Serous mastitis is a pathology that often brings a lot of unpleasant sensations and disrupts the normal process of breastfeeding. This is due to the fact that mastitis often develops in nursing mothers due to the characteristics of the feeding process. The prevalence of serous mastitis is great and the main task is to prevent the development of a purulent process with further complications. Therefore, knowledge of the causes and the main symptoms will promptly turn to the doctor and prevent such consequences.
The epidemiology of serous mastitis is such that every second lactating mother meets this pathology. Therefore, more than 90% of cases of diseases have a lactational genesis. About 50% of cases of serous mastitis occur with complications in the form of infection and the formation of a purulent process, which indicates an incorrect treatment tactic or its untimely time. This must be taken into account to avoid such high rates of complications, because then not only does mother suffer, but also a child who must be weaned for this period.
Causes of the serous mastitis
Knowing the main causes of the development of serous mastitis allows not only to prevent the development of this process, but it is also better to treat the disease at early stages, affecting all links of pathogenesis. Mastitis is an inflammation of the mammary gland, which is of a diffuse nature, that is, parenchyma and milk ducts are inflamed. The word "serous" means that the process is favorable, that is, the inflammation is not purulent. In this case, the inflammatory infiltrate does not consist of a lot of white blood cells, as with purulent mastitis, but from lymph and intercellular fluid. This indicates that it is possible to prevent the formation of pus by intervening in time.
The frequent cause of the development of serous mastitis is improper care of the gland. This process is taught to a woman in the hospital, so you need to listen and remember the main points. There is no need to wash the gland before every feeding and after it, but it is enough just to wipe the nipple with a drop of milk. In this case, one does not need to rub the nipple heavily to avoid the formation of cracks. As for hygiene procedures, only the morning shower is enough, and it is not necessary to wash the gland specifically. Minimal interventions are the key to successful feeding. It is very important that the baby covers the whole nipple when feeding, does not pull it and quietly eats. In this case, cracks are not so often formed, which is the main cause of the development of serous mastitis. The pathogenesis of the development of serous mastitis is a violation of the normal outflow of milk, which in turn leads to its stagnation. Breast milk is an excellent nutrient medium for various microorganisms, including bacteria. Therefore, only in the case of milk stagnation the processes of absorption and release of lactic acids and other components are violated, which leads to a violation of the process of cell filtration. In this process of formation and movement of the intercellular fluid is also disrupted - this serous fluid penetrates into the breast tissue, forming an infiltrate. Also, the process of lymph drainage is disturbed, which further leads to even greater changes and the inflammation of the gland tissue with serous content takes place. If any number of opportunistic bacteria enters this serous infiltrate, then it is possible that the inflammatory process progresses with the formation of purulent mastitis. But at the same time, an imperative condition is skin damage, which is the gateway for infectious agents. That's why it's so important to avoid nipple cracks.
But we should also say about the causes of the development of serous mastitis in unkempt mothers, because this also happens. In this case, any woman can feel all the symptoms of the disease, without being pregnant or in the case of postpartum mastitis. Then the most common cause of serous mastitis in a woman who does not have other risk factors may be surgery or any intervention on the mammary gland. Very often, young women who have not yet experienced the joy of motherhood, resort to the services of plastic surgery to increase the size of the breast. In this case, they are warned about possible complications of such a procedure, one of which is mastitis. This happens due to the fact that the anatomy of the dairy ducts is broken because of their implantation, and this contributes to the development of artificial lactostasis. Therefore, a process such as mastitis can very often develop.
Do not forget about other external causes of development of serous mastitis, because any operation entails the possibility of infection.
It is important to know the causes and risk factors for the development of serous mastitis, not only in order to select an adequate treatment, but also in order to prevent this disease.
Risk factors for the development of serous mastitis are also important to know in order to avoid them. Among such factors in the first place is lactostasis - stagnation of milk in the breast of a nursing mother. After giving birth, the woman begins to be allocated milk for feeding the child, which under normal conditions is regulated by sexual hormones. In this case, the amount of milk that is necessary for the baby is formed in the mammary gland. But with various disorders, including with improper feeding and care of the mammary gland, the process of normal lactation can be disrupted, which leads to the development of serous mastitis. Therefore, the main cause of serous mastitis can be called violations of the process of feeding and nursing. Therefore it is very important to apply the newborn baby to the breast without night breaks, at his request. This contributes to the normal development of the process of lactation, because during the night hormones are released that affect the dairy moves. This allows for a normal lactation process to be established during the first month of a child's life, and then avoid various problems in the future.
