What causes mastitis?

[Cathy Weeks]

I wound up with mastitis for the first time - and my nurseling is
nearly 2 years old! I thought it was rare this far into a
trouble-free nursing relationship?

I woke up Wednesday morning (after having no symptoms previously) with
a sore breast, and felt awful - fever and muscle aches (on top of the
cold I already had) and when I sat in the hot tub, I managed to
express - pus. Yuck. Doctor said to pump and dump on that side, to
avoid having Kivi ingest pus. After 36 hours on antibiotics I started
nursing on that side again, and 4 days into it, I'm much, much better.
It was sore, had a red streak, and a red patch, had hard areas, was
hot to the touch, the works. No fun.

So what causes it?

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Irrational Number]

Cathy Weeks wrote:
> I wound up with mastitis for the first time - and my nurseling is
> nearly 2 years old! [...] After 36 hours on antibiotics I started
> nursing on that side again, and 4 days into it, I'm much, much better.
> It was sore, had a red streak, and a red patch, had hard areas, was
> hot to the touch, the works. No fun.
>
> So what causes it?

Had you been having a plugged duct beforehand?
Have you noticed red streaks on the side of your
breast or pain (like a bruise) or white spots
on the nipple?

I've been getting those and been frantically
staying in the hot shower (I normally like tepid
showers) trying to express the plugs out. I think
one of the causes of mastitis is if plugged ducts
stay around for awhile and bacteria build up
behind them...

-- Anita --
--
SUCCESS FOUR FLIGHTS THURSDAY MORNING ALL AGAINST
TWENTY ONE MILE WIND STARTED FROM LEVEL WITH ENGINE
POWER ALONE AVERAGE SPEED THROUGH AIR THIRTY ONE
MILES LONGEST 57 SECONDS INFORM PRESS HOME CHRISTMAS.

[Lara]

Cathy Weeks > wrote:

> I wound up with mastitis for the first time - and my nurseling is nearly 2
> years old! [...] Yuck. Doctor said to pump and dump on that side, to
> avoid having Kivi ingest pus.

A healthy two year old is at no risk from mastitis milk. Unless you're a
_really_ good pump responder and experienced with a breast pump, a
nursing baby is likely to empty your breast a lot more thoroughly than a
pump, which is the key to successful mastitis treatment. Antibiotics are
just an adjunct. Rule One in mastitis treatment is "nurse, nurse,
nurse".

Lara

[Naomi Pardue]

>So what causes it?

Like any infection, mastitis is caused by bacteria. Hard to say what caused
you to get it this late. Getting overtired, Kivi not nursing well for some
reason, (is she nursing less often lately?) causing your breasts to become
engorged, a crack or sore spot on the nipple.. (is she teething?).

Glad you're feeling better.


Naomi
CAPPA Certified Lactation Educator

(either remove spamblock or change address to to e-mail
reply.)

[Cathy Weeks]

(Lara) wrote in message >...
> Cathy Weeks > wrote:
>
> > I wound up with mastitis for the first time - and my nurseling is nearly 2
> > years old! [...] Yuck. Doctor said to pump and dump on that side, to
> > avoid having Kivi ingest pus.
>
> A healthy two year old is at no risk from mastitis milk. Unless you're a
> _really_ good pump responder and experienced with a breast pump, a
> nursing baby is likely to empty your breast a lot more thoroughly than a
> pump, which is the key to successful mastitis treatment. Antibiotics are
> just an adjunct. Rule One in mastitis treatment is "nurse, nurse,
> nurse".

Hmmm.... I'm not so sure. I just looked up mastitis in the Breast
Feeding book, and it doesn't mention nursing in the presence of pus.
Let me be a little more clear about what was happening:

1. About 7 years ago, I had my nipples pierced. I didn't like it, so
removed the piercings after about 5 or 6 months. The holes never
fully closed, and during nursing, milk leaks out the hole on the side
of my nipple, in addition to the end of my nipple.

