Blockage of the ducts of the mammary glands

Sometimes it happens that during the lactation period, not all milk is removed from the breast. As a result, there may be a blockage of the ducts of the mammary glands, since in the milk ducts a clot (cork) is formed from milk, which becomes an obstacle to its normal outflow. As a result, milk does not come out, stagnates, which causes discomfort and even pain. Moreover, if this condition is not treated, then this can provoke the development of mastitis and other complications.

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Causes of the blockage of mammary ducts

The mammary glands are divided into 15-20 segments, from each of the lactiferous ducts. When milk from any segment is not completely removed, then the corresponding duct is blocked by a milk stopper. Externally, this is manifested by painful condensation and redness of the affected breast. The general condition of the woman is not violated.

Factors causing the appearance of blockage, a lot:

• irregular and non-durable feeding;
• missing feed, a significant time interval from one feeding to another;
• incorrect attachment of the baby when he simply can not fully suckle the breast;
• improperly selected bra or other clothing items;
• The presence of excess weight, too large a breast size, an altered shape of the breast;
• improper support of the gland during feeding, etc.

However, modern specialists do not have a single view on the causes of occlusion of the ducts of the mammary glands. Some of them argue that the blockage develops as a result of the initial oppression of the reflex of milk yield. Others adhere to the opinion of the low-excitable neuromuscular apparatus of the paraspine zone, which leads to a complicated withdrawal of milk and stagnant phenomena. An important role is also assigned to the degree of elasticity of the muscle-epithelial cells of the ducts.

Pathogenesis

Primary blockage often occurs in women who have given birth for the first time. This is due to the instability of the lactation function in the body.

The very process of lactation consists of stages that are adjusted from the second to the tenth day after birth.

Primary blockage occurs when stabilization of secretion occurs faster than stabilization of accumulative and evacuation functions.

With physiological blockage, the rate of milk production outstrips the normalization of the accumulative function. The fact that the property of the gland to store milk can depend not only on the anatomy of the breast of a particular woman, but also on the tone of the muscle-epithelial cells that line the walls of the lactiferous canals and alveoli. When the milk accumulates in the ducts, the cellular tone decreases, which makes it possible to accumulate milk without problems.

Accelerated milk production is usually accompanied by blocking secretion. This state continues until the tension of the duct cells is normalized at the same time as the milk is withdrawn. But this does not happen in all cases. With insufficient accumulative and evacuation functions, increased milk production can lead to its accumulation, stretching of the ducts, blocking the functionality of the gland.

A baby can give up such a breast, and it's hard to express a woman. The gland becomes compacted, uneven, and pain and discomfort appear.

At the same time, the viscosity of milk increases, which only exacerbates the problem.

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Symptoms of the blockage of mammary ducts

The first signs of stagnant phenomena in the chest should be able to recognize all women before the onset of pregnancy. Of great importance is the early detection of blockage, because with the appearance of the first symptoms and with timely measures, the disease can be stopped at the initial stage of development.

Symptoms can be as follows:

• compaction in the chest;
• slight increase in temperature indicators (up to 38 ° C);
• a feeling of heaviness, fullness in the gland, later a burning sensation and soreness may appear;
• in the far-gone cases, reddening of the skin is observed, therefore at the late stage of blockage it is difficult to externally distinguish from mastitis.

The main manifestations of the disease are puffiness of the gland, an unpleasant and painful feeling in the chest, the appearance of visually enlarged vessels like a grid on the affected side of the gland. There may be general symptoms, such as headache and discomfort.

Tension and pain in the mammary gland in most cases do not pass even after the emptying of the breast.

[4], [5]

Forms

Code on the ICD 10:

• O 00-O 99 - The period of pregnancy, childbirth and after childbirth.
• O 85-O 92 - Complicated postpartum period.
• O 92 - Other changes in the mammary gland, as well as lactation disorders, which are associated with the birth of a child.
• O 92.7 - Other and unspecified lactation disorders.
• O 92.7.0 - Lactostasis.

[6], [7],

Complications and consequences

Stagnant phenomena in the chest can quickly cause the development of veno-and lymphostasis. As a consequence, the swelling of the alveoli, the milky canals and the stroma usually develop. The accumulation of fluid in the tissues promotes the rapid reproduction of bacteria that have penetrated into the organ, which in a short period of time can cause the development of the inflammatory process.

