Small plugs in the ducts can cause the milk glands to become over distended with milk. A firm or hard lump in the breast is most likely a plugged duct. It may occur anywhere in the breasts including in the underarm area.
Relief for Engorgement
Put a warm, moist washcloth on your breasts or take a warm shower for 10-20 minutes. Massage your breasts before and during feedings, moving from the chest wall to the nipple. If your breast is hard, hand express or pump a little milk before nursing.
A clogged duct (also called a plugged or blocked duct) is when milk flow becomes obstructed, usually from milk staying in one spot for too long (milk stasis). You may notice a hard lump or small area of engorgement in one breast. That area may feel tender, hot, and may look red.
If you do and don't do anything, the engorgement will likely last for 7 to 10 days. But if you take steps to treat the engorgement, usually it will be gone within maybe 24 to 48 hours, at least the worst part of it.
If you pump for too long, you may make the engorgement worse or last longer than usual. If your breasts still hurt after your baby is 5 days old or you feel a lump in your breast that does not go away after you breastfeed, call your doctor or breastfeeding specialist.
You may think pumping will relieve breast engorgement, and it will—in the short term. But in the long term, pumping only encourages your body to produce more milk, exacerbating the issue.
Plugged duct symptoms progress gradually, and can include pain, a hard lump, a warm and painful localized spot or a wedge-shaped area of engorgement on the breast. Mastitis symptoms appear rapidly and include flu-like symptoms such as fever, chills, fatigue and body aches.
A plugged milk duct feels like a tender, sore lump or knot in the breast. It happens when a milk duct does not drain properly. Pressure builds up behind the plugged duct, and the tissue around it gets irritated. This usually happens in one breast at a time.
It may be red or large enough to be visible if you look at your breast in a mirror. If you've ever dealt with engorgement, the lump from a clogged duct feels like that. Other symptoms of a clogged milk duct are: Pain during letdown (letdown is the initial flow of milk).
The first few times you pump may feel uncomfortable but pumping should not be painful, result in sore nipples, or cause bleeding. Pain, sore nipples, and nipple irritation or bleeding may be signs of an injury.
In some cases, clogs can cause a small white dot at the opening of the duct on your nipple. You might also notice that your milk looks thicker, grainy or stringy.
Aim to spend 15 to 20 minutes hooked up to the pump to net a good amount of breast milk (some women will need 30 minutes or more with the pump, especially in the early days). Pump until the milk starts slowing down and your breasts feel well-drained. Be sure to clean the breast flanges after every use.
If you find a breast lump that feels round, smooth and firm, it could be a cyst — a dilated milk duct filled with fluid. A breast cyst can be large or small, and the surrounding breast tissue may be tender. A breast cyst may appear before your menstrual period and get smaller or disappear afterward.
The lumps are milk ducts and tissues around them that have grown and widened to form cysts. These enlarge quickly in response to hormones released near your period. The lumps may be hard or rubbery and could feel like a single (large or small) lump. Fibrocystic changes can also cause breast tissue to thicken.
Plugged ducts usually occur in one breast at a time and are often caused by inadequate milk drainage. When pressure builds up behind the clog, the surrounding breast tissue becomes inflamed. The good news is that most clogged ducts clear up on their own in a couple of days, especially if you keep your milk flowing.
Signs and symptoms of mastitis often develop quickly and can include: sore breasts that feel swollen, hot, painful to touch. You may also have red patches, but redness can be harder to see on brown and black skin. a lump or hard area on your breast.
“If a plugged milk duct persists [for longer than two days] and there's no relief, there's a chance it can develop into mastitis,” Kramer says. “With mastitis a mother develops a fever (100.4 degrees Fahrenheit), begins to feel fatigued and achy and should seek medical attention immediately.”
Previous studies have suggested that the use of a breast pump increases a mother's risk for developing mastitis, however, incidence rates of mastitis over the stages of lactation do not match breast pump usage rates.
Some might feed every 90 minutes, whereas others might go 2–3 hours between feedings. Newborns should not go more than about 4 hours without feeding, even overnight.
Excessive or habitual pumping can lead to overproduction of milk and prolonged engorgement. If you're exclusively pumping and feeling engorged, make sure you're pumping enough (eight to 12 times in a 24-hour period) and that your pump is working well.
But you'll know when it's too much or too often. Look for signs that your baby is having tummy aches, such as arching their back while crying or making a strained facial expression. If you notice that gas is a daily, constant issue for your baby, then an oversupply of breastmilk might be the culprit.
It's important to lean slightly forward while pumping. If you don't, your pump will have to work quite a bit harder to draw milk from your breast, and you may not be emptying your breast properly. Place a pillow behind you to help you comfortably lean forward and use gravity to help empty your breasts.
Ultimately, if your baby has reached its birth weight and you're pumping enough milk during the day, it's okay to sleep eight hours without pumping at night. Keep in mind there is an adjustment period for your body as it begins to acclimate to the decrease in overnight milk removal.