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Ductal Thrush and Breastfeeding

I am a mother who experienced ductal thrush, sharing what I learned. My information was reviewed by a Board Certified Lactation Consultant.

REVIEWED BY
Ruth Hale, Founder, IBCLC & Doula at Birth to Breast

Ductal Thrush: Signs and Help for Breastfeeding Moms

Ductal Thrush: Signs and Help for Breastfeeding Moms

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 (may be related to it). Ductal thrush is when a fungal yeast infection (candida) affects the milk ducts, and the pain is experienced in the deep tissue of the breast. There may be signs of thrush on the nipple as well, but sometimes there isn't, meaning it can be difficult to diagnose and therefore get properly treated.

When there are no obvious symptoms of thrush, the condition is sometimes misdiagnosed as either vasospasm or mastitis. In the UK, general practitioners sometimes don't know much about ductal thrush or its treatment. If you think you have ductal thrush, it is important to gather information before going to see your doctor. Midwives and health visitors or caregivers are sometimes more clued into the condition and can speak to your doctor for you if you feel you aren't getting anywhere.

Symptoms of Ductal Thrush

If left untreated, ductal thrush gets very painful very quickly, so it's best to nip it in the bud before it becomes so painful you struggle to breastfeed. Here are some clues that can help lead to a proper diagnosis:

  • You have or had thrush when you gave birth
  • Your baby has thrush in the nappy (diaper) area
  • Your baby has oral thrush (white patches inside the mouth that cannot be easily removed)
  • You are experiencing painful latch-on after a period of pain-free feeding
  • You notice signs of thrush (white patches) on your nipples
  • You feel burning or stabbing pain deep within your breast after feeding that lasts for up to two hours

A Stabbing, Burning Pain Deep in Your Breast After Feeding

You and your baby may have no visible signs of thrush, but if you are experiencing pain deep in your breast after feeding, then you almost certainly have ductal thrush.

The stabbing, burning pain becomes very painful if left untreated. It can last up to two hours—that means that as soon as the pain subsides, it's time to feed again, so you are in almost 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—not so much during the actual feed but when latching and after feeding. It is important to get treated quickly and correctly in order to be able to continue breastfeeding comfortably.

Treatments for Ductal Thrush

The most important thing in the treatment of ductal thrush is that BOTH you and your baby must be treated at the same time—regardless of whether your baby has obvious symptoms of thrush in their mouth. If you have ductal thrush, then your baby most certainly has thrush as well, and if you are not treated together, you will keep passing the infection back and forth and it will be impossible to heal. Insist that your doctor treats you both!

Treatment for the mother:

  • Nipple Cream (2% Miconazole). You will need a cream for your nipples, even if you have no obvious signs of thrush there. The cream is called miconazole 2% and should be applied topically after every feeding.
  • Antifungal Tablets. You will need an antifungal tablet to treat the ductal thrush. Fluconazole is the drug used, although the company that makes the drug has not licensed it for breastfeeding. This does not mean it is unsafe for breastfeeding women. The WHO says that fluconazole is compatible with breastfeeding, but you may have to convince your doctor to prescribe it. Your next issue will be to ensure you are given the correct dose. It is 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 (see below).
  • Tylenol. For pain, nursing mothers can get over-the-counter relief like Tylenol (acetaminophen) or Advil (ibuprofen) for a short term. Follow the dosage directions on the label.

Treatment for the baby:

  • Miconazole Gel. Your baby will need miconazole oral gel, which should be applied gently inside the mouth with a clean finger to ensure all surfaces have been covered. Do this after each daytime feeding, or at least 4 times a day. Note the gel is not recommended for use in babies under 4 months old due to a risk of choking, not because the medicine isn't safe.

Using Fluconazole for Resistant Cases of Thrush

For resistant and hard-to-get-rid-of cases of thrush, oral fluconazole is recommended by the Academy of Breastfeeding Medicine (ABM). After your doctor has reviewed your prescriptions and medical history to make sure there are no contraindications, they recommend a loading dose of 200 mg for your first day followed by a lower dose of 100 mg for the next seven days.

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. There are some other things you can do to help and to help prevent being reinfected.

How to Avoid Reinfection With Ductal Thrush

  • Have every person in the household use only their own towel
  • Sterilize every bottle, nipple, and dummy (pacifier) your baby uses
  • Some say eating less sugar and yeast helps, and recommend eating probiotic yoghurt.
  • If you express milk, it is best not to save any whilst you have the thrush infection, as you may reinfect your baby.

Other Possible Diagnoses

Thrush may have some symptoms in common with both vasospasm and mastitis. Below you will find some information that may help you understand the difference.