Symptoms of the serous mastitis
To understand the symptoms of this disease, for starters, it is necessary to find out the processes that occur in this case in the gland tissue itself. The infiltrate that forms in the mammary gland can be localized or spread throughout the tissue. Accordingly, the main types of mastitis are distinguished - localized and diffuse, which also differ in symptomatology.
Also, in some cases, there may be a staged prevalence of the process. In this case, the following stages are distinguished:
local - at this stage the process takes only a small portion of the gland;
a common stage - characterized by infiltration of the entire gland;
complicated stage - when there are any complications.
The first signs of serous mastitis can easily be suspected when the pain for the first time arises and the child's dissatisfaction with the milk eaten is evident. In this case, the infiltrate that forms, squeezes the milk ducts and disrupts the process of milk drainage - therefore, when the baby sucks the breast - it does not gorge. This causes him to put more effort, which causes pain in the chest during feeding. The severity of the pain can be of a different nature, but in most cases this is the first sign of such a pathology. Further, the lactation process becomes even more complicated, since lactostasis worsens the outflow of not only milk, but also the outflow of lymph, and the entire process of circulation in the gland. Therefore, the process of resorption of the infiltrate is complicated. Together with these symptoms, there are others. First of all, there is a feeling of heaviness and roughness, which causes pain and discomfort. One gland increases in size and it also causes discomfort, but there are no systemic manifestations or local inflammatory reactions in the form of redness of the gland or rising of body temperature.
There may be other symptoms - from the nipple before feeding or during the period between the feeds, droplets of transparent non-inflammatory fluid are allocated - this is the serous secret which is the substrate of the disease. In this case, there are no purulent discharge or bloody - which indicates exactly the serous mastitis. Therefore, the main symptoms of serous mastitis are the subjective sensations of a woman, which at this stage is important to understand for carrying out and differential diagnosis.
Further, with the progression of the disease, when the serous secret spreads to the entire gland, then an even greater increase occurs and the lactostasis is more pronounced. This not only complicates the process of feeding, but it is also difficult for a woman to express milk. If such a process develops over a period of one week, then this is an acute serous mastitis. The chronic process is rare, because of a violation of feeding at this stage, women are treated with acute inflammation, preventing them from becoming chronic.
Serous lactation mastitis is something that occurs most often, as the process itself is a risk factor for the disease. Therefore, the above symptoms are associated with lactational mastitis. The treatment of such mastitis has some peculiarities. Nelaktatsionny serous mastitis occurs precisely in the aftermath of surgical interventions. The lactation process is not related to mastitis. Symptoms are also similar, but the first sign may be the secretion of serous secretion from the nipple. This should alert the woman and get them to take action.
The main symptoms of mastitis need to be known in order to address the doctor in time and in time to avoid an unpleasant process of surgical treatment of pathologies that have already appeared on this background.
Complications and consequences
Complications, which most often occur in serous mastitis, are purulent inflammation with the formation of purulent mastitis or abscess. This is due to the lack of adequate treatment of the serous process, in which pathogens fall into the infiltrate and cause an immune reaction with the formation of a purulent process. If such a process is limited to a capsule, then it is an abscess, which is a serious complication and requires prompt treatment.
The consequence of untimely and inadequate treatment of serous mastitis can be phlegmon of the breast - it is diffuse inflammation with the destruction of glandular tissue. All these complications are dangerous because the child should not breast-feed during the treatment of the purulent process. This greatly affects the health of the baby, since this is the main food for its normal development.
Also, one of the consequences of improper treatment of serous mastitis can be the formation of cysts or galactocele. These structures are formed due to the expansion of the milk duct, their distal sections, which is accompanied by the accumulation of liquid in them. Such cysts have a potential danger, as it is possible their suppuration or complications in feeding future children.
Diagnostics of the serous mastitis
Diagnosis of serous mastitis should be timely - and this is the main thing that the nursing mother must remember in order to maintain normal lactation. Therefore, if you have any symptoms, or if you have any questions, you should contact the doctor. You can even phone a simple pediatrician who can answer you, have problems with feeding with normal physiological causes or symptoms of the disease. And only in the latter case it is necessary to turn to a specialist.
Diagnosis of serous mastitis should begin with the collection of patient complaints and clarification of the nature of the feeding. It is necessary to find out whether there was normal lactation from the first days, and whether there was a problem with stagnation of milk earlier. It is necessary to pay attention to the possible rise in body temperature. Then you need to perform an external examination and palpation of the breast. With serous mastitis, one can see the compaction and painful infiltration in the thick of the gland, but the site does not have redness. If it is easy to press on the gland, a clear liquid can be released from the nipple. Such changes indicate a benign process.
