Pain while pumping

Why does it hurt when I pump?

Some mothers feel pain in their nipples and areolas while pumping. It’s important to find the cause, because pain is unpleasant and it can make expressing less effective, resulting in a decreasing milk supply and other problems. Mothers who have pain should try to find which area is painful. This can help find the cause. Mothers may need to try different sizes and styles of breast pump shields and make sure the shield is centred on the nipple before and during pumping. If the pain is because the suction is too strong, mothers may need to decrease the suction and consider improving the let-down, breast compression, manual expression, or using a constant-suction pump. Sometimes the pain is because the pumping time is too long. Mothers should reassess their technique if it takes more than 20 minutes on each breast.

A) Finding the cause of painful pumping

Location of pain caused by pumping.

Pumping sometimes causes pain, which is unpleasant and can make expressing less effective, resulting in a decreasing milk supply over time and problems for the mother.

Pain from pumping can affect part or all of the nipple, the nipple bottom, and the central part of the areola.

If you have pain with pumping, touch your nipple and areola with a clean finger and try to find which area is painful. This can help you find the cause and allow you to fix the problem. There may be more than one cause. This is outlines in the following table.

Table: Location of Tenderness Caused by Various Pumping Issues

(Links to more information about the topics in the above table: pump suction strength; breast pump shield size)

If the nipple is very elastic, pumping may stretch the nipple and cause it to swell. Both can cause nipple inflammation and pain. Mothers may consider:

  • Adding a breast shield insert:
    • With silicone cushions.
    • To change the angle between the breast shield barrel and funnel.
  • Changing the breast shield.

Some mothers find their bodies can adapt and the pain decreases with time. Others may find that pumping is always slightly uncomfortable (Francis 2019).

Mothers who exclusively pump may have dead, white skin on the nipple face. This is normal and not a cause of pain or a sign of a bacterial or yeast infection. It does not need treatment. Rather the nipple skin is adapting to trauma by building up a protective layer. It can be a sign that the pumping technique needs adjusting.

B) Pump times are too long

Most mothers need to pump for 10 to 20 minutes on each breast. If you take longer, reassess your pumping technique to make it more effective

C) Suction is too strong

To find the right suction strength, increase the suction until you are no longer comfortable and then decrease it a little to where you are comfortable. Different mothers need different amounts of suction.

If you are not pumping effectively, consider adding breast compression and power expressing and improving your let-down instead of increasing the suction strength.

If you still have pain even with less suction and your breast shield size is correct, gentle use of a hand pump instead of an electric pump may help. You can also change to manual expression or a constant-suction pump for some or all of the time until the pain settles.

D) Breast shields are the wrong size

Every mother is a little different. You may need to experiment with breast shield sizes and styles.  

If this does not help, consider manual expression or a constant-suction pump for some or all of the time until the pain settles.

E) The breast shields are not centred on the nipple

This happens when the breast shield is not properly placed on the breast at the start of pumping. It can also happen when the shield or breast moves during pumping, bringing them out of alignment.

If your nipple is away from the centre of the breast shield, one area of the nipple and areola may become sore as it is pulled to one side more than the other. The nipple and areola may also rub on one side of the shield.

If the nipple is pulled to the left, for example, the right side of the nipple and areola is stretched more than the left and becomes painful and the left side of the nipple may rub on the shield.

Ensure that your nipples are centered in the breast shield when you start pumping. Look at the nipple as you remove the breast shields when done pumping. They should remain centered.

F) The breast shields have slid down on the breast or are pushing into the lower part of the breast

Breast shield pressing into the lower half of the breast.

If your hands and wrists are not supported and get tired, the breast shield may:

  • Slide down the breast so the nipple and areola are pulled downward.
  • Tip down so that the lower half of the breast shield presses into the underside of the breast.

Both can cause nipple and areolar pain.

If the breast shield presses into the breast, the milk may not flow well, causing plugged ducts and increasing the risk of a breast infection (mastitis or a breast abscess).

Consider supporting your wrists with a regular pillow, a breastfeeding pillow, or a table or using a hands-free system.

References

Francis J, Dickton D. Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial. Breastfeed Med. 2019 Sep 4