Breastfeeding is now widely recognized as the ideal source of infant nutrition and nurturing. The most commonly reported problem with breastfeeding is sore nipples. A degree of transient soreness postpartum is accepted as normal by some lactation specialists, but soreness should be mild and completely gone by the end of the second week.  If nipple pain is more intense than mild tenderness and/or if pain occurs between feedings or lasts longer than a week or two, the cause of the pain needs to be addressed.

Treating sore nipples in breastfeeding mothers quickly and  effectively is important in improving the duration of breastfeeding beyond just a few weeks.

Causes of sore nipples include, but are not limited to, mechanical trauma (improper latch-on), bacterial infections and mastitis, candidiasis or yeast infection, dermatitis and other skin conditions and vasospasm.

Most cracked nipples and breast infections occur during the first 2 weeks after childbirth, when pathogens from the hospital may be present in wounds.  Untreated bacterial infections of the nipple can spread, causing mastitis or systemic illness.  

Yeast infections of the nipple or breast are difficult to diagnose. Lactation specialists usually diagnose candidiasis of the nipple and breast after only after taking a careful history, examining the mother and infant and excluding other sources of pain. The most common symptom of nipple candidiasis is persistent and often severe nipple pain that doesn't respond to careful adjustment of positioning and latch-on  technique.

Postpartum women can be especially sensitive to contact irritants which can include nipple creams and ointments, the plastic on breast shells, cologne, deodorant, hair spray or powder used near the nipple, and laundry detergent.

Treatment of nipple pain  includes a daily, gentle cleansing of nipple wounds with warm, soapy water  (avoiding antibacterial soaps) followed by a warm-water rinse. Custom compounded nipple creams/ointments are often prescribed because they allow the prescriber to order a  prescription that will treat the individual patient’s needs. These ointments usually combine an antibiotic (mupirocin) with an  anti-inflammatory agent (betamethasone) and antifungals (nystatin and clotrimazole, or miconazole).  The ointment is applied sparingly after each feeding and does not have to be wiped off before the next nursing.  It is recommended that the patient use the ointment until the nipples are pain free, then gradually reducing application over a week.*

* International Journal of Pharmaceutical Compounding Vol. 7 No. 6 Nov/Dec 2003

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