipple, called the
areola, may be very hard. This makes it difficult for
your baby to latch on.
- Can cause a slight fever of around
100°F (37.8°C).
- Can cause slightly swollen and tender
lymph nodes in your armpits.
How can you prevent breast engorgement?
You can
prevent breast engorgement by closely managing the milk your breasts make and
keeping milk moving out of your breasts. During your body's first week or two
of adjusting to breast-feeding, take care not to let your breasts become
overfilled.
- Breast-feed your baby whenever he or she
shows signs of hunger. If your breasts are hard and overfilled, let out
(express) enough to soften your nipples before putting your baby to the
breast.
- Make sure that your baby is latching on and feeding well.
- Empty your breasts with each feeding. This will help your milk
move freely, and your milk supply will stay at the level your baby needs.
If you have any concerns or questions, this is a good
time to work with a
lactation consultant, someone who helps mothers learn
to breast-feed.
How is breast engorgement diagnosed?
Breast
engorgement is diagnosed based on symptoms alone. No exams or tests are needed.
How can you treat breast engorgement?
A few days
after your milk comes in, your milk supply should adjust to your baby's needs.
You can expect relief from the first normal engorgement within 12 to 24 hours
(or in 1 to 5 days if you are not breast-feeding). Your symptoms should
disappear within a few days. If not, or if your breasts do not soften after a
feeding, start home treatment right away.
To reduce pain and
swelling, take ibuprofen (such as Motrin or Advil), apply ice or cold
compresses, and wear a supportive nursing bra that is not too tight.
To soften your breasts before feedings, apply heat, massage gently, and
use your hands or use a pump to let out (express) a small amount of milk from
both breasts.
If your baby can't feed well or at all (such as
during an illness), be sure to gently pump enough to empty each breast. You can
store or freeze the breast milk for later use.
If your breasts
still feel uncomfortable after nursing, apply cool compresses.
If
you are not breast-feeding, avoid stimulating the nipples or warming the
breasts. Instead, apply cold packs, use medicine for pain and
inflammation, and wear a supportive bra that fits
well.
Frequently Asked Questions
Learning about breast engorgement: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Symptoms
Symptoms of
breast engorgement happen when the breasts produce and
fill with milk but little milk is removed from them. Milk overfills and
engorges the breasts.
If your breasts are engorged, you may notice
the following:
- Breasts are swollen, firm, and painful. If
severely engorged, breasts are very swollen, hard, shiny, warm, and slightly
lumpy to the touch.
- Your nipple may flatten out and the dark area
around the nipple, called the
areola, may be very hard.
- Your baby may have trouble latching on to
a flattened, hard nipple and may not be able to get enough milk
out.
- If your baby is not able to get enough milk, he or she will
suck harder than usual during nursing and want to nurse more often.
- Your nipples may become damaged by your baby's efforts to latch on
well and get enough milk.
- You have a slight fever of around
100°F (37.8°C).
- The
lymph nodes in your armpits may be slightly swollen
and tender.
Complications of engorgement
If you are
breast-feeding and don't relieve breast engorgement, you are likely to develop
one or both of the following:
Call your doctor now if you
have:
- Increasing pain in one area of the
breast.
- Increasing redness in one area of the breast or red streaks
extending away from an area of the breast.
- Drainage of pus from the
nipple or another area of the breast.
- A fever of
101°F (38.5°C) or
higher.
Call your doctor today if you
have:
- Swollen glands (lymph nodes) in the neck or armpit.
- A
fever less than 101°F (38.5°C).
Call your doctor if you have cracked and bleeding nipples
after trying home treatment for 24 hours.
See
Blocked Milk Ducts and Breast-Feeding. And for more information, see the topic
Mastitis While Breast-Feeding.
Exams and Tests
No exams or tests are needed to
diagnose
breast engorgement. If your doctor suspects a breast
infection (mastitis), you will be treated with antibiotics.
For more information, see the topic
Mastitis While Breast-Feeding.
Treatment Overview
Breast engorgement is a common problem after birth and during breast-feeding.