2. When I woke up that morning, I nursed Kivi, knowing the advice is
to nurse, nurse, nurse. I felt so wretched after we got up, that I
let Kivi watch TV while I got into the hot tub (knowing moist heat is
also recommended), and massaged my breast. I was more than a little
grossed out when I expressed pus. The pus, which is thicker than milk
didn't come out the holes in the end of the nipple, rather it came out
the hole in the side of my nipple, which is bigger, and more easily
allows the pus to come out. It was greenish-yellow, and oily. It
wasn't just a little amount, but I got it to come out repeatedly,
small amounts each time. When I pumped, a small amount came out, too.
So I know that my daughter would have (and probably did) ingest it
prior to me realizing it was there.

So, that said, is the advice still to nurse a child on the affected
side, given that pus was coming out? I'm not so sure. I asked my
doctor, and she said that mastitis without pus, the recommendation is
to nurse often, but with pus, to pump instead.

So, I guess I'm asking you to go back to your sources and check to see
if it still holds true with pus. I have to admit - it seems pretty
icky to me.

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Cathy Weeks]

(Naomi Pardue) wrote in message >...
> >So what causes it?
>
> Like any infection, mastitis is caused by bacteria. Hard to say what caused
> you to get it this late. Getting overtired, Kivi not nursing well for some
> reason, (is she nursing less often lately?) causing your breasts to become
> engorged, a crack or sore spot on the nipple.. (is she teething?).

For the last six months, I've not pumped during the days she goes to
daycare (three days per week). This is for 8-9 hours. She gets an
extra-milky nursing as soon as she gets home. But the engorgement is
only slight, and after six months, you'd think I'd be used to it.
When she's with me, she nurses pretty frequently - 5-6x per day, and
usually 1-2x a night. The infection cropped up after 5 consecutive
days at home, so I tend to discount the skipped feeding due to daycare
as being the cause.

No cracks, and no she's not teething. However, I did have some latch
problems and soreness. But that was a few weeks ago, and things were
better.

I did have a very bad cold, and I suspect my resistance was down.

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Cheryl S.]

"Cathy Weeks" > wrote in message
m...
> 1. About 7 years ago, I had my nipples pierced. <snip>
> The pus, which is thicker than milk
> didn't come out the holes in the end of the nipple, rather
> it came out the hole in the side of my nipple, which is bigger,
> and more easily allows the pus to come out. <snip>

Maybe these larger holes allowed bacteria to get in easier, and that's
what caused the mastitis?
--
Cheryl S.
Mom to Julie, 2 yr., 8 mo.
And Jaden, 3 months

Cleaning the house while your children are small is like
shoveling the sidewalk while it's still snowing.

[Lara]

Cathy Weeks > wrote:

> So, that said, is the advice still to nurse a child on the affected
> side, given that pus was coming out? I'm not so sure. I asked my
> doctor, and she said that mastitis without pus, the recommendation is
> to nurse often, but with pus, to pump instead.

I can't find any evidence base for this recommendation anywhere. Even
mainstream sources such as
http://www.emedicine.com/aaem/topic300.htm
say it is safe to nurse. Here's our local guide:
http://www.health.gov.au/pubhlth/publicat/document/brfeed/practice_guide
..pdf
which says nothing about mastitis milk ever being unsafe, and reinforces
the necessity to continue feeding. Mothers continue to nurse even with a
frank abscess, which is a collection of pus. If you want to squeeze as
much pus as you can out first, then nurse, that would be fine too.

thebestfedbaby says:
"Our mother's generation used to experience breast abscesses a lot, not
because they were anatomically different, but because mothers then were
encouraged to put babies on a rigid schedule (leading to plugged ducts),
and were then told NOT to nurse their babies because the milk was
infected and would make them sick. Nowadays, every doctor knows that the
milk from an infected breast will not harm the baby in any way, because
antibodies in the milk protect him from infection."

Not to mention that the bacteria quite likely came from the baby's mouth
in the first place.