Long-term blockage of the milk ducts can lead to the appearance of mastitis or abscess. These complications are usually manifested by a sharp increase in pain, fever, purulent and bloody discharge from the chest. This state requires emergency doctor help. The development of mastitis occurs quickly, for 2 or 3 days, after which surgery may be required. For this reason, it is not recommended to engage in self-medication, but immediately consult a doctor.

[8], [9], [10], [11]

Diagnostics of the blockage of mammary ducts

Diagnostic measures for detecting blockage are in the daily examination of the mammary glands. It is necessary to pay special attention to the change in the color of the skin on the chest, the possible asymmetry of the glands, the location of the nipples. In addition, it is recommended to probe each gland clockwise from the nipple to the periphery.

An important diagnostic value is the measurement of the body temperature of a woman who is breastfeeding. Often, fever is one of the first symptoms of lactostasis. If any suspicious signs were found during examination of the breast, it is necessary to consult urgently with the doctor who will prescribe the following types of studies:

• analysis of blood, urine and discharge from the breast (for the presence of an inflammatory process);
• instrumental diagnostics (ultrasound and mammography).

Ultrasound of the mammary glands is an absolutely harmless, painless and accessible research technique. Such a procedure will not harm even pregnant and lactating women.

The study is conducted up to 10 minutes, but during this time the doctor will be able to examine all important structures of the glands, including the detection of obstruction of the ducts.

Mammography is an x-ray method of investigation, therefore it is not recommended to conduct it during pregnancy and in the lactation period. Usually, such a study is prescribed mainly to women after 45 years of age, or in cases when an ultrasound is suspected of a serious illness and can not be avoided without confirmation of a mammogram.

Differential diagnosis of obstruction of the milk ducts is carried out, first of all, with mastitis, infectious process, mastopathy, cysts, galactocele, and with the development of neoplasms in the breast.

[12], [13],

Treatment of the blockage of mammary ducts

There are many methods of eliminating blockage of the milk ducts. Until now, especially popular method is breast massage and the use of thermal and alcohol effects. Such methods are simple enough to use and very quickly alleviate the condition of a woman. For example, under the effect of a heat compress, the lactiferous channels expand, the tension in the chest decreases and the soreness recedes. But remember that the attachments should be warm, not hot.

In combination with a quality massage, you can achieve a successful emptying of the breast.

Depending on the degree of lactostasis and the duration of the process, many doctors resort to forced prevention, inhibition or complete suppression of lactation. For this, all kinds of medicines are used:

• preparations based on hormones (estrogens);
• means of nonhormonal origin (saluretics, salt laxatives, camphor, cardiovascular drugs such as dithrim or phalicor).

Among the medical methods of treatment of blockage are the following:

• The use of relatively small dosages of estrogens, in the form of separate or combined treatment with the use of dopamine receptor agonists, for six to 12 days. Estrogens have an immediate effect on production in the body of prolactin, acting directly on the function of the pituitary gland.
• In order to completely suppress lactation, direct stimulants-inhibitors of prolactin are used. Among such drugs, ergot-based drugs are most commonly known, which can directly lower the amount of prolactin in the bloodstream. Such drugs have a more stable effect, in contrast to estrogen-containing drugs.
• To enhance the evacuation function of the glands used hormonal drugs in the posterior lobe of the pituitary gland. This allows you to withdraw the accumulated milk in the glands, reduce the intrathoracic pressure, reduce the tension of the affected breast.

The goal of all treatment procedures in case of blockage is to reduce swelling of the tissues and eliminate spasms of the milk channels, so that the milk can be discharged outside. Means for external use should successfully remove the inflammatory process and not harm the child who is breastfeeding. In addition, external preparations can have a sharp aroma, which can push the baby away from the chest.

What is recommended for outdoor use:

• homeopathy - harmless drugs, quite effective and popular (Traumeel ointment, Arnica's homeopathic remedy, Ledum);
• Ointment Malavit - used between approaches to feeding, helps to remove puffiness and inflammation;
• Magnesia - used only for compresses. Before feeding after the compress, the iron should be rinsed from the medicine, otherwise the child may have diarrhea. The gauze moistened in magnesia is applied to the affected breast in the intervals between the feedings.

Conservative treatment of blockage of the milk ducts should be comprehensive and includes:

• feeding the baby with the breast and periodically expressing the milk;
• injections of oxytocin by 0.5 ml;
• reception of no-shpy or injection of 1 ml of papaverine 10-15 minutes before the decay during 4 days;
• treatment with antibiotics (cephalosporins, semisynthetic penicillins, fluoroquinolones, vancomycin) with increasing temperature, forming seals;
• UHF procedures, ultrasound treatment, phonophoresis;
• symptomatic therapy.

