Raynaud's of the nipple
Do your nipples go white after breastfeeding or when exposed to the cold? If so then you could be suffering a condition called Raynaud's of the nipple.
Raynaud's of the nipple, or breastfeeding Raynaud's, is a condition where women have nipple vasospasms, these are typically triggered by either the cold or breastfeeding. Vasospasm is the constriction of blood vessels, cutting off the blood supply.Because the breast pain associated with Raynaud’s is so severe and throbbing, it is often mistaken for Candida albicans infection (thrush) It is not unusual for mothers who have Raynaud’sto be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents.
Symptoms:
When nipple vasospasm is caused by Raynaud’s Phenomenon (Raynaud’s of the nipple), the nipple turns white, then there is a noticeable triphasic color change – from white to blue to pink – as blood flow returns.
Nipples will be sensitive and sore when exposed to the cold.
Usually your nipples will be sore throughout pregnancy.
As different blood vessels can constrict for different lengths of time, it can be possible to see all three colours in the nipple at once.
Vasospasm due to Raynaud’s is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud’s phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.
Pain with latching:
This can be another symptom that breastfeeding women develop. Damage to the nipple can occur if a child latches onto a constricted nipple during a vasospasm event. The constricted nipple does not stretch well, and the internal, and sometimes external, damage can cause high levels of pain during latching and sometimes also with milk let down. Any such internal damage can take a week or so to heal and become pain free.
After the first vasospasm event, vasospasm is likely to continue to occur with each feeding or exposure to the cold, with treatment typically taking a week or two for the events to subside. Vasospasm events may last from a few minutes to continuously if the nipple is not warmed. Pain can be described as being in either the nipple or the whole breast.
Some maternal medications have been associated with vasospasm, including oral contraceptives containing estrogen. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud’s phenomenon.
Raynaud's is often misdiagnosed as poor latch, as pain can occur when feeding, external damage may be present, and it may not hurt every time you breastfeed. This can be a very frustrating diagnosis for the mother, as trying to repeatedly latch the baby to get the 'perfect latch' can result in intense pain every time. Raynaud's is sometimes also misdiagnosed as thrush or as a milk bleb. Broken capillaries and ducts due to Raynaud's can bleed into the surrounding tissue. When a milk duct is damaged a white ring can form around the duct, looking like a milk bleb. These "bleb's" do not need to be opened up or cleared, but will generally heal themselves.
Treatment:
- Avoid cold. Apply dry heat to the breast when needed (this relaxes the “cramping” blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.). Use Breastwarmers, which insulate the breast, or woollen breastpads can be used to keep the breasts warm.
- Apply dry heat immediately after breastfeeding. Cover the nipple as soon as possible after baby comes off the breast. If he/she comes off frequently during a breastfeeding, cover straight away with your hand. Never allow your nipple to air dry. The evaporation of milk and saliva causes the nipple to quickly cool, causing vasospasm. Ensure that all bras and breastpads have either a wool or synthetic fabric against the skin - cotton must be avoided, as it feels cold when wet. If you have cotton bras then use breastpads with a synthetic or wool liner. During vasospasm phases some women find their nipples become sensitive to some fabrics such as wool, in this case synthetic, stay-dry, fabrics, such as microfibre should be used against the skin. Breastpads should be changed as soon as they become wet. Lanolin barrier cream or olive oil can help stop the nipple from air-drying, the cream or oil should be warmed in your hands before being applied.Massage the nipple with olive oil when mom is feeling pain from the vasospasm.
- When vasospasm occurs, repeatedly squeezing the nipple will help blood flow back into this area. Doing this immediately will limit damage to the nipple caused by a lack of blood, and will improve recovery times. Gently squeezing the nipple to ensure it is not constricted prior to latching will help ensure that secondary damage to the nipple does not occur. The Nbci website recommends massage of the chest muscles, these are below the collar bone and above the breast.If the nipple is constricted then the breast should be warmed before the baby is latched on.
- For serious vasospasm problems increased heat can be provided from heated wheat packs or socks filled with dry rice and microwaved for 45 mins. Using a hair drier directed down your top for a minute or so after feeding can also provide great relief
- Avoid caffeine, nicotine/smoking, diet pills, cold medications containing pseudoephedrine or phenylephrine, beta blockers, and other vasoconstrictive drugs, as they can precipitate symptoms. Oral contraceptives containing estrogen have also been associated with vasospasm.
- Medications and dietary supplements may also be helpful:
- Ibuprofen.
- Dietary supplementation with calcium/magnesium.
- Dietary supplementation with a vitamin B complex that includes B6 and niacin.
- Dietary supplementation with fish oil supplements.
- Low dose oral nifedipine.
- Use of breastwarmers and heating systems can increase milk supply, and may also help mothers who suffer from mastitis or blocked ducts.