Firm nipple root

Why is my nipple root hard?

Nipple roots may become hard because of swelling, a breast abnormality, or the squeezing of the muscles of the areola. When this happens, a breastfeeding baby may have trouble latching or staying latched or getting the nipple deep enough into the mouth. That can make breastfeeding ineffective and increase the risk of nipple pain and damage. The treatment of a firm nipple root depends on its cause. Hardening of the nipple root can be caused by breast engorgement, receiving excess fluid during labour, having a nipple that tips down, and breast infections or cancer.

A) Describing firmness of the nipple root

The part of the areola closest to the nipple (the central areola) and the tissues under the central areola, which together form the nipple root, can become spongy, firm, or even hard. There are three main causes:

  • Excess fluid in the tissues (swelling)
  • Abnormalities in the breast
  • The contraction of the muscles of the areola.

 Check your nipple root for firmness using the pinch test.

B) Problems caused by a firm nipple root

When the nipple root is firm, a baby needs more suction to latch and stay latched and the nipple root may not go deep enough into the baby’s mouth (McClellan 2015). This increases the risk of:

The risk of latching problems is even higher if the baby is:

C) Swelling causing a firm nipple root

1) Swelling in the nipple root

a) Swelling caused by pregnancy and labour

Swelling and the resulting hardness of the skin may be caused by excess fluid in the body brought on by pregnancy or from receiving a lot of intravenous fluid during delivery.

The excess fluid flows downward, causing swelling in the feet and legs. Such mothers may also notice pitting.

To check for pitting:

  1. Push firmly into the swelling with one finger for 10 seconds.
  2. Remove the finger.
  3. Look at the skin that was under the finger to see if it remains pushed in or depressed.
  4. Pitting is present if the depression remains for a half-minute or more before returning to normal.

Extra fluid in the body may also cause the nipple root to swell, because it is located at the end of the breast and may be lower than the rest of the breast (Kujawa-Myles 2015). Mothers with longer breasts and nipples that point downward are the most likely to have this kind of swelling. They can even have pitting of the areola and underside of the breast.

If you have swelling in your feet or legs before delivery, it is important to do a pinch test before you try breastfeeding to ensure that your nipple root isn’t also swollen.

2) Other causes of swelling of the nipple root

Breast engorgement and a large milk supply can result in swelling of the nipple root. Most commonly, these affect both breasts at the same time.

Areas of the breast affected by mastitis, a breast abscess, a plugged duct, a breast mass, or cancer. These can be present away from the nipple root but the body’s attempt to fix the problem may result in generalized breast swelling or swelling of the nipple root. If one nipple root suddenly becomes swollen, please see your health-care providers to check for these problems.

2) Treatment of nipple root swelling

If your nipple root is swollen, use nipple root massage to soften it.

Breast massage and cold compresses, which are also used for treating engorgement, can reduce the overall swelling in the breast.

Latching may be easier using the sandwich technique or when breastfeeding using the laid-back hold. 

Any underlying conditions should be treated. 

D) Abnormalities of the breast causing a firm nipple

1) Abnormalities causing a firm nipple root

A firm nipple root can be caused by abnormalities in the nipple root including:

2) Treatment

The treatment of a firm nipple root in this situation depends on the cause.

E) Contraction of the muscles of the areola causing a firm nipple root

1) Causes of contraction of the muscles of the areola

The muscles of the areola may tighten (contractwhen stimulated, such as when the mother is cold or has tender or damaged nipples.

When the muscles contract, the areola looks wrinkled and feels hard during the pinch test.

Term babies can usually latch if the muscles are contracted but will do so by increasing their suction strength. Weaker ones might find latching and staying latched challenging.

Once the baby is latched, the warmth of the mouth and the massage-like effect of breastfeeding will soften the muscles after a few minutes. 

2) Treatment of areolar muscle contraction. 

Nipple root massage done just before latching can easily relax the muscles and fix the problem. Tools for keeping the nipple and areola warm as are used for nipple vasospasm may also help between feeds but are usually not needed. 

References

Branger B; Breastfeeding Commission of the Pays de la Loire Birth Safety Network (France). Description of 101 cases of nipple cracks and risk factors via case-control study in eight units of a perinatal network. Arch Pediatr. 2019 Nov 26;S0929-693X(19)30192-7
 
Kujawa-Myles S, Noel-Weiss J, Dunn S, et al. Maternal intravenous fluids and postpartum breast changes: a pilot observational study. Int Breastfeed J. 2015;10:18
 
McClellan HL, Kent JC, Hepworth AR, et al. Persistent Nipple Pain in Breastfeeding Mothers Associated with Abnormal Infant Tongue Movement. Int J Environ Res Public Health. 2015;12(9):10833–10845