Surgical treatment can be shown only when purulent, destructive inflammatory processes, such as mastitis, abscess, etc., are connected. It is possible to perform a puncture with emptying the infectious focus, wide opening of the abscess, excision of necrotic tissues, etc. In rare cases, a sectoral resection of the dairy Glands with acute purulent mastitis.

Alternative treatment

There are a lot of alternative drugs known to help cope with blockage at the initial stages of its development.

• In order to get rid of inflammation, the usual leaf of white cabbage is used. One large sheet is washed, then a little tapping with a hammer so that the leaf lets out the juice and becomes softer. Further it is applied to the affected breast under the bra and held for 3 hours, after which it is changed to fresh. Some experts advise to lubricate the breast with honey before applying cabbage, but this can be advised only to those women who do not suffer from allergies to beekeeping products.
• To treat stagnant milk, you can apply chamomile. The easiest way to brew a camomile color and drink it instead of tea throughout the day.
• Will help with blockage of ducts and onions. Peeled onions are baked in the oven and warmed to the breast for about 2-3 hours.
• An old proven method is the application of a loaf of honey to the breast. To make it, you need to cut the onion finely and mix it with honey and dark flour (equally). Knead the dough and make a cake out of it. This cake is applied to the affected gland for at least a day.
• It helps in the stagnation of milk compress with camphor oil: gauze is moistened in oil and applied to the chest, top covered with cellophane and wrapped with a woolen shawl or scarf. This compress is put on at night.
• Another effective means is a compress of vodka, diluted evenly with water. The compress is applied to the sick chest, from above is placed cellophane and wrapped in a warm kerchief. Such a compress should be worn, not removing, throughout the day.

Treatment with herbs should be discussed with the doctor, as not all specialists welcome the use of alternative means. If the obstruction of the milk ducts has all the chances to go into the inflammatory process, then you should not take risks - visit a doctor who will prescribe competent medication.

Prevention

Preventive measures to prevent blockage of the ducts, we divided into two lists: those that are recommended for use, and those that do not.

What to do is extremely undesirable:

• infringe oneself in the use of liquid, especially before the next feeding of the child;
• apply hot compresses to the breast;
• aggressively knead the chest, express milk, applying force;
• try to express the breast completely;
• use infusions and teas with the addition of mint, sage and other plants that depress lactation;
• try all known or not-so-far-out tools;
• wait for the disturbed lactation to restore itself.

What advice is worth listening to:

• the lactating woman should give enough time to rest, at the slightest opportunity to try to sleep, avoid stresses, as under stress and severe fatigue the production of the hormone responsible for lactation is blocked. If you can not relax, you can ask your doctor to prescribe a safe sedative;
• you need to carefully consider the choice of underwear, in particular to choose a bra - it is important that he was comfortable and did not squeeze the breast;
• during lactation, a woman is not recommended to sleep on her stomach;
• it is desirable to periodically feed the child in different positions;
• do not make significant interruptions in feeding;
• it is useful to carry out a gentle superficial breast massage;
• no more than 1-2 times a day is recommended to express before feeding the baby, while watering the breast with warm water from the shower;
• if the breast has already formed densification, then the baby should be put chin on the side of the seal - so the child can eliminate the blockage.

Actions to prevent stagnation should be applied, the earlier, the better, and adhere to them systematically. If the stagnation still started, then it is necessary to get rid of it for 2-3 days, otherwise the inflammatory process may develop.

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Forecast

With regular feeding and careful decanting of excess milk, the blockage can pass by itself. It is necessary to be more attentive to yourself, avoid heavy physical exertion and nervous stress, get enough sleep, drink enough pure water, consume vegetables and fruits.

If milk stagnation does happen, you should consult your doctor as soon as possible, in no case stopping lactation. Only in this case it is possible to protect yourself from possible adverse consequences.

With timely treatment, the secretory function of the breast, as a rule, is restored to its fullest.

The obstruction of the ducts of the mammary glands most often does not pose a threat to women's health, unless a woman begins to listen to the advice of non-professionals, as many unverified methods can significantly exacerbate the disease. So, there is nothing terrible in this state, if you do not start and do not ignore the process, and in time turn to a doctor for help.

[15], [16], [17], [18],