Treating vasospasm

How do I treat vasospasm?

Nipple vasospasm is nearly always controllable with massage and warmth and settles once the underlying problem is treated. Nipple vasospasm can be stopped by massaging the nipple sides and face, by applying warmth to the nipples, or possibly by medication, but most mothers say massage is the easiest, safest, and most effective tool. Massaging the sides and face should make the pink return to the nipple within 15 to 30 seconds. Mothers can control the condition by applying warmth to the nipples by hand, heating pad, or other method and can prevent it by keeping themselves warm during breastfeeding. Another option is medication but this may have side-effects. Our clinic has found it is rarely needed. Fixing the underlying problems and using massage and occasionally warmth are very effective.

A) Describing the treatment of nipple vasospasm

While nipple vasospasm (vasospasm) can be painful, it is mostly a nuisance and settles once the underlying cause is treated. Mothers should:

  • Fix any breastfeeding problems.
  • Consider limiting caffeine in their diet and exposure to tobacco smoke.
  • Ensure that they are not taking any medication that can cause it.

Vasospasm

  • Is nearly always controllable with massage and warmth.
  • Does not cause short- or long-term damage to nipples.

Mothers should treat vasospasm as soon as it starts. The longer it lasts, the more it will hurt.

The following will minimize the pain of vasospasm until the underlying issue is dealt with.

B) Massaging the nipple sides and face

Nearly all mothers find that massaging the nipple is the easiest, safest, and most effective treatment. Mothers can:

  1. Massage the nipple sides:
    1. Place your index (pointer) finger and thumb on opposite sides of the nipple, near the nipple bottom.
    2. Pinch together slightly and roll the fingers gently back and forth.
    3. Periodically change positions on the nipple sides.
  2. Massage the nipple face by placing your thumb on the nipple face and making tiny circles
  3. Use the palm of the hand to generate warmth and massage the nipple face.

Mothers can alternate between any of these. There is no real right or wrong way to this, as long as it works and does not cause further pain.

This should continue until the pink colour returns and the pain stops. These changes should happen within 15 to 30 seconds. Sometimes the nipple turns whiter as mothers start massaging. If they keep going, the nipple will soon return to pink.

If mothers are in public, they can use pressure instead of massage. It is created by crossing arms in front of the nipples and pushing inward.

The video below shows various ways of massaging the nipple. 

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C) Applying warmth

1) Warmth for treatment

Warmth can be applied to the nipples using:

  • The palm of the hand
  • A hot water bottle
  • A heating pad
  • “Rice socks”or other heated item

A rice sock is a baby’s sock filled with rice and sewn closed. It is microwaved to create a warm pad that can be placed in a bra. Mothers should ensure they do not burn themselves. 

Most mothers at our clinic have told us that nipple massage is easier and more effective for treatment than warmth.

2) Warmth for prevention

In some cases, simply doing up the bra flap immediately after breastfeeding instead of allowing the nipple to air-dry may be all that is needed. Other mothers may find fleece breast pads helpful.

Keeping warm during feedings can help prevent vasospasm. Ways to keep warm include:

  • Staying out of drafts.
  • Placing a shawl or blanket around the shoulders.
  • Placing a hot water bottle or heating pad behind the back.

Wearing several cloth breast pads may help the nipple stay warm. Homemade or commercial wool or fleece breast warmers are another option. At night, wearing warmer bedclothes may help.

D) Medication and supplements

1) Medication

Nifedipine, a medication used for high blood pressure and heart problems, has been used to treat vasospasm (Jansen 2019; Wu 2012). Other similar options are amlodipine and verapamil. All of these:

  • Are compatible (poses very little or no risk to the baby) with breastfeeding.
  • Are prescription medications and must be obtained from your health-care providers.
  • Can cause side-effects in mothers (Anderson 2020).
  • Should not be combined with domeperidone, a medication used to increase milk supply, as this can increase the risk of abnormal heart rhythms.

Starting doses are best kept low to decrease side effects.

Please discuss these options with your health-care providers. We have not found it necessary to resort to medication very often. Fixing the underlying problems and using massage and warmth are very effective.

2) Supplements

Several lower-quality studies have reported that dietary supplements are effective in treating vasospasm. These include (Anderson 2020):

  • Evening primrose oil
  • Fish oil
  • Vitamin B(pyridoxine)
  • L-arginine

References

Anderson PO. Drug Treatment of Raynaud's Phenomenon of the Nipple. Breastfeed Med. 2020 Nov;15(11):686-688

Jansen S, Sampene K. Raynaud Phenomenon of the Nipple: An Under-Recognized Condition. Obstet Gynecol. 2019 May;133(5):975-977
 
Wu M, Chason R, Wong M. Raynaud's phenomenon of the nipple. Obstet Gynecol. 2012 Feb;119(2 Pt 2):447-9