In my opinion, the onus of evidence is always on the person recommending
pumping & dumping (or weaning), not the person recommending
breastfeeding. I reckon that switching to pumping-only (especially if
you're tired and not a good pump responder) is more likely to lead to
abscess, not less. Have you asked your doctor for her source of
information?

Lara

[Lara]

Cathy Weeks > wrote:

> I did have a very bad cold, and I suspect my resistance was down.

That's just adding insult to injury, isn't it? I hope you feel better
soon. I used to get blocked ducts when I was underslept or sick - I
wondered if it had something to do with not eating well at those times,
too. Have you tried adding lecithin?

Lara

[Cathy Weeks]

"Cheryl S." > wrote in message >...
> "Cathy Weeks" > wrote in message
> m...
> > 1. About 7 years ago, I had my nipples pierced. <snip>
> > The pus, which is thicker than milk
> > didn't come out the holes in the end of the nipple, rather
> > it came out the hole in the side of my nipple, which is bigger,
> > and more easily allows the pus to come out. <snip>
>
> Maybe these larger holes allowed bacteria to get in easier, and that's
> what caused the mastitis?

Why now? Kivi has been breastfeeding for 2 years now.

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Nina]

"Cathy Weeks" > wrote in message
om...
> "Cheryl S." > wrote in message
>...
> > "Cathy Weeks" > wrote in message
> > m...
> > > 1. About 7 years ago, I had my nipples pierced. <snip>
> > > The pus, which is thicker than milk
> > > didn't come out the holes in the end of the nipple, rather
> > > it came out the hole in the side of my nipple, which is bigger,
> > > and more easily allows the pus to come out. <snip>
> >
> > Maybe these larger holes allowed bacteria to get in easier, and that's
> > what caused the mastitis?
>
> Why now? Kivi has been breastfeeding for 2 years now.
>

No telling. Its possible she has gotten into something and has new bacteria
in her mouth that are getting inthe nipple

[Cathy Weeks]

(Lara) wrote in message >...
> Cathy Weeks > wrote:
>
> > I did have a very bad cold, and I suspect my resistance was down.
>
> That's just adding insult to injury, isn't it? I hope you feel better
> soon. I used to get blocked ducts when I was underslept or sick - I
> wondered if it had something to do with not eating well at those times,
> too. Have you tried adding lecithin?

You know, I've been seeing a lot of mentions of this - as an additive
to smoothies, etc. What's it supposed to do? And where do I find the
granuals loose (not in capsules)?

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Cathy Weeks]

(Lara) wrote in message >...
> Cathy Weeks > wrote:
>
> > So, that said, is the advice still to nurse a child on the affected
> > side, given that pus was coming out? I'm not so sure. I asked my
> > doctor, and she said that mastitis without pus, the recommendation is
> > to nurse often, but with pus, to pump instead.
>
> I can't find any evidence base for this recommendation anywhere. Even
> mainstream sources such as
> http://www.emedicine.com/aaem/topic300.htm

The URL above had the following quote:

"If left untreated, an abscess, which is an infection within an
enclosed space that forms a collection of pus, can develop in the
breast tissue. This infection is more serious and may require surgical
drainage."

"You should be seen by a doctor right away if you have any of the
following symptoms:
A persistent high fever greater than 101.5°F
Nausea or vomiting that is preventing you from taking the antibiotics
as prescribed
Pus draining from the breast
Red streaks extending toward your arm or chest
Dizziness, fainting, or confusion"

"A breast abscess may require surgical drainage, IV antibiotics, and a
short hospital stay. A small incision is made and usually heals quite
well. Prognosis for complete recovery is also good. Breastfeeding
should be avoided in the infected breast when an abscess is present."

