Nipple vasospasm and breastfeeding

Nipple vasospasm happens when the blood vessels supplying the nipple spasm (tighten) and reduce blood flow to the nipple. It can cause severe pain during breastfeeding.

It is common to feel intense pain when this happens, especially if the weather is cold.

Nipple vasospasm can occur in response to nipple trauma (injury). For example, this may occur if your baby does not attach well to your breast during breastfeeding.

It may be triggered by cold or stress.

It can also happen randomly and unrelated to breastfeeding — for example, due to Raynaud's phenomenon (commonly known as Raynaud's).

Some people are more likely to have nipple vasospasm, including those who:

• tend to have cold fingers and feet
• have poor circulation
• have a family history of Raynaud's phenomenon
• smoke — because nicotine constricts the blood vessels
• drink alcohol or coffee, or take certain medicines

Some people first experience nipple vasospasm during pregnancy.

Raynaud's phenomenon occurs when vasospasm happens randomly. It is unrelated to breastfeeds. Vasospasm symptoms can also occur in the fingers and toes in response to cold.

Raynaud's is caused by a temporary interruption to normal blood flow in the small blood vessels. Blood flow returns to normal after some time. The most common body parts affected are:

• fingers
• toes
• nose
• lips
• ears
• nipples

If you have Raynaud's and are pregnant, you may also experience nipple vasospasm when you are breastfeeding.

People with vasospasm commonly describe it as an intense, throbbing, burning type of pain in their nipples. Your nipples might feel very sensitive, even to very light touch.

The pain may affect just the nipples or the whole breast.

When the blood vessels in the nipples are affected by vasospasm, you may feel pain before, during or after breastfeeds. The pain can last for a few seconds or longer.

Your nipple or its tip may look more pale than usual during vasospasm. The colour of your nipple may change again when your blood flow returns after the spasm. This can mean a change from white to purple, blue or red, as your nipples return to their normal colour.

If you have nipple vasospasm, you will experience pain during breastfeeding, even when your baby is attached properly and sucking well.

Breastfeeding should not be painful. It is common in the early days of breastfeeding to experience some nipple sensitivity or pain as your body adjusts to feeding.

Ask your midwife or lactation consultant if you think you may have nipple vasospasm.

You can manage nipple vasospasm by avoiding or reducing exposure to triggers that worsen your symptoms. Triggers may include:

• nipple damage
• cold temperatures
• smoking
• positioning while breastfeeding
• some medicines

If cold temperatures trigger your symptoms, consider dressing in light layers. You can take them off easily if you feel you're overheating.

There are other strategies you can try — here are some examples:

• Apply a warm compress or heat pack soon after breastfeeding.
• Use breast or nipple warmers made from wool or reflective materials — ask your pharmacist about the options available.
• Avoid caffeine — some people report that this is helpful.
• Wear extra layers of clothing to avoid getting cold, and keep your nipples covered, especially when it's cold.

Ask your midwife or a lactation consultant to help you check that your baby is attaching well during breastfeeding. They can also check if you have nipple trauma or nipple thrush.

Calcium channel blockers are medicines that are sometimes used to treat or prevent nipple vasospasm. If your symptoms are severe or persistent, ask your doctor, midwife, or a lactation consultant for advice.

Some people find that supplements help relieve symptoms. Magnesium tablets can help to relax the blood vessels.

Before taking any new medicines or supplements, speak with a healthcare professional or your pharmacist. This is especially important while breastfeeding, as some medicines can be passed on to your baby through your breast milk.

Many breastfeeding issues can be solved with the help of someone skilled in breastfeeding support.

For more help with nipple vasospasm and breastfeeding, contact:

• your midwife or child health nurse
• a lactation consultant
• the Australian Breastfeeding Association on their helpline — 1800 mum 2 mum (1800 686 268)

The Australian Breastfeeding Association also has tips on how to manage nipple vasospasm.