Ductal Thrush and Breastfeeding
What is Ductal Thrush?
Ductal thrush is a painful and annoying condition that can affect breastfeeding mothers. It is not the same as thrush in the nipple but can be related to it. Ductal thrush is where the thrush infection is in the milk ducts and so the pain is experienced in the deep tissue of the breast. There may be signs of thrush on the nipple as well but often there is not meaning it can be difficult to get diagnosed and therefore treated.
Where there are no obvious symptoms of thrush the condition can often be misdiagnosed as mastitis. In the UK general practioners tend not to know much about ductal thrush or its correct treatment. It is important if you think you have ductal thrush to arm yourself with all the information before going to see your doctor. Midwives and health visitors seem to be a lot more clued up on the condition and can speak to your doctor for you if you feel you aren't getting anywhere.
How can I tell if I've Got Ductal Thrush?
If left untreated ductal thrush gets very painful very quickly so it's best to try nip it in the bud before it becomes so painful you struggle to continue to breastfeed. Some clues that you might be getting ductal thrush are:
1) You have thrush or had thrush when you gave birth
2) Your baby has thrush in her nappy area
3) You notice your baby has oral thrush- white patches inside your baby's mouth that cannot be easily removed
4) You are experiencing painful latch on after a period of painfree feeding
5) You have signs of thrush on your nipples
6) You begin to notice a burning or stabbing pain deep within your breast after feeding that lasts for up to two hours
Note you and your baby may have no visible signs of thrush but if you are experiencing the pain described in point 6) then you almost certainly have ductal thrush.
The stabbing, burning pain becomes very painful if left untreated and can last for up to two hours that means that as soon as the pain subsides you are due to feed again and therefore you are almost in constant pain. Some women say the pain of ductal thrush is worse than labour pains. Although it is perfectly safe to feed your baby whilst you have thrush it does make feeding painful- although not so much during the actual feed more when latching your baby on and then afterwards. It is important to get treated quickly and correctly in order to be able to continue breastfeeding comfortably.
What is the Treatment for Ductal Thrush?
The most important thing in the treatment of ductal thrush is BOTH you and your baby must be treated at the same time- this is regardless of whether your baby has obvious symptoms of thrush in his mouth- if you have ductal thrush then your baby most certainly has thrush as well as if you are not treated together then you will keep passing the infection back to one another and the thrush will be impossible to shift.
Demand that your doctor treats you both!
Treatment for the mother-
1) You will need a cream for your nipples- even if you have no obvious signs of thrush on your nipples. The cream is called miconazole 2% and should be applied topically after every feed.
2) You will need an antifungal tablet to treat the ductal thrush- flucanazole is the drug used. However the company who make the drug have not licensed it for breastfeeding. This is more to do with the fact they don't want to pay for a license and not because it is unsafe for breastfeeding women. The WHO say that flucanazole is compatible with breastfeeding but you will have to convince your doctor to prescribe you it as it will be up to her discrection to give you it.
Your next issue will be to ensure you are given the correct dose. It seems it is quite common for doctors to give women the incorrect dose meaning that the thrush persists. To start with you should be given a larger dose on day one known as a loading dose. This should be 15-300mg you will then need 50-100mg two times a day for at least 10 days. If you have particularly aggressive or persistent ductal thrush you may need a higher dose.
3) Your baby will need miconazole oral gel- this should be applied gently inside the baby's mouth with a clean finger to ensure all surfaces have been covered. Do this at all day time feeds or at least 4 times a day. Note the gel is not recommended for use in babies under 4 months, however this is due to a risk of choking not because the medicine isn't safe. Therefore the gel is OK to use on younger babies just ensure you give small amounts at regular intervals and avoid using a medicine spoon.
No It's Not Mastitis!!!
As I mentioned earlier many doctors misdiagnose ductal thrush as mastitis- perhaps this is because they actually know something about mastitis! The only thing in common between the two conditions are that you may feel a burning pain in your breast. To ensure you aren't confusing mastitis for ductal thrush here are the main symptoms of mastitis:
- a red segment of your breast that feels hot
- usually only affects one breast- ductal thrush usually affects both
- your breast may feel hard
- burning pain in your breast even during feeding
- generally feeling unwell
Trust your instincts- if you know you haven't got mastitis stand your ground and don't let your doctor misdiagnose you.
What Else Can I Do?
The most important thing to do if you suspect you have ductal thrush is to go to your doctor and get it treated at once- after taking the fluconazole you should feel less pain within three days. However there are some other things you can do to help and to help prevent being reinfected.
- have every person use their own towel only
- sterilize any bottle teats and dummies your baby uses- avoid using them if possible
- Diet- some women say eating less sugar and yeast helps. Also try eating probiotic yoghurt
- If you express milk it is best not to save any whilst you have the thrush infection