I think I had an abscess (though my doctor didn't do anything to drain
it). I had almost all of the more serious symptoms. I wasn't
vomiting, but I did have a fever higher than 101.5 (but only slightly:
101.6). I had a red streak, and a big red patch. I wasn't fainting
or confused, but did have dizzy periods. I think my doctor didn't do
anything to drain it because of how soon the treatment began. I woke
up that morning with it (with no prior symptoms) and was seen that
evening. And honestly, I prefer the more conservative treatment, and
wait and see if draining became necessary.

But this source recommend against breastfeeding with an abscess.

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Cheryl S.]

"Cathy Weeks" > wrote in message
om...
> "Cheryl S." > wrote in message
>...
> > "Cathy Weeks" > wrote in message
> > m...
> > > 1. About 7 years ago, I had my nipples pierced. <snip>
> > > The pus, which is thicker than milk
> > > didn't come out the holes in the end of the nipple, rather
> > > it came out the hole in the side of my nipple, which is bigger,
> > > and more easily allows the pus to come out. <snip>
> >
> > Maybe these larger holes allowed bacteria to get in easier, and
that's
> > what caused the mastitis?
>
> Why now? Kivi has been breastfeeding for 2 years now.


You might have just now been exposed to some source of bacteria that you
weren't in the previous two years, or as you said elsewhere maybe it's
just your resistance being low for other reasons, or a combination of
those things. Who knows. I hope that you are feeling better soon.
--
Cheryl S.
Mom to Julie, 2 yr., 8 mo.
And Jaden, 3 months

Cleaning the house while your children are small is like
shoveling the sidewalk while it's still snowing.

[Cathy Weeks]

"Cheryl S." > wrote in message >...

> You might have just now been exposed to some source of bacteria that you
> weren't in the previous two years, or as you said elsewhere maybe it's
> just your resistance being low for other reasons, or a combination of
> those things. Who knows. I hope that you are feeling better soon.

I'm feeling much better, thanks. It's been just over a week now, and
I'm symptom free. I have one last antibiotic to take.

Cathy Weeks
Mommy to Kivi Alexis 12/01

[Chookie]

In article >,
(Cathy Weeks) wrote:

> So what causes it?

Having read the other posts -- nobody has suggested an ill-fitting bra or
injury (eg from being accidentaly kicked by your child). These seem to make
mastitis more likely.

WRT the pus question -- I thought that pus, though icky, consisted of dead
cells? While it might not be terribly nutritious :-0 , it wouldn't be harmful.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"Jeez; if only those Ancient Greek storytellers had known about the astonishing
creature that is the *Usenet hydra*: you cut off one head, and *a stupider one*
grows back..." -- MJ, cam.misc

[Lara]

Cathy Weeks > wrote:

> (Lara) wrote:
> > Cathy Weeks > wrote:
> >
> > > So, that said, is the advice still to nurse a child on the affected
> > > side, given that pus was coming out? I'm not so sure. I asked my
> > > doctor, and she said that mastitis without pus, the recommendation is
> > > to nurse often, but with pus, to pump instead.
> >
> > I can't find any evidence base for this recommendation anywhere. Even
> > mainstream sources such as
> > http://www.emedicine.com/aaem/topic300.htm
>
> The URL above had the following quote:
[snip]
> "A breast abscess may require surgical drainage, IV antibiotics, and a
> short hospital stay. A small incision is made and usually heals quite
> well. Prognosis for complete recovery is also good. Breastfeeding
> should be avoided in the infected breast when an abscess is present."

As I said, "even mainstream sources". Most breastfeeding-friendly
doctors I know would disagree with that last sentence. I was giving this
page as an example of a non-breastfeeding-friendly source still advising
to continue nursing in the presence of mastitis, not as an example of
what I consider breastfeeding-friendly advice.

You skipped the bit that said, "Do not stop nursing from the affected
breast. (Yes, this will be painful.)[...] The infection will not harm
the baby because the germs that caused the infection probably came from
the baby's mouth in the first place. An alternative to this is to pump
the affected breast to relieve the milk and discard the milk. Nurse from
the unaffected side and supplement with infant formula as needed."

