Obstruction 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, the milk ducts may become blocked, as a clot (plug) of milk forms in the milk ducts, which becomes an obstacle to its normal outflow. As a result, the milk does not come out, stagnates, which causes a feeling of discomfort and even pain. Moreover, if this condition is not treated, it can provoke the development of mastitis and other complications.

[ 1 ], [ 2 ]

Causes ductal blockages in the mammary glands

The mammary glands are divided into 15-20 segments, each with a milk duct. When milk is not completely released from a segment, the corresponding duct is blocked by a milk plug. Externally, this is manifested by a painful compaction and redness of the affected breast. The general condition of the woman is not affected.

There are many factors that cause blockage:

• irregular and short-term feeding;
• skipping feedings, a significant period of time between one feeding and another;
• incorrect attachment of the baby, when he simply cannot suckle fully;
• an incorrectly fitted bra or other clothing item;
• excess weight, excessively large breast size, altered breast shape;
• improper support of the gland during feeding, etc.

However, modern specialists do not have a single view on the causes of the occurrence of blockage of the milk ducts. Some of them claim that blockage develops as a result of the initial suppression of the milk-flow reflex. Others adhere to the opinion of the low-excitability neuromuscular apparatus of the areola, which leads to complicated milk removal and stagnation. An important role is also given to the degree of elasticity of the muscular-epithelial cells of the ducts.

Pathogenesis

Primary blockage often occurs in women who have given birth for the first time. This occurs as a result of instability of the lactation function in the body.

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

Primary obstruction occurs when stabilization of secretion occurs faster than stabilization of the storage and evacuation functions.

With physiological blockage, the rate of milk production outpaces the normalization of the storage function. The fact is that the ability of the gland to accumulate milk may depend not only on the anatomy of the breast of a particular woman, but also on the tone of the muscular-epithelial cells that line the walls of the milk ducts and alveoli. When milk accumulates in the ducts, the cellular tone decreases, which allows milk to accumulate without problems.

Accelerated milk production is usually accompanied by secretion blocking. This condition continues until the tension of the duct cells is normalized simultaneously with the milk output. But this does not happen in all cases. With insufficient storage and evacuation functions, increased milk secretion can lead to its accumulation, stretching of the ducts, and blocking of the gland's functionality.

The baby may refuse such a breast, and the woman finds it difficult to express milk. The gland becomes compacted, uneven, pain and discomfort appear.

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

[ 3 ]

Symptoms ductal blockages in the mammary glands

All women should be able to recognize the first signs of congestion in the chest even before pregnancy. Early detection of blockage is of great importance, because when the first symptoms appear and if measures are taken in time, the disease can be stopped at the initial stage of development.

Symptoms may include:

• lump in the chest area;
• a slight increase in temperature (up to 38°C);
• a feeling of heaviness, fullness in the gland, later a burning sensation and pain may appear;
• In advanced cases, redness of the skin is observed, so at a late stage it is difficult to distinguish the blockage from mastitis externally.

The main manifestations of the disease are considered to be swelling of the gland, an unpleasant and painful feeling in the chest, the appearance of visually dilated vessels like a mesh on the affected side of the gland. General symptoms such as headache and discomfort may also be observed.

In most cases, tension and pain in the mammary gland do not go away even after emptying the breast.

[ 4 ], [ 5 ]

Forms

ICD 10 code:

• O 00-O 99 – 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 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

Congestion in the chest can quickly cause the development of veno- and lymphostasis. As a result, swelling of the alveoli, milk ducts and stroma usually occurs. Fluid accumulation in the tissues promotes rapid reproduction of bacteria that have penetrated the organ, which can cause the development of an inflammatory process in a short period of time.

Long-term blockage of the milk ducts can lead to mastitis or abscess. These complications usually manifest themselves as a sharp increase in pain, fever, purulent and bloody discharge from the breast. This condition requires emergency medical attention. Mastitis develops quickly, within 2 or 3 days, after which surgical intervention may be required. For this reason, it is not recommended to self-medicate, but to immediately consult a doctor.

