Treating plugged ducts

What is the treatment for a plugged duct?

There are a number of ways to settle a plugged duct including: warm compresses, changing the baby’s position at the breast, medication to decrease inflammation, and opening any milk pimples. Mothers can also consider gently compressing the breast during breastfeeding, gentle breast massage, a warm water breast bath in a constant-suction pump, and ultrasound treatment. In some cases, the plug may have to be drained by a radiologist using a needle and ultrasound. Mothers should see their health-care providers if the plugged duct does not improve after three days, if it involves more than one quarter of the breast, or if the skin over it becomes red. They should also do so if they feel feverish or notice bleeding from the nipple as these are not commonly caused by plugged ducts but rather are signs of other problems.

A) Tools to treat a plugged duct

There are many reported tools to empty a plugged duct. Unfortunately, there is very little research to say which are the most effective and safest. As plugged ducts can be hard to settle, mothers may benefit from using more than one. Any treatments should be gentle and if mothers are using warmth, they should be careful to not burn themselves.

1) Anti-inflammatory medication

Mothers should consider anti-inflammatory medication, such as ibuprofen, to decrease the inflammation that may be the cause of the blockage and to reduce pain.

2) Opening milk pimples

If a milk pimple is present along with a plugged duct, it should be opened as it may be contributing to the plug.

3)  Generally safe and accepted tools 

Other generally safe and accepted ways of treating plugged ducts include:

  • Putting warm compresses on the breast or resting the breast in a bowl of warm water before breastfeeding to encourage the let-down.
  • Changing the baby’s position at the breast at each feed so that the baby’s mouth rotates around the breast.
  • Dangle feeds in which the baby is below the mother’s breast. Commonly, the baby lies on their back while the mother crouches over the baby on all fours.
  • Using a warm water breast bath in a constant-suction pump after breastfeeding.
  • Using cold cabbage compresses to decrease pain and swelling.

4) Breast manipulation

Mothers with plugged ducts have a lot of breast swelling (inflammation). Aggressive breast manipulation, such as massaging between breastfeeds or compression during breastfeeding or while expressing, can further increase the amount of inflammation and result in pain, delay healing, and possibly cause tissue damage. Any breast manipulation should be gentle, done for only a few minutes, and stopped if not effective.

5) Health-care providers

Please see your health-care providers if you notice any of the following:

  • The plug does not improve significantly within three days. This can mean:
  • Signs of an infection(mastitis or an abscess):
    • The lump is becoming larger or more painful. 
    • The lump involves more than one quarter of the breast.
    • The skin overlying it becomes red.  
    • You have a fever or feel unwell.  
  • There is bleeding from the nipple. This too can be a sign of cancer.

Health-care providers may recommend an ultrasound to examine the plug or use it to guide the needle as they drain the milk from the plug. Ultrasound has also been reported to treat plugged ducts (Cooper 2015; Lavigne 2012).

B) Breast massage to clear a plugged duct

A plugged duct can be softened or cleared by massaging the breast after breastfeeding (Witt 2016). However, it may also cause more inflammation and even tissue damage and should be used sparingly and gently.

Breast massage is done with the hands:

  1. Start right after the baby has breastfed or you have expressed.
  2. Use a bit of cooking oil on your hands to help the hands glide over the breast.
  3. Place the fingers at the back edge of the plug, between the plug and the chest wall.
  4. Slowly and gently push over the plug toward the nipple.
  5. Only use as much pressure as is comfortable.
  6. Each stroke should take about five seconds.
  7. Ideally, the plug will release and milk will flow.
  8. Stop massaging if:
    1. You do not notice any softening after 30 seconds. 
    2. The area is significantly softened.
    3. Two minutes have passed.
    4. It causes more than mild discomfort.
  9. At each feeding, repeat the above steps until the plug clears, which is usually within three days.

C) Draining plugged ducts

A plugged duct can be drained with a needle:

  • If the plug is particularly painful.
  • If it is not improving.
  • If it is close to the areola and preventing the baby from latching.
  • To make sure that it is not an abscess.

Draining with a needle is best done by a radiologist guiding the needle by ultrasound. Alternatively, it can be done without ultrasound. There is a small risk that the needle will introduce bacteria into the plugged duct, causing infection.

Older plugged ducts may contain thickened, semi-solid material that cannot be drained with a needle. Mothers may need to have a small tube (drain) placed in the duct for a few days (Ghosh 2004). Drains may also be used if the plug returns or is large.

The contents of the plug should be tested for bacteria. If present, mothers will need to be treated with antibiotics. The contents may also be examined under a microscope to see which types of cells are present and check for cancer.

D) Preventing plugged ducts

Mothers with plugged ducts tend to develop milk pimples. Prevention is the same for both conditions and includes regular and effective milk removal, avoiding a milk oversupply, and possibly lecithin.

References

Cooper B, Kowalsky J. Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women. Women’s HealthPhys Ther 2015;39:115-126
 
Ghosh K, Morton MJ, Whaley DH, et al. Infected galactocele: a perplexing problem. Breast J. 2004 Mar-Apr;10(2):159
 
Lavigne V, Gleberzon BJ. Ultrasound as a treatment of mammary blocked duct among 25 postpartum lactating women: a retrospective case series. J Chiropr Med. 2012;11(3):170-8
 
Witt AM, Bolman M, Kredit S, et al. Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. J Hum Lact. 2016 Feb;32(1):123-31