You can prevent and treat it at home. You do not need to visit your doctor
unless you have symptoms of an infection (mastitis),
which may require antibiotic treatment.
If you are not going to
breast-feed, there currently is no safe medicine available for "drying up" your
breasts and preventing breast engorgement.
You can use self-care
measures to help prevent or relieve breast engorgement.
- If you are breast-feeding, self-care focuses on increasing the flow of milk out of
your breasts. You do this with frequent breast-feedings, making sure that your
baby is latched on well. You can expect some relief within 12 to 24 hours. And
the discomfort should disappear within a few days.
- If you are not breast-feeding, breast engorgement will improve
as your breasts stop producing milk. Pain and discomfort should go away in 1 to
5 days. You may find home treatment helpful for relieving symptoms.
For more information on self-care measures to help prevent
or relieve the discomfort of breast engorgement, see the Home Treatment section
of this topic.
Home Treatment
To prevent severe breast engorgement
If you are planning to breast-feed, do the following to
prevent severe
breast engorgement.
- Start breast-feeding as soon as possible
after your baby is born, and continue to breast-feed often. This is the best way to prevent
severe engorgement.
- In the first few days after birth,
breast-feed at least every 1 to 2 hours. Short periods of time between feedings
may help reduce or prevent severe breast engorgement. During this time, you may
have to wake your baby to breast-feed.
- Feed your baby whenever he
or she is hungry or at least every 2 hours.
- Make sure that your breasts are soft enough for
your baby to latch on well. If your breasts are hard and too full of milk, let
out (express) a small amount of milk with your hands or with a pump. Then put your
baby to the breast.
- Empty your breasts with each feeding.
- Your baby should breast-feed at least 15
minutes or more on the first breast before changing to the second breast. You
will know it is time to move to the other breast when your baby becomes less
eager to suck.
- If your baby becomes full before your breasts are
empty, use a pump or use your hands (manual expression) to squeeze
the remaining milk from your breasts to
store for later use. This is especially important during the early stages of
breast-feeding.
- Early engorgement will decrease as breast-feeding
becomes more routine and your baby is able to feed for longer periods of
time.
- Change your baby's breast-feeding position now
and then to make sure that all parts of your breasts are emptied. For
information on breast-feeding positions, see the topic
Breast-Feeding.
- Make sure your baby is
latched on properly. If your nipples are flat, gently massage the nipple and
areola. This should stimulate your nipple to become
more erect. Then gently support your breast with your thumb on top and fingers
underneath. This added support will make it easier for your baby to latch on.
View a slideshow of
proper latch-on for breast-feeding.
- Discuss any breast-feeding
problems or concerns with your doctor or a breast-feeding specialist (lactation consultant).
When your baby is breast-feeding well, do the following to help prevent future breast engorgement
problems:
- If your breasts are becoming overfull, take a
warm shower, letting the water flow over your breasts. This should trigger the
let-down reflex, allowing some milk to leak out and
slightly softening the nipple and areola. Remove excess milk and relieve
pressure by using a pump or by hand (manual expression).
- If your milk is not flowing
well and you are becoming overfull, place warm, moist towels on your breasts
before breast-feeding. The moist heat should help your milk flow more
easily.
- Anytime you are not able to breast-feed your baby, arrange
for a time and place to manually express or pump milk from your breasts at
least every 3 to 4 hours.
- When you and your baby are ready to
wean, gradually stop breast-feeding over a period of
several weeks. Start by dropping the least favorite breast-feeding time. Wait a
few days until your supply decreases, then drop another feeding, and so on.
Gradual weaning is best for both you and your baby. It gives your breasts time
to adjust gradually to your baby's decreasing demand, and it gives your baby
time to develop new eating patterns. For more information, see the topic
Weaning.
To relieve breast engorgement
If you need to breast-feed but breast engorgement is preventing you from
doing so, use these steps to keep your milk flow going and relieve your pain
and swelling:
- Soften your nipple and areola before
breast-feeding, to avoid nipple damage. When the nipple and areola are soft,
the nipple protrudes more easily, allowing your baby to latch on well. View a
slideshow of
proper latch-on for breast-feeding.
