Preventing nipple yeast infection

How can I avoid another nipple yeast infection?

Some mothers may occasionally have a second nipple yeast infection or rarely, a third one. If mothers do get another nipple yeast infection, they generally recognize the symptoms right away and promptly start treatment. They should address any contributing factors. A yeast wick, a pad that prevents the trapping of moisture between the nipple and areola, can help prevent infection. Sterilizing bras, washing nipples, and changing the mother’s diet is unlikely to help.

A) Preventing more nipple yeast infections

Preventing another nipple yeast infection does not mean getting rid of Candida, the cause of most nipple yeast infections, as it often lives on and in us. The medical term for this is colonization. Even after oral antifungal treatment for nipple yeast infection, Candida may still be present on or in the mother’s body or may return (Gunther et al. 2014). This does not mean, however, that it is causing problems. Indeed, having more than one nipple yeast infection is not all that common.

There are several steps mothers can take to prevent another nipple yeast infection. The same factors that increased the risk of getting a nipple yeast infection can also increase the risk of getting a second one and should be reviewed. Mothers can also consider yeast wicks.

Unfortunately, some mothers will use approaches that are not generally helpful such as sterilizing items, washing their breasts, dietary changes, and throwing out previously expressed breast milk.  

If mothers do get another nipple yeast infection, they generally recognize the symptoms right away and promptly start treatment. In this situation, most mothers are back to normal two weeks after starting to use an antifungal cream.

B) Nipple yeast wicks

A nipple yeast wick

1) Reasons for yeast wicks

Mothers who have repeated episodes of nipple yeast infections may want to consider using a yeast wick if there is significant contact between the nipple and the areola when wearing a bra. This can be caused by:

  1. The nipple being pushed straight back (telescoped) into the breast.
  2. The nipple being longer, bending over, and lying against the areola.

Wicking means to absorb or draw off moisture. Yeast wicks are absorbent doughnut-shaped pads used to prevent direct contact between the nipple and areola. This limits the trapping of moisture between them. As Candida needs moisture, eliminating moisture can help prevent further infections.

The alternative to this is not wearing a bra.

2) Choosing and making a yeast wick

One type of yeast wick allows the nipple to stay upright inside the bra instead of being pushed into the areola. Another type keeps it from folding over onto the areola.

To choose a yeast wick, put your bra on in the usual way and then slowly peel it off from the top down and look at how your nipples rest in the bra.

a) For nipples that are telescoped

To make a yeast wick for nipples that are telescoped:

  1. Obtain several cotton or disposable breast pads.
  2. Using scissors, make a hole in the centre just large enough for the nipple to pass through.
    1. A hole that is too small can cause pain.
    2. A hole that is too big will not have the desired effect.
  3. Prepare one to three more pads in this way for each nipple.
  4. The number of pads depends on the length of the nipple.
  5. When stacked and with the nipple in place in the hole, the nipple face should be below the level of the final pad and the nipple should stand erect.
  6. Mothers who leak should use an extra pad without a hole to cover the nipple face and collect the leaked milk.

b) For nipples that bend over

To make a yeast wick for nipples that bend over:

  1. Prepare one pad with a hole for each nipple as described above.
  2. Once the pad is in place and the bra is on, the nipple should bend over and rest on the pad instead of the areola.
  3. Mothers who leak should use an extra pad without a hole to cover the nipple face and collect the leaked milk.

3) How long to use a yeast wick

To prevent infections, wear the yeast wick as much as possible each day. Most mothers use them for a few months. Do not use them if they cause any discomfort.

C) Things that are not generally helpful

1) Sterilizing or throwing out things

The Candida present in and on the person is the cause of most infections. Candida is less commonly acquired from inanimate objects (fomites) (Hota 2004). Consider that Candida albicans is found in:

  • The skin, mouth, or gut of 30-60% of the population.
  • The vaginas of 20% of women.
  • As many as half of the mouths of babies.
  • The milk of some mothers.

Eliminating Candida from the household is unlikely if some of the members are hosts, as it can be transmitted from person to person.

A variety of fungi, including Candida, are also present on indoor surfaces and can survive for months making “sterilizing” of a household very difficult if not impossible (Adams 2013; Kramer 2006).  

Therefore, the following will not treat or prevent infections:

  • Boiling or sterilizing bras and other clothing.
  • Sterilizing the baby’s toys.
  • Sterilizing pump parts more than is recommended.

2) Washing nipples and areolas

Washing nipples and areolas can increase the risk of nipple yeast infection and other problems because washing:

  • Can remove normal oils and dry the nipples, allowing Candida and bacteria to enter.
  • Can cause other problems when various products are used.

3) Changing the diet or avoiding certain foods

There is little evidence that supports using a specific diet to treat or prevent nipple yeast infections.

Candida diets were popular a few years ago and focused on:

  • Increasing intake of vegetables and proteins and avoiding refined sugars and carbohydrates.
  • Avoiding sources of “yeast”.
  • Consuming probiotic-laden foods or probiotic preparations.

A healthy, balanced diet can increase overall well-being, but there is no conclusive evidence diet affects Candida colonization or infection.Foods containing probiotics such as yoghurt and kefir can be part of a healthy, balanced diet. There is very limited evidence for the use of probiotic preparations.

There is no point avoiding certain foods out of concerns that they carry Candida. The following foods are not prepared with Candida but with other members of the fungus family, and mothers don’t need to avoid the following:

  • Fermented foods
    • Cheese
    • Blue cheese
    • Sauerkraut
  • Bread
  • Yeast-extract spreads

4) Treating a baby who does not have thrush for Candida

Mothers with nipple yeast infections often ask if they should treat a baby who does not have thrush. If a mother has a nipple yeast infection, it is very likely that the baby has Candida in the mouth and the mother continues to have it on her breasts.

The treatments for nipple yeast infection don’t eliminate yeast; they just stop the problem, which is the invasion of the skin of the areola.

We do not recommend treating the baby in this situation because:

  • Treatment of the baby’s mouth with antifungals will likely not eliminate Candida from the baby’s mouth or from the mother’s breast milk or skin.
  • Even if Candida were eliminated, it can be re-acquired from the individual’s environment (Moossavi 2020).
  • There is no evidence that mothers will have less recurrence of nipple yeast infection.
  • We want to avoid treating a healthy baby with antifungal medication.

In our clinic, we would only consider treating a healthy baby if the mother had at least two episodes of nipple yeast infection and all other possible causes had been addressed. We have only had to resort to this a few times.

However, if the baby has thrush and the mother is at an increased risk of nipple yeast infection, it is reasonable to treat the mother's nipples and areolas with an antifungal cream for ten days while the baby is treated. 

5) Throwing out expressed breast milk

There is no need to throw out breast milk that was expressed before treatment for nipple yeast infection was started.

References

Adams RI, Miletto M, Taylor JW, et al. The diversity and distribution of fungi on residential surfaces. PLoS One. 2013 Nov 1;8(11):e78866

Gunther LS, Martins HP, Gimenes F, et al. Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women. Sao Paulo Med J. 2014;132(2):116-20
 
Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis. 2004 Oct 15;39(8):1182-9. Epub 2004 Sep 27
 
Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug 16;6:130

Moossavi S, Fehr K, Derakhshani H, et al. Human milk fungi: environmental determinants and inter-kingdom associations with milk bacteria in the CHILD Cohort Study. BMC Microbiol. 2020 Jun 5;20(1):146