Nipple fissure are a defect, damage to the integrity of the skin on the nipples of the mammary glands. They are manifested by sharp soreness with irradiation into the scapula when feeding a child. They can be complicated by infection of wounds, the development of nipple candidiasis, mastitis. If cracks are infected, there is a danger of infecting the baby during feeding. May lead to refusal of breastfeeding. Treatment begins with the elimination of their cause. In parallel, prevention of their infection is carried out, means are used to promote early healing (sea buckthorn oil, vit. E, dexpanthenol, etc.).
Overview
Medicine unconditionally recognizes the advantages of breastfeeding over artificial and recommends that all healthy mothers breastfeed whenever possible, even if it causes a woman certain inconveniences: discomfort up to soreness during feeding in the first days (when developing nipples and ducts of the mammary glands). Most often, these problems disappear after a few days, and feeding ceases to cause pain. However, sometimes, as a result of inept application of the baby to the breast, cracks of the nipples appear.
In addition to the violation of feeding techniques, the appearance of cracks on the nipples can contribute to hypovitaminosis, general malaise. Cracks often occur in women who have naturally retracted underdeveloped nipples, sensitive easily injured skin, and a weakened neuromuscular system. An excitable baby can damage the nipple when feeding, the development of cracks can contribute to insufficient hygiene of the nipples.
Causes
The main reason for the appearance of cracks is the insufficient capture of the breast by the baby during breastfeeding. When properly applied to the breast, the nipple rests against the palate, the baby is in a fixed stationary position, the child squeezes the periarticular circle with his jaws, contributing to the expiration of milk. At the same time, the child’s lower lip is turned up. If the nipple is not embedded to the proper depth, then it turns out to be on the tongue, acquiring mobility, the lower lip injures the nipple and areola, and the jaws compress the breast in the most sensitive and easily damaged place. As a result of constant irritation of the areas of the nipple and areola, damage to the skin occurs – cracks form. With improper feeding, the duration of feeding does not matter, even if you follow the recommendations of obstetricians and feed for no more than three minutes, regular irritation of the tender areas of the nipple will still lead to damage. Properly attached to the breast, the baby can suckle for any amount of time and not cause any damage to the mother.
The second common cause of nipple fissure may be improper weaning of the baby from the breast. Often, when feeding, mothers do not support the baby’s head, and also have his stomach not to themselves, but up. As a result, at the end of feeding, the baby turns away from the breast, pinching the nipple in the jaws. There is pressure on the areas of the nipple that are not intended for this. It also happens if the mother pulls out the baby’s nipple, and the child tries to hold it by clenching his jaws.
Thus, the correct position of the baby when feeding is to hold the baby with its belly to the mother, as close as possible to the breast and support the head. If there is a need to interrupt feeding before the baby releases the nipple itself, then it is necessary to fix the slightly open jaws by inserting a clean little finger between them and then get the nipple.
Another frequent reason may be excessively frequent washing of the nipples. Modern medicine does not support the need to wash the breast after each feeding. With frequent washing, their natural lubricant is washed off from the nipples, which is secreted by special glands in the skin of the areola (Montgomery glands) and the nipples lose one of the natural protective mechanisms. This lubricant, in addition to softening properties, has an antiseptic effect and protects the nipples from many microorganisms. To comply with the rules of hygiene, it is enough to observe the usual daily breast toilet.
Also outdated is the recommendation to lubricate nipples with cracks with green paint. Although this measure disinfects the area of cracks, it only aggravates skin irritation and contributes to the emergence of new damage and the progression of existing ones.
Among other things, doctors do not recommend nursing mothers to constantly wear breast pads, which get wet, become a favorable environment for bacteria and irritate the nipple. When separating milk, it is better to use linings made of natural, breathable fabrics.
Cracks can also develop when feeding older children as a result of bites with erupted teeth. The appearance of nipple fissure is facilitated by the developed thrush.
Symptoms
Nipple fissure are single or multiple skin lesions of varying depths of one or both nipples. Cracks can be superficial, as well as deepen into the subcutaneous layers. If the subcutaneous capillary network is damaged, the crack may bleed. The addition of infection causes inflammation of the nipples: infiltration of tissues, hyperemia, the formation of erosions and ulceration, purulent discharge. Infection of cracks (especially fungal etiology) can cause the development of mastitis.