Analyzes that are necessary in the diagnosis of serous mastitis are mainly in the exclusion of other pathologies and are general clinical. For the diagnosis it is necessary to give an overall analysis of blood, urine, blood sugar level. In the general analysis of blood there should be no changes, when mastitis becomes purulent, then there may be talk about some changes. Other tests also should not be different from the norm.
Instrumental diagnostics of serous mastitis is used more often for the purpose of differential diagnosis or in the long-term treatment of an acute process. The main diagnostic method is ultrasound. This method uses ultrasound, which penetrates normally evenly through all layers of the breast. If there is milk stasis, infiltration or serous fluid in the interstitial tissue, it will be visualized on the monitor in the form of different echoes. This ultrasound diagnosis allows you to accurately determine the size and location of mastitis, and also makes it possible to determine the presence of a capsule. Also with the help of this method of diagnosis, you can monitor the effectiveness of treatment.
Differential diagnosis of mastitis is very important, because the tactics of treatment for its different forms is different. The main pathologies with which to perform differential diagnosis of serous mastitis is purulent mastitis and abscess. Purulent mastitis is accompanied by a marked pain syndrome in the chest, its redness, and also the discharge of pus from the nipple. Whereas with serous mastitis these symptoms are not present. Also, with purulent mastitis, there are systemic manifestations in the form of hyperthermia, headache, muscle pain and other manifestations of intoxication syndrome.
The abscess of the breast has similar clinical manifestations with serous mastitis, since this process is limited to a capsule and reddening with a purulent discharge may not be. At the same time, as well as in the serous process, there is agitation and an increase in the area in the volume without reddening. The only distinguishing feature of the abscess is the fluctuation in palpation, so it is very important to carefully examine the gland. If there are doubts in the visual examination, then you can confirm the diagnosis with the help of ultrasound.
Timely diagnosis and careful differential diagnosis allows you to correctly diagnose and prescribe treatment.
The main principles of treatment of serous mastitis are the normalization of the outflow of milk, which removes the severity of edema and improves blood circulation and lymph drainage from the site. This allows the serous fluid inside the gland to be absorbed, and the problem is solved by itself. In this case, non-drug methods of treatment are used, and medicines can be used only symptomatically or for the purpose of prevention.
First of all, it must be emphasized that if the mastitis is serous, and the woman does not take antibacterial drugs, then breastfeeding should be continued, because it improves the outflow of milk and accelerates recovery.
To begin treatment of a serous mastitis it is necessary with correct decanting of milk. For this, you can simply express with light massaging movements along the duct in a radial direction to the nipple, or you need to use a breast pump. After all, it is necessary not only to improve the outflow of milk through the milk ducts, but to eliminate the milk that is stagnant and may be the source of further infection. The use of such a breast pump should be correct, according to the instructions. Eliminating milk stagnation reduces edema and allows the serous fluid to be absorbed faster and withdrawn with an outflow of lymph. Very good in the treatment of serous mastitis massage. The advantage of this method of treatment is not only its effectiveness, but also the possibility of treatment at home. Massage in this case relaxes the muscle fibers of the milk duct, stimulates their contraction, and thus the reduction of these fibers improves and milk is better excreted from the milk duct, and then lactation itself improves. Thus the condensed sites in a breast can be massaged and normalize outflow of milk from these sites. Also, massage improves blood circulation and lymph drainage from the chest, which in turn removes swelling in serous mastitis. The result of this method depends on the correctness of all the components of the massage and the subsequent expression of milk. For proper performance, massage movements should be neat and light to avoid pain and trauma. The technique of this procedure is to use stroking, rubbing, kneading with accurate smooth movements. Fingers of two hands need to carry out massaging movements from the top to the nipple. Next, you need to spend stroking around the gland in the direction of the armpits - to the places of lymph drainage. After such a massage, you must necessarily express the milk and you can put a warm warmer on the chest, which relaxes the muscle fibers and improves blood circulation. The course of massage should be carried out during a week two times a day. After a few procedures, the effect will be noticeable in the form of a decrease in the size of the gland and removal of the serous infiltrate.
