If you’ve ever had sore nipples (or, even worse, cracked nipples!), you’ll know what a nightmare it is. And it really doesn’t help when everyone says to you “breastfeeding is not supposed to hurt – you must be doing something wrong!” Or, even worse, “just hang on for two (or six or ten) weeks until your nipples toughen up!” So I won’t say either of those things. I’ll just give you some advice on how to make the pain better, here and now, so that you can face another day of breastfeeding.
Get to the root cause
The most important thing is to figure out why your nipples are hurting in the first place. If you have no idea, check out this post for some of the common causes of nipple pain. The thing is, if you don’t find and fix the root cause, your nipples just won’t get better no matter what else you do. The good news is, if you do fix the cause, things get better very quickly!
Help sore nipples heal
Even when you have figured out what caused your sore nipples and fixed the problem, the skin and tissue of the nipple still needs to recover and heal. The deeper the injury was, the longer this will take: a surface abrasion will be fine within a day or two, whilst a bad crack might take a week or more to fully heal. Either way, here are some things that will help speed up the healing process regardless of how serious it is:
Nipple creams help to soften and moisturize the skin of the nipple – basically, nipple cream does for your nipple what lip balm does for your lips. In most cases, nipple cream doesn’t make the skin heal more quickly, but it does help ease the pain and discomfort.
The basic ingredient in most nipple creams is purified lanolin – in fact, some well-known brands of nipple cream contain nothing but pure lanolin. Nipple creams can also have other ingredients added. One that is worth looking out for is dexpanthenol; it is a precursor of vitamin B5 that can potentially help damaged skin to recover more quickly. But my favourite nipple cream actually comes out of my kitchen cupboard: coconut oil. It’s wonderful for moisturising the skin, and unlike other nipple creams, it also has anti-fungal properties.
Please take note that if you have any sort of infection in the nipple (e.g. thrush or an open wound), a regular nipple cream may not be appropriate; you will need a medicated ointment. And it’s not a good idea to use creams intended for other parts of the body on the nipples – so no Vaseline, aqueous cream or other lotions! Nipple creams are specifically formulated to not be dangerous for baby to ingest.
Breast milk itself is actually one of the best lotions for healing cracked nipples. The anti-infective factors in the breast milk help to eliminate any germs that may be present, while growth factors and vitamins help the skin to heal. After each feed, express a few drops of milk and rub it into the nipple area (make sure your hands are clean, so that you don’t introduce an infection to the nipple). Leave it to air dry before putting your bra back.
Hydrogels are little gel pads that are designed to be worn in the bra against the nipples. They are intended to soothe the skin and help it heal. There is some disagreement on how effective hydrogels are, but some women do find that they help. Unfortunately they can only be used for a short time – usually a few days – and they are quite expensive, so they are not my first choice. Do not use hydrogels if you suspect you have thrush or another infection.
Wound care nurses will tell you that sunshine is an excellent healer for any kind of wound, and sore nipples are no exception. Sit with your nipples exposed to direct sunlight (not through a window) for a few minutes several times a day.
Laser and other light therapies
Physiotherapists offer laser treatment and other kinds of light therapy for sore nipples. It works in much the same way as sunlight, except that the exposure is concentrated in a shorter time, and you don’t need to sit topless in the backyard. Most women who have gone for this therapy have found it very helpful. Just remember that you need to address the cause of the sore nipples at the same time.
Clean and dry
Keeping the nipples clean is important for preventing infections. If there is any broken skin, it is advisable to wash the nipple with clean water after every feed, so that you remove any bacteria that may have been transferred to the nipple from baby’s mouth.
It’s also important to keep the nipple dry: skin that is constantly wet becomes very fragile and can break very easily. This means you need to let your nipple air-dry before putting your bra back – or go bra-less if you prefer. If you leak milk, it is important to wear absorbent breast pads and to change them as soon as they feel wet against your skin.
If you have any broken skin on the nipple, there is a risk for infection. It’s very important to prevent such an infection, because an infected wound will take much, much longer to heal. The first step, as I said in the previous point, is to wash the nipple after every feed. Then you should also apply an antibacterial ointment to prevent infection: apply a tiny amount of mupirocin ointment (the trade name is Bactroban or Supiroban) to broken skin three times a day. There is no need to wash it off before feeds, since it will be completely absorbed by then; and even if the baby swallows a bit of the ointment it won’t be absorbed by his body.
Breast shells are plastic “domes” that are placed inside the bra; they prevent the bra from touching your nipple. They won’t necessarily make the skin heal any faster, but if your nipples are very sensitive they may help keep you more comfortable in between feeds. If you do use breast shells, wash them well every day to prevent them becoming a breeding ground for bacteria. You should never sleep with breast shells in place; they can easily move around and cause problems such as blocked ducts.
I know some hospitals are very fond of recommending nipple shields as a treatment for sore nipples. To me, they are a last resort when all else has failed; I will honestly only recommend a nipple shield when it’s either that or stop breastfeeding. Why? Because nipple shields come with their own problems. If not used correctly, they can cause breast milk production to decrease because the nipple is not stimulated enough. Baby can also become so used to the shield that he refuses to breastfeed without it; having to carry around that piece of plastic the whole time is just irritating. If you do decide to use a nipple shield, please do so under the supervision of a lactation consultant that can make sure it is not affecting your milk production or baby’s feeding. And ensure that you still address the problem that caused the sore nipples in the first place!
Resting the nipple
In some cases, the nipple is so painful that you just can’t bear to feed baby on it. If that’s the case, you can express the breast and feed the milk to baby with a cup or syringe (I don’t recommend a bottle before baby is about 6 weeks old). If the nipple is already damaged, I would definitely recommend hand expressing rather than pumping; there’s a good chance the pump will damage the nipple even further.
There’s a few reasons why it’s important to keep expressing every three hours while the nipple rests: Firstly, you need something to feed your baby, and expressed breast milk is definitely to be preferred over formula (even if there’s a bit of blood from the nipple in the milk, it’s not harmful, except if you are HIV-positive). Secondly, you need to keep stimulating milk production – if you don’t remove the milk from the breast, your body will assume it needs to make less milk. And thirdly, you don’t want the breast to become engorged or develop mastitis, both of which can happen if the breast isn’t emptied frequently.
Once the nipple feels a bit better, you can try to get baby back on the breast. Take great care to latch baby well, so that you don’t repeat the same process and end up in the same situation again!
So here’s a summary of the treatments you can try:
- Things that almost always help:
- Nipple creams: Coconut oil, lanolin or a cream with added dexpanthenol.
- Breast milk on the nipple
- Sunshine; or otherwise laser and other light therapies –a physiotherapist can do these treatments
- Keep the nipples clean and dry
- If the nipple is already cracked: prevent infection of any cracks by applying a small amount of mupirocin ointment 3x per day
- Things that may or may not help
- Hydrogels: very expensive
- Breast shells may be useful to keep raw nipples comfortable between feeds
- And if all else fails
- Nipple shields – only as a last resort
- Resting the nipple: if you can’t take it anymore, hand express your milk and feed baby with a cup or syringe.
- And the MOST IMPORTANT one of all: find out what’s causing your nipples to hurt, and fix that!
Back where we started
All of the treatments I’ve described above have one thing in common: they don’t fix the problem. They are, at best, a Band-Aid: they help you feel better and they help the nipple heal, but if you don’t find and address the initial cause of the nipple pain, the problem will just keep repeating itself. So please, figure out what caused the pain in the first place – get help if you need to – so that you can be breastfeeding pain-free as soon as possible!