There is a pronounced soreness of the damaged skin, which increases during feeding and often forces mothers to stop feeding.
Complications
Nipple fissure are complicated by the addition of infection, with the development of inflammation of the mammary glands (mastitis) up to the formation of a purulent focus. The infection can be transmitted from the mother to the child. If infection of the nipples is suspected (redness, swelling, fever in the area of inflammation, as well as general body temperature), it is necessary to immediately stop breastfeeding, and feed the baby with carefully pasteurized expressed milk.
Treatment
If nipple fissure occur, first of all, it is necessary to determine and eliminate the cause of their development, after which means and techniques that contribute to the speedy healing of injured skin should be used in the treatment. In addition, measures are taken to prevent infection of the nipples.
If the damage to the nipple is minor, you can lubricate the areola and nipple with squeezed milk and wait until completely dry. The effect of air and sunlight (in moderation) promotes healing, so you can leave your chest open for a while. Vitamin E, sea buckthorn oil is applied to the chest to accelerate regeneration. Lubricate the damaged skin and leave to dry for 5-10 minutes. There is no need to wash off these funds.
Healing ointments and creams with dexpanthenol, lanolin. The cream is also applied to the nipple in a small amount, left until completely dry and does not wash off. Deep cracks of the nipples should be treated with a healing gel, which is inserted directly into the wound and promotes healing. Of the physiotherapy procedures for nipple fissure, UFO therapy, UHF and SMT are used.
Prevention
Preventive measures to prevent nipple fissure are compliance with the rules of applying the baby to the breast and proper care of the nipples.
During pregnancy, it is advisable to observe the necessary hygiene rules that help maintain normal moisture, elasticity and protective properties of the skin of the nipples. To do this, daily breast washing is performed (washing off dried secretions) and nipple massage with the use of cosmetic oil. In the last trimester, it is advisable to use less soap, preserving the natural lubricant secreted by the areola glands. The nipples are washed with warm water, then wiped dry.
It is also recommended to rub the nipples with a coarse cloth to reduce skin sensitivity and the use of contrast baths (alternating washing with cold and warm water) to train the muscular contractile apparatus.
After the birth of a child, when feeding, the following recommendations on nipple hygiene must be observed.
Before each feeding, the breast is washed with warm water (without soap) and soaked (not wiped) dry with a clean towel or gauze. Washing with soap should be carried out no more than 1-2 times a day.
It is contraindicated to use alcohol solutions for skin disinfection, since they tend to dry the skin and remove the protective film of natural lubricant.
You can wash the nipples with a weak soda solution (1 teaspoon of soda dissolves in a glass of boiled water).
Use special ointments and creams based on lanolin to soften the nipples. Other bases (vegetable oil or vaseline) are contraindicated, since they can cause an allergic reaction or a disorder of the digestive system in an infant. It is better to lubricate the nipples immediately after feeding, so that the product has time to be absorbed (or washed off with water) before the next meal.
Be sure to use soft pads between the nipples and the bra, which must be changed regularly. It is better to use gaskets made of soft, air-permeable natural materials.
Literature
- Prasad Y, Chandrakala P, Manasa G. Common breast feeding problems in mothers in early postnatal period. IJCP. 2017;4(2): 625-628.
- Santos KJ, Santana GS, Vieira T de O, et al. Prevalence and factors associated with cracked nipples in the first month postpartum. BMC Pregnancy Childbirth. 2016;16(1):209. link
- Vieira GO, Martins CC, Vieira TO, et al. Factors predicting early discontinuation of exclusive breastfeeding in the first month of life. J Pediatr (Rio J). 2010;86(5):441-444. link
- Tengku Alina TI, Wan Manan WM, Mohd Isa B. Factors predicting early discontinuation of exclusive breastfeeding among women in Kelantan, Malaysia. Health and the Environment Journal. 2013;4(1):42-54.
- Eksioglu A, Yesil Y, Demir Gungor D, Ceber Turfan E. The effects of different breastfeeding training techniques given for primiparous mothers before discharge on the incidence of cracked nipples. Breastfeed Med. 2017;12:311-315. link