Medications that are used for serous mastitis are mainly directed to local symptomatic action. Systemic administration of medications for serous mastitis is not required. To treat use of compresses from ointments and tinctures. The main drugs that are used to treat:
But-shpa is a drug that has a myotropic antispasmodic property, which is realized due to the action of arterial vessels on the muscle fibers, and this leads to their expansion and to a decrease in pressure. With serous mastitis, the drug is used as a combined treatment as a compress to improve the outflow of milk and reduce the severity of symptoms. This is how the analgesic effect of no-shpa is realized with pain in the chest and its engorgement. An additional effect of the drug is its tocolytic effect, which makes it possible to use it even in the first days of the postpartum period. Side effects of the drug may manifest dyspepsia - nausea, pain in the abdomen, a violation of the stool. In people with disabilities, the drug can cause allergic reactions of varying degrees from simple rashes to severe swelling. A sharp vasodilation can cause a decrease in blood pressure and a bradycardia. The widening of the peripheral vessels of the skin can be manifested by hyperemia and excessive work of sweat glands. The method of using no-shpy and the dose that is used depend on the severity of the symptoms and the need for a rapid analgesic effect. The dosage of tablets is 10, 20, 40 milligrams. The solution in ampoules is 2% in the volume of 2 milliliters. For complex treatment it is recommended to use intramuscular no-shpu or in the form of tablet forms with severe pain syndrome, and also as compresses for local treatment. To do this, take a few ampoules no-shpa, dilute in a glass, then moisten the gauze fabric, folded in several layers, and apply to the densified sections of the breast. From above you can attach a dry gauze cloth and a film. It is better to wear loose linen so that there is no strong compression. Such compresses need to be done several times a day.
Malawit is a natural remedy, which includes many components - sage, mint, chamomile, yarrow, peony, calamus, calendula, bark of oak, birch, pine, resin of fir tree and cedar, as well as glycerin and other oils. Due to this composition the preparation has anti-edematous, anti-inflammatory action, relieves itching and soreness. The drug is available in the form of a solution for external use, so for the treatment of serous mastitis it is necessary to apply the drug as a compress. For such a compress, you need to take 50 milliliters of Malavita solution and Dimexide can be added to it, then make a gauze pad and soak in the solution. Such a compress is better to do several times a day or alternate its use with compresses from no-shpy.
Progestogen is a hormonal drug consisting of progesterone - a natural hormone. Due to the shape of the release, such a tool is conveniently used in the form of a gel for the treatment of similar pathologies, especially if mastitis is lactative. Progesterone penetrates the breast tissue and reduces vascular permeability, relieves edema and normalizes the mitotic activity of milk duct cells. The progestogen is not absorbed into the systemic circulation and does not cause adverse reactions, but there may be slight redness or itching in the area of application. Dosage and method of using the drug - a small droplet of gel needs to be grinded over the mammary gland, applying this treatment twice a day. Precautions - can not be used for more than two weeks, as local complications are possible due to the composition of the drug.
Menovazine is an ointment, which includes alcohol, menthol, anesthesin and novocaine, so the analgesic effect of the drug is revealed. Menthol also dilates blood vessels and improves blood circulation in the gland. The way of application of the preparation is to apply a small amount of ointment on the breast with massaging movements. Side effects are possible in the form of redness in the place of use of the ointment, which is caused by the presence of menthol. If the sensation of itching is strongly pronounced, then it is necessary to wash off the ointment. Precautions - do not use the drug in case of allergy to novocaine.
Vitamins for the treatment of serous mastitis can be used in complex therapy, especially if the nutritional diet of the nursing mother does not adequately provide all the nutrients. In this case, the use of complex vitamins in combination with trace elements - Vitrum, Supradin, Undevit, Quadevite is recommended.
Physiotherapeutic treatment of serous mastitis has a very good healing effect due to its active effect on the vessels and parenchyma of the gland. The main effect of such procedures is to improve the lymph flow and circulation, which relieves swelling, pain and inflammation. You can use many techniques, but only if there is no purulent inflammation. Electrophoresis is the method by which drugs penetrate the skin with ions under the influence of tension. In this case, you can use Magnesia, Dimexide, Malavit and other antiseptics, and anti-inflammatory drugs. This accelerates their effect and improves the effect of these drugs. You can also use infrasound and magnetotherapy with a high-intensity impulse wave.
Alternative treatment of serous mastitis
Alternative treatment of serous mastitis is used very often, since this process can be cured by such means without the help of antibacterial drugs. To this end, use herbal packs and herbal remedies, which, together with the proper decantation of milk, are very effective. The main alternative recipes are:
Compresses from cabbage are known for their pronounced effect for any edema, including swelling of the breast caused by serous mastitis. Cabbage leaf restores local blood circulation and normalizes the function of milk allocation, which is very important in the treatment of mastitis. To prepare the compress, you need to take a cabbage leaf from the middle of the head, rinse it in warm water and put on the chest, fixing the top with linen. This compress is best done at night. In the morning, you need to express the milk.
