April 7, 2019

Reviewed by Kimberly Langdon M.D.

Plugged ducts. Clogged ducts. Blocked milk ducts. Whatever you want to call them, they’re awful. Comedian Ali Wong has equated them to being like “a kidney stone in your titty.”

But they’re very, very common for breastfeeding mothers. As I’m typing this, I have just gotten over my 10th clogged duct (always in the right breast) and if you’re reading this, I feel for you.

What does a plugged duct feel like?

Typically it feels like a hard, very sensitive swollen spot in your breast. It can feel as small as a pea and as big as an apple. It might make breastfeeding more painful. Or your entire existence more painful - for me, personally, my plugged ducts last throughout the day.

The area may feel extremely tender, it may be hot or look reddened. And one of the crazier parts - the plug location may shift.

A plugged duct is different than mastitis. It can lead to mastitis but a plugged duct by itself shouldn’t be present with a fever. If you have a fever, you may already have mastitis. But unplugging a duct can help nip that in the bud.

What causes a plugged duct?

In general, they occur when milk flow is restricted or there is poor drainage in your breast for some reason or another.

It’s important to think about what might be causing the plugged duct - it’s not what you want to hear right now (your main thought is probably HOW DO I FIX THIS MAKE IT STOP), but you want to think on this piece to prevent them in the future.

Some of the causes can be:

• A bad latch
• A plugged nipple pore (also called a bleb - it can look like a white head on your nipple)
• Oversupply
• Rushed or distracted feedings (leading to low breast drainage)
• Nipple shields
• Infrequent or skipped feedings (also leading to low breast drainage)
• Pressure on the duct (sometimes caused from pressing your breast down to provide nostril space for your baby but also due to tight clothes, your sleeping position, things like a seatbelt or diaper bag pressing in on your breast, etc.)

How do I fix it?

Nurse. Nurse aggressively. Pump if you cannot nurse. It is your best and fastest treatment plan to unplugging that duct.

It may be painful, but you need your baby to help unplug the duct to prevent mastitis and other complications.

If you can’t nurse, try to express milk either by hand or with a breast pump. If it’s too painful to nurse on the affected side, start on the other breast then have your baby switch to the plugged duct breast after let-down.

Try to feed every 2-3 hours (no more than 3 hours in between feedings) and get the breast with the plugged duct as empty as possible, but don’t forget about the other breast or else you’ll wind up with plugged ducts on both sides.

Other things to keep in mind:

• Drink more water. Make sure you’re staying hydrated.
• If possible, before you nurse, get some warmth on your breast. You can use a warm compress (like a wet cloth), a basin soak (soaking your breast in warm water), or just take a hot shower.
• Massage your breast and the plugged duct area. Gently.
• Try different feeding positions.One feeding position that may work is nursing your baby on all fours with the baby on pillows below you. Remember: if it's stupid but it works, it isn't stupid.
• Pump or express milk after nursing to ensure sufficient drainage. It’s a catch-22, some babies struggle to latch and can’t feed when you have a plugged duct. Or they might not like the taste of your milk during this time - if this happens, you must pump more and you may want to consider a hospital-grade pump.
• Switch to cold compresses after feeding to help with the inflammation.
• Rethink your bra and clothing - make sure you’re not putting extra pressure on your breasts.
• If you have an electric toothbrush, use the base of the toothbrush against the plugged duct to help aid the massage. It feels very weird but it can be very helpful.
• Consider taking ibuprofen (an anti-inflammatory) for pain or consider acetaminophen/Tylenol.
• Take lecithin capsules to smooth out the consistency of your breast milk, if you’re having persistent plugged ducts.
• Contact a lactation consultant.

Rest is one of the most important things but including rest on a list of suggestions for a new mom seems ridiculous to me. You’d be getting rest if you could…

For me, my right breast has been the angry plugged duct side for the entirety of my baby’s nursing time and I developed tricks to work around that issue. For instance, I ended up never carrying my son on my right shoulder because that would lead to too much pressure and plugged ducts. At night, I also went to sleep on the side that was emptied last. This also helped me in the middle of the night with remembering which side to feed on next - whichever side I woke up on, it was time to feed on the opposite side.

When to see a doctor

If you feel like you have a plugged duct that has escalated to mastitis or if you are worried about mastitis, contact a doctor immediately. Signs of mastitis may include:

• Lumpy/stringy milk
• Milk containing mucus, blood or pus
• Sore, cracked, bleeding or infected nipples
• A fever
• Plugged duct(s) lasting more than 48 hours
• Red streaks are present in your breast(s)
• A warm and reddened area of the breast

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.