- If your breasts are freely leaking, you
can use a warm compress for a couple of minutes before
breast-feeding.
- Gently
pump or use your hands (manual expression) to let out a small amount of milk. Be
careful not to injure your breast tissue. An automatic cycling breast pump with
the suction adjusted to low is best for relieving engorgement.
- Use gentle breast massage to promote milk flow.
- Breast-feed your baby more often, or pump your breasts if your
baby won't breast-feed. Take care to empty your breasts each time. You can
freeze pumped milk in clean containers or bags for later use.
-
Reduce swelling and relieve pain. After breast-feeding:
- Take a
nonsteroidal anti-inflammatory drug (NSAID), such as
ibuprofen (Advil or Motrin, for example), in addition to the nonmedicine
treatments. When taken as directed, ibuprofen is safe to use while
breast-feeding.1
- Try cold compresses. Apply a frozen wet towel, cold gel or
ice packs, or bags of frozen vegetables to your breasts for 15 minutes at a
time every hour as needed. To prevent tissue damage, do not apply cold to your
bare skin. Place a thin cloth between the cold pack and your skin.
- Avoid constricting bras that press on your
breasts. A tight bra can reduce milk flow through the ducts, eventually causing
blocked ducts.
If you are bottle-feeding formula and you experience breast engorgement after childbirth, use one or more of
the following measures to help relieve discomfort:
- Avoid pumping or removing a large amount of
milk from your breasts. This stimulates milk production and makes engorgement
worse. Remove just enough milk to make you feel more comfortable.
- Take ibuprofen (such as Motrin or Advil) in addition to the
nonmedicine treatments.
- Try cold compresses. Place a frozen wet towel, cold gel or ice
packs, or bags of frozen vegetables on your breasts for 15 minutes at a time
every hour as needed. To prevent tissue injury, do not apply cold directly to
bare skin. Place a thin cloth between the cold pack and your skin.
- Wear a
supportive bra that fits well.
Other Places To Get Help
Organizations
|
HealthyChildren.org |
| 141 Northwest Point Boulevard |
| Elk Grove Village, IL 60007 |
| Phone: |
(847) 434-4000 |
| Web Address: | www.healthychildren.org |
| |
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more. |
|
| American Academy of Family
Physicians |
| P.O. Box 11210 |
| Shawnee Mission, KS 66207-1210 |
| Web Address: | www.familydoctor.org |
| |
The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its Web site has topics on medicines, doctor visits, physical and mental health issues, parenting, and more. |
|
| La Leche League International (LLLI) |
| 957 North Plum Grove Road |
| Schaumburg, IL 60173 |
| Phone: | 1-800-LA-LECHE (1-800-525-3243)
(847) 519-7730 |
| Fax: | (847) 969-0460 |
| Web Address: | www.llli.org |
| |
La Leche League International (LLLI) offers information and
encouragement—mainly through personal help—to all mothers who want to
breast-feed their babies. It also offers support and information about
breast-feeding babies with various disabilities, such as cleft lip or cleft
palate. Call for information about a chapter in your area. |
|
| Office on Women's Health |
| Department of Health and Human Services |
| 200 Independence Avenue, SW Room 712E |
| Washington, DC 20201 |
| Phone: | 1-800-994-9662
(202) 690-7650 |
| Fax: | (202) 205-2631 |
| TDD: | 1-888-220-5446 |
| Web Address: | www.womenshealth.gov |
| |
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers. |
|
References
Citations
- Lawrence RM, Lawrence RA (2009). The breast and
physiology of lactation. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 125–142. Philadelphia:
Saunders Elsevier.
Other Works Consulted
- American Academy of Pediatrics (2009). Feeding your baby: Breast and bottle. In SP Shelov et al., eds., Caring For Your Baby And Young Child: Birth to Age 5, 5th ed., chap. 4, pp. 91–93. New York: Bantam.
- Cunningham FG, et al. (2010). Breast engorgement section of The puerperium. In Williams Obstetrics, 23rd ed., pp. 652. New York: McGraw-Hill.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
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| Last Revised | May 4, 2011 |
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