Honey - a product known for its multifaceted therapeutic effect, which contributes to the improvement of filtration and absorption of serous fluid from the interstitial tissue of the mammary gland. It can be used as a compress in combination with other drugs, for example with papaverine, magnesium sulfate or other ointments. For the compress, you need to take honey in a semi-solid state, make a small cake of it and put it on your chest. Such a compress should be covered from above with a food film, which improves the warming effect. The duration of therapy is at least two hours per day.
The alcohol compress is known for its warming properties, but only if there are no contraindications in the form of purulent inflammation. To make such a compress you need to take alcohol, wet the gauze in it, you can also add aloe juice, and apply it as a compress. But we should not forget about the possible harm of such a compress for the baby, so before breastfeeding you need to wash your chest.
Treatment with herbs for serous mastitis is also very effective, since herbs can be used as a compress, as well as healing infusions or ointments.
Arnica is a plant that has a very good effect with proper and systematic use. This plant has anti-edematous effect, spasmolytic, desensitizing. Also, the drug activates the processes of resorption of the infiltrate, stimulating the release of milk along the ducts, and thus improves blood circulation, thereby reducing the severity of the gland and swelling. As a compress you need to use tincture, why boil the grass in hot water. Treatment should be done in the morning and in the evening, by applying a compress to the affected areas.
Yarrow - has many useful fatty acids that are able to penetrate the skin and normalize lactation processes with the relaxation of the milk ducts. To prepare the compress you need to steal the grass and make a compress from the present. Ingestion can be done in parallel with the use of honey.
St. John's wort - is used because of its spasmolytic effect, and also because of the property to reduce the pressure in the vessels and improve the outflow of blood from the site of the inflammatory tissue. To prepare a compress, you need to insist leaves of St. John's wort in a small amount of water and apply throughout the day several times.
Homeopathy can also be widely used in the treatment of serous mastitis, as a local remedy.
Mucose compositum is a homeopathic remedy of inorganic origin. This remedy improves local blood circulation in the mammary gland, and is especially effective for cracking the nipple and breast tenderness. The dosage of the drug at the beginning of treatment is five homeopathic granules three times a day, then two weeks later, you need to reduce the dose to three beads per day. Side effects are possible in the form of drawing pains or discomfort in the lower abdomen, which occurs after a few days. Precautions - You can not use the drug with a purulent process in the gland.
Echinacea is a homeopathic remedy of natural plant origin. This plant is predominantly a systemic means for improving lactation, since the plant stimulates the active excretion of milk. The method of using the drug is the use of a homeopathic solution in ampoules, dissolving them in pure water. When lactostasis is dosed half the teaspoon twice a day. Side effects can be in the form of increased pressure, tachycardia, insomnia. Violations of stools in the form of perforations are often observed. Precautions - if you have arterial hypertension take with caution, under the control of blood pressure - when lifting it, you need to reduce the dose or stop taking the drug.
Merkulius is a one-component preparation that has a very pronounced spasmolytic effect due to the relaxation of cells in the muscle fibers. For the treatment of lactostasis, it is recommended to use ointment, which is especially effective for pronounced edema and a feeling of heaviness in the chest.
Operative treatment of serous mastitis can be used only in the development of complications. If it is a question of infection and development of purulent mastitis and abscess, then surgical treatment should be used. In this case, the purulent focus is opened, drainage and active antibacterial therapy. In other cases, when serous mastitis has a benign course, surgical intervention is not required.
Prevention of serous mastitis is very simple, so knowing the basic rules of proper breastfeeding and care can easily prevent any complication. The main prevention measures are as follows:
To feed the child it is necessary on its inquiries, not paying attention to night breaks and to put to a breast in the first month not less, than every three hours;
the right care of the breast in the period between feedings and before it is very important. Do not wash or rub the nipple every time - this is a risk factor for the formation of cracks. It is necessary before each meal to wipe a nipple with a drop of milk. Enough morning shower and there is no need to wash with soap or other means of iron every time.
adequate sleep and normal feeding of the nursing mother is very important for the normal formation of milk and the prevention of mastitis.
The prognosis for serous mastitis for recovery is favorable with timely measures of treatment.
Serous mastitis is an inflammation of the mammary gland of an inflammatory nature, in which the normal process of feeding the baby is disrupted and there are unpleasant sensations in this case. The disease itself is not as serious as possible complications, which, if untreated, develop rapidly. Therefore, it is important to pay attention to any symptoms associated with chest pain, discomfort or disruption of normal feeding, as this affects your baby's health in the first place.
Last update: 25.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
The treatment of mastitis is aimed at stopping the inflammatory process that develops in the tissues of the mammary gland due to bacterial infection, and getting rid of its symptoms, in particular, swelling of the chest, pain, febrile state, etc.