Pus is just dead cells and bugs. The baby already has the bugs. The dead
cells aren't going to do any harm. But hey, it's your breast, and your
baby.

> I think I had an abscess (though my doctor didn't do anything to drain
> it). I had almost all of the more serious symptoms. I wasn't
> vomiting, but I did have a fever higher than 101.5 (but only slightly:
> 101.6). I had a red streak, and a big red patch.

None of these signs and symptoms are specific to abscess. Mastitis is a
serious infection and can rapidly give severe sytemic and local symptoms
in the absence of abscess.

Lara

[Hillary Israeli]

In >,
Cathy Weeks > wrote:

*I woke up Wednesday morning (after having no symptoms previously) with
*a sore breast, and felt awful - fever and muscle aches (on top of the
*cold I already had) and when I sat in the hot tub, I managed to
*express - pus. Yuck. Doctor said to pump and dump on that side, to
*avoid having Kivi ingest pus. After 36 hours on antibiotics I started

Really? My doctors have always said "nurse, nurse, nurse" when I've had
mastitis (both my pediatrician and my obstetrician have said it, I mean).

*So what causes it?

Probably bacteria entering through a somewhat traumatized nipple, with or
without the complicating factor of ins****ated milk in a duct somewhere.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

[Sidheag McCormack]

Hillary Israeli writes:

> the complicating factor of ins****ated milk in a duct somewhere.

that's the best new word I've learnt in months - thank you! Ins****ated...

Sidheag
DS Colin Oct 27 2003

[Ruth Shear]

G'day Cathy

> So what causes it?

Naomi Pardue wrote

> Like any infection, mastitis is caused by bacteria. Hard to say what caused
> you to get it this late. Getting overtired, Kivi not nursing well for some
> reason, (is she nursing less often lately?) causing your breasts to become
> engorged, a crack or sore spot on the nipple.. (is she teething?).

I'm not sure if anyone mentioned this, but having a new bra that perhaps
is more tight fitting, or lying or sitting in a funny position that
squashes part of your breast, so milk backs up can do it. I got mastitis
once after an hour long ride in a small commuter plane. It was cramped
and I fell asleep while bf DS in a weird position.Being sick or run down
certainly can be a contributing factor.

You may want to google for my postings on inflammatory mastitis last
year. There's lots of interesting stuff there. Since you had pus, it
seems like you had the blocked duct sort of mastitis - I never got pus
and always seemed to have the inflammatory variety.

DrRuth
Mum to Joshua Eamon (Nov 15th, 2001)
<http://uts.cc.utexas.edu/~drruth/joshua/>

[mitch]

(Cathy Weeks) wrote in message >...
> I wound up with mastitis for the first time - and my nurseling is
> nearly 2 years old! I thought it was rare this far into a
> trouble-free nursing relationship?
>
> I woke up Wednesday morning (after having no symptoms previously) with
> a sore breast, and felt awful - fever and muscle aches (on top of the
> cold I already had) and when I sat in the hot tub, I managed to
> express - pus. Yuck. Doctor said to pump and dump on that side, to
> avoid having Kivi ingest pus.

I woke New Years Day with exactly the same. I continued nursing and
pumping to keep that side milked out. (Just as we do with the cows)
I went to the Dr Friday morning and he gave me some anti-biotics and
told me to use hot and cold compresses and carry on nursing only on
the infected side (even though there was pus which is quite normal
with mastitis) and pump the other if I could until the pain subsided
then carry on with normal nursing. I'm still a bit lumpy but mostly
pain free now.

Emma is 7 months now and I haven't had any problem with nursing. Just
one of those things I suppose.

Mitch


After 36 hours on antibiotics I started
> nursing on that side again, and 4 days into it, I'm much, much better.
> It was sore, had a red streak, and a red patch, had hard areas, was
> hot to the touch, the works. No fun.
>
> So what causes it?
>
> Cathy Weeks
> Mommy to Kivi Alexis 12/01