Is It Vasospasm?

Your pain might also be caused by vasospasm (aka mammary constriction syndrome, MCS), which is when the blood vessels in your nipple abnormally contract, impairing blood flow to the area and causing pain in the nipples and/or breasts. According to one study, almost 25% of all mothers experience vasospasms within the first eight weeks after giving birth.

Symptoms of vasospasm:

  • Burning, pulsing, and/or “pins and needles” pain in the nipple and/or breast, usually just after feeding.
  • During breastfeeding, there may or may not be pain.
  • Pain may also be experienced with abrupt changes in temperature that cause the nipple to harden.
  • The nipple pain might be accompanied by a change in shape or color.

The contraction of blood vessels may cause a lack of blood flow to the area, which may delay healing. To learn more, read How to Treat Nipple Vasospasms and Nipple Blanching When Breastfeeding.

Is It Mastitis?

As I mentioned earlier, many mistake ductal thrush for mastitis. The only thing in common between the two conditions is that you may feel a burning pain in your breast. To ensure you aren't confusing mastitis for ductal thrush, here is the difference.

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
  • fever
  • chills
  • generally feeling unwell

Trust your instincts. If you know you don't have mastitis, stand your ground and don't let your doctor misdiagnose you.

Symptoms: Ductal Thrush vs. Vasospasm vs. Mastitis

Ductal ThrushVasospasmMastitis

Breast feels and looks normal, except during latching and after feeding, when there is deep pain.

The pain is experienced in the nipple, not the entire breast. Nipples may change color (red, pink, brown, or white).

Breast is red and feels hot and hard; pain is felt before, during, and after feeding.

Usually affects both breasts.

More likely to occur on both sides, but can affect just one nipple.

Usually affects one breast.

White patches appear on the nipple (and possibly in the baby's mouth).

She may also feel nipple pain when moving from warm to cold, like when getting out of the shower.

Woman experiences fever, chills, and general symptoms of illness.

FAQ

Can I have thrush in one breast only?

Ductal thrush usually affects both breasts, but may occur in only one breast (or nipple).

Will thrush eventually go away on its own?

Thrush rarely goes away on its own. It requires treatment with antifungals. Of course, always consult your doctor to find out which treatment is right for you.

What happens if thrush is not treated?

Left untreated, those symptoms will likely persist and possibly worsen. Left untreated, the thrush may become more severe, and there is a risk of the infection spreading further in your body.

Can I take Aleve?

Naproxen is not recommended. Because of its long half-life and the possibility of digestive complications for the newborn, nursing mothers are told to use it only with great caution and only for a limited time. To learn more, read Medication Use and Breastfeeding.

Sources

ABM Clinical Protocol #26: Persistent Pain with Breastfeeding

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Cami on May 10, 2018:

I have ductal thrush! It is one of the most painful things I have ever experienced (and I gave birth naturally 4 times)! It is the worst when baby eats and does not drain the breast completely. Then about 5-20 minutes later the pain sets in. It usually lasts about 2 hrs but last time it was nearly 4! It is horrible! I wish I had known what it was and had gotten treated sooner! My dr tried to treat for mastitis but I know it wasn't right. I have had mastitis twice already with this baby and was on an antibiotic one of the times (which is probably why I got thrush) this is very different than mastitis. No fever and chills just lots of intense burning throughout the breast that starts after baby eats! I had to see a second dr and she prescribed an anti fungal tab and cream. I am now also taking lecithin. It is a supplement that helps prevent the milk ducts from clogging. Hopefully no more mastitis or thrush!

Gabrielle Perry on March 31, 2018:

Can ductile yeast cause decrease in milk supply?

Georgia Estes from Arkansas on June 17, 2017:

This is a helpful article for breastfeeding moms! Thanks for the details.

Meg Moon (author) from United Kingdom on October 07, 2014:

Sonam you need to go to your Dr asap and get some fluconazole. Also you must get thrush gel for your baby's mouth. See article above for more advice.

sonam on October 07, 2014:

i have ductal thrush. dere is a lot of pain in my breast during or 1 hr after feeding.wat to do

Meg Moon (author) from United Kingdom on April 02, 2013:

I agree- when I got ductal thrush with my third baby I was prepared for it and knew what to do so I was able to overcome it a lot easier. Thanks for your comments.

Recipe Gal on April 01, 2013:

Breastfeeding is so important for babies. I think many women wean early because they have problems that they don't know how to overcome. I think articles like this are great to help women figure out what those problems might be and how to fix them. Good work!