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

Diagnostics ductal blockages in the mammary glands

Diagnostic measures to detect blockage include daily examination of the mammary glands. It is necessary to pay special attention to changes in the color of the skin on the chest, possible asymmetry of the glands, and the location of the nipples. In addition, it is recommended to palpate each gland clockwise from the nipple area to the periphery.

Measuring the body temperature of a woman who is breastfeeding is of great diagnostic importance. Often, an increase in temperature is one of the first symptoms of lactostasis. If any suspicious signs are detected during breast examination, it is necessary to urgently consult a doctor who will prescribe the following types of examinations:

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

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

The examination takes up to 10 minutes, but during this time the doctor will be able to examine all the important structures of the glands, including detecting blockages in the ducts.

Mammography is an X-ray examination method, so it is not recommended to conduct it during pregnancy and lactation. Usually, such a study is prescribed mainly to women after 45 years of age, or in cases when, during an ultrasound, there are suspicions of some serious disease, and it is impossible to do without confirmation of a mammogram.

Differential diagnostics of milk duct blockage is carried out, first of all, with mastitis, infectious process, mastopathy, cysts, galactocele, as well as with the development of neoplasms in the mammary gland.

[ 12 ], [ 13 ]

Treatment ductal blockages in the mammary glands

There are many methods for eliminating blockage of milk ducts. To this day, breast massage and the use of heat and alcohol are considered to be particularly popular methods. Such methods are quite easy to use and very quickly alleviate a woman's condition. For example, under the influence of a heat compress, milk ducts expand, tension in the chest decreases and pain recedes. But it should be remembered that the applications should be warm, not hot.

In combination with a quality massage, successful breast emptying can be achieved.

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

• drugs based on hormones (estrogens);
• non-hormonal agents (saluretics, saline laxatives, camphor, cardiovascular agents such as difrim or falicor).

Among the medicinal methods of treating blockage, the following are distinguished:

• The use of relatively small doses of estrogens, either alone or in combination with dopamine receptor agonists, for six to 12 days. Estrogens have an immediate effect on the body's production of prolactin, acting directly on the function of the pituitary gland.
• In order to completely suppress lactation, direct prolactin stimulants-inhibitors are used. Among such drugs, the most well-known are ergot-based agents, which can directly reduce the amount of prolactin in the bloodstream. Such agents have a more stable effect, unlike estrogen-containing drugs.
• To enhance the evacuation function of the glands, hormonal preparations of the posterior pituitary gland are used. This allows the milk accumulated in the glands to be removed, intrathoracic pressure to be reduced, and the tension of the affected breast to be lowered.

The goal of all treatment procedures for blockage is to reduce tissue swelling and eliminate spasms of the milk ducts so that milk can be released. External agents should successfully relieve inflammation and not harm the child who is breastfed. In addition, external preparations may have a strong aroma, which can push the baby away from the breast.

What external agents are recommended for use:

• homeopathy – harmless drugs, quite effective and popular (Traumeel ointment, homeopathic remedy Arnica, Ledum);
• Malavit ointment – used between feedings, helps relieve swelling and inflammation;
• Magnesia - used only for compresses. Before feeding after the compress, the gland should be washed from the medicine, otherwise the child may develop diarrhea. Gauze soaked in magnesia is applied to the affected breast between feedings.

Conservative treatment of blocked milk ducts should be comprehensive and include:

• breastfeeding the baby and periodically expressing milk;
• oxytocin injections of 0.5 ml;
• taking no-shpa or administering 1 ml of papaverine 10-15 minutes before pumping for 4 days;
• treatment with antibiotics (cephalosporins, semi-synthetic penicillins, fluoroquinolones, vancomycin) in case of fever and formation of seals;
• UHF procedures, ultrasound treatment, phonophoresis;
• symptomatic therapy.

