Nipple vasospasm

Why do my nipples turn white after breastfeeding?

Some mothers have nipple vasospasm, a condition in which blood vessels suddenly narrow and don’t let blood into the nipple. This causes the nipple face to turn white or rarely purple. It can be painful and last up to an hour or more, but with treatment it goes away within minutes. Nipple vasospasm is most likely to develop late in the feed or right after it. It can also happen when the mother is cold, such as after a shower or when leaving the home on a cold day. Nipple vasospasm can affect one or both nipples, and the pain can be mild to severe burning. It can go right around the chest and into the lower shoulder blade.

A) Describing nipple vasospasm

Nipple vasospasm.

“Vasospasm” comes from the word vaso, which refers to blood vessels, and spasm, which refers to a squeezing of muscles.

Nipple vasospasm (vasospasm) is a condition in which the blood vessels suddenly narrow and don’t let blood through. The lack of red blood entering the nipple causes the nipple face to change from pink to white and sometimes even to purple. This lack also keeps oxygen and nutrients from entering the nipple and allows a buildup of waste products. Both of these can cause nipple pain.

When the blood vessels open, allowing blood to again flow into the nipple, it returns to a pink colour and the pain soon stops. The longer the spasm and the more purple the nipple, the greater the pain and the longer the pain takes to stop once the spasm is gone.

Vasospasm is fairly common. One study (Buck 2014) found that 23% of women reported vasospasm within 8 weeks of delivery. It has a number of causes.

B) Appearance

Most often, vasospasm results in the nipple face turning white or pale. As it clears, the nipple usually returns to its normal pink colour.

In some women with more severe vasospasm, the nipple face turns purple. As it settles, the nipples turn darker red and then finally back to pink.

Vasospasm rarely affects the nipple sides and is usually limited to the nipple face.

It may be harder to diagnose vasospasm in mothers with darker nipples. However, the type of pain and the timing are usually strong signs that this is present.

C) Timing

Vasospasm is most likely to develop late in the feed or right after it. Mothers may notice the nipple face is white as the baby lets go at the end of breastfeeding, or it may turn white shortly afterward. The pain starts as the nipple turns white.

Vasospasm can also happen when the mother is cold:

  • Leaving the home on a cold day.
  • After showering.
  • In the freezer section of the grocery store.
  • Entering an air-conditioned room.

A small number of mothers have random episodes of vasospasm. 

Vasospasm can affect:

  • Only one nipple.
  • One nipple more often or more severely than the other.
  • Both nipples equally at the same time.

Without treatment, it can last for up to one hour or more. Treatment clears it in a few minutes. The pain generally stops soon after the nipples return to their normal pink or shortly thereafter. 

D) The type of pain

Most vasospasm is painful. A small number of mothers will have painless vasospasm.

Vasospasm causes mild to severe burning of one or both nipples. Occasionally it can shoot into the outer side of the breast or go right around the chest and into the lower shoulder blade as it follows the T4 nerve (referred pain).

Severe vasospasm can wake mothers up.

E) Confusion with other problems

Because both vasospasm and nipple yeast cause burning after feeds, some mothers with vasospasm are misdiagnosed as having nipple yeast (Wu 2012).  

Nipple yeast infections can cause vasospasm and it may persist even as the nipple yeast infection is getting better. This may result in a mother believing that her nipple yeast is not responding to treatment when in fact it is.

A similar type of pain can also be caused by spasm (squeezing) of the nipple muscle but it is rarely as severe.

Mother who only pump and do not breastfeed may develop a layer of dead skin on the nipple face. This is not vasospasm. 

F) Comparing Raynaud disease and Raynaud disease of the nipple

Nipple vasospasm is sometimes called Raynaud disease of the nipple, which can make it sound a little scary.

Raynaud disease is different from Raynaud disease of the nipple. Raynaud disease is like nipple vasospasm in that the blood vessels narrow, but Raynaud disease affects the fingers and toes.

Raynaud disease can be primary; it just develops. Mostly it affects women, and when cold, their fingers and toes turn white and painful. This is generally only a nuisance and rarely needs treatment.

Raynaud disease can also be secondary and caused by rheumatoid arthritis or other diseases in which the body attacks itself (autoimmune diseases), diseases of the arteries, or medication.

Nipple vasospasm, like primary Raynaud disease, does not increase the risk of other diseases.

References

Buck ML, Amir LH, Cullinane M, et al. Nipple pain, damage, and vasospasm in the first 8 weeks postpartum. Breastfeed Med. 2014 Mar 1; 9(2): 56–62
 

Wu M, Chason R, Wong M. Raynaud's phenomenon of the nipple. Obstet Gynecol. 2012 Feb;119(2 Pt 2):447-9