Surgical treatment may be indicated only when purulent, destructive inflammatory processes are present, such as mastitis, abscess, etc. It is possible to perform a puncture with emptying of the infectious focus, wide opening of the abscess, excision of tissues affected by necrosis, etc. In rare cases, sectoral resection of the mammary gland is performed in acute purulent mastitis.

Folk remedies

There are quite a few folk remedies known that help to cope with blockage in the initial stages of its development.

• To get rid of inflammation, a regular white cabbage leaf is most often used. One large leaf is washed, then tapped a little with a hammer so that the leaf releases juice and becomes softer. Then it is applied to the affected breast under the bra and kept for 3 hours, after which it is replaced with a fresh one. Some experts advise to lubricate the breast with honey before applying cabbage, but this can only be advised to those women who are not allergic to bee products.
• Chamomile can be used to treat milk stagnation. The easiest way is to brew chamomile flowers and drink it instead of tea throughout the day.
• Onions will also help with blocked ducts. Peeled onions are baked in the oven and applied to the chest while still warm for about 2-3 hours.
• An old and proven method is to apply a honey cake to the breast. To prepare it, you need to finely chop an onion and mix it with honey and dark flour (in equal parts). Knead the dough and make a cake out of it. This cake is applied to the affected gland for at least a day.
• A compress with camphor oil helps well with milk stagnation: gauze is soaked in oil and applied to the chest, covered with cellophane on top and wrapped in a woolen scarf or shawl. This compress is applied at night.
• Another effective remedy is a compress of vodka diluted equally with water. The compress is applied to the sore chest, cellophane is placed on top and wrapped in a warm scarf. This compress should be worn without removing for 24 hours.

Herbal treatment should be discussed with a doctor, as not all specialists welcome the use of folk remedies. If the blockage of milk ducts has every chance of developing into an inflammatory process, then it is not worth the risk - visit a doctor who will prescribe competent medical treatment.

Prevention

We have divided preventive measures to prevent duct blockage into two lists: those that are recommended for use and those that should not be done.

What is highly undesirable to do:

• limit your fluid intake, especially before the next feeding of the baby;
• apply hot compresses to the chest;
• aggressively knead the breast, express milk using force;
• try to express milk from your breast completely;
• use infusions and teas with the addition of mint, sage and other plants that suppress lactation;
• try all known or unknown remedies indiscriminately;
• wait until the disrupted lactation is restored on its own.

What advice is worth listening to:

• a nursing woman should devote enough time to rest, try to get enough sleep whenever possible, avoid stress, since stress and extreme fatigue block the production of the hormone responsible for lactation. If you cannot relax, you can ask your doctor to prescribe a safe sedative;
• you need to be careful when choosing underwear, in particular when choosing a bra - it is important that it is comfortable and does not squeeze the chest;
• During lactation, women are not recommended to sleep on their stomach;
• It is advisable to periodically feed the baby in different positions;
• there should be no significant breaks in feeding;
• It is useful to perform a gentle superficial massage of the chest;
• It is recommended to express milk no more than 1-2 times a day before feeding the baby, while pouring warm water from the shower over the breast;
• If a lump has already formed in the breast, the baby should be placed with his chin on the side of the lump - this way the baby will be able to remove the blockage himself.

Measures to prevent stagnation should be taken the sooner the better, and adhered to systematically. If stagnation does begin, it should be eliminated within 2-3 days, otherwise an inflammatory process may develop.

[ 14 ]

Forecast

With regular feeding and careful expression of excess milk, the blockage may go away on its own. You should be more attentive to yourself, avoid heavy physical exertion and nervous tension, get enough sleep, drink enough clean water, eat vegetables and fruits.

If milk stagnation does occur, you should see a doctor as soon as possible, but never stop lactation. Only in this case can you protect yourself from possible adverse effects.

With timely treatment, the secretory function of the breast is usually fully restored.

Blockage of milk ducts most often does not pose a danger to women's health, unless a woman begins to listen to the advice of non-professionals, because many unverified methods can significantly worsen the disease. Thus, there is nothing terrible in this condition, if you do not start or ignore the process, but seek help from a doctor in time.

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