IS THRUSH CAUSING MY SORE NIPPLES?

Introduction Common reasons for ongoing nipple pain Approaches to try to help resolve painful nipples or breasts If you still suspect thrush Do I need to stop nursing or discard my milk? Persistent thrush? Resources for additional information References Is thrush causing my sore nipples? Perhaps you recently had a baby and you have sore nipples. Perhaps your baby is a few months old and you suddenly are experiencing an uncomfortable latch. The internet, other parents, or your healthcare provider may suggest thrush as a diagnosis. But is this the most likely cause of this pain? Finding the source of discomfort is an important step in treatment. In the past, persistent nipple pain was often attributed to thrush, a fungal infection caused by Candida albicans. The connection is controversial. Yeast is common on our bodies and recent research disputes that yeast plays a role in breast and nipple pain. (Jimenez) Thrush on the nipple or breast was often assumed if nipple pain was combined with recent antibiotic use, predisposition to candida infections, existing nipple injury, yeast infection in the baby, latch or shooting pain in the breast. However, all of these symptoms can be associated with other conditions. It is always wise to consult your healthcare provider for a full diagnosis and consider all explanations. Common  reasons for ongoing nipple pain may include: Everyday factors that may contribute to a painful or irritating skin reaction on the nipple include: Approaches to try to help resolve painful nipples or breasts: Recent research suggests that thrush in a baby’s mouth does not automatically mean it will be passed along to you through breastfeeding therefore continued breastfeeding is not a concern. See more information in the following National Center for Biotechnology Information’s article (see discussion section, last line, 7th paragraph) and this article in the Physician Guide to Breastfeeding. According to the Academy of Breastfeeding Medicine and several other sources, there is no need to discard milk that was pumped during a presumed thrush infection. You can read this in the upper left of page 393, #10: “If a mother has breast or nipple pain from a bacterial or yeast infection, there is no evidence that her stored expressed milk needs to be discarded.” Sometimes the treatments you’ve been offered may resolve the issues. Consult with your primary healthcare provider and your baby’s physician, as both you and your baby will often be treated. Physicians prescribe a variety of treatment options when they diagnose thrush. Anti-fungal ointments with other ingredients are common  (Newman, 2017). Nystatin, miconazole and fluconazole may be prescribed for either you or your baby  (Berens et al, 2016). Different people react better to different medicines, so you may have to try more than one. Check with your healthcare professional about the medications listed and other options. New research suggests that several commonly used treatments may not be effective for the mother and may actually cause increased discomfort. (See ABM Protocol #36). This is especially the case with gentian violet (less than 0.5% aqueous solution). This treatment has been used historically as a treatment of thrush.  However, it has recently been identified as a cause for concern. (Wambach and Spencer, 2021). Both the World Health Organization (WHO) and Health Canada advise against its use. There has also been a suggestion that fluconazole may also worsen symptoms of vasospasm. (Nipple Vasospasm Patient Handout 2019. Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic). If your symptoms persist after you have tried these interventions,  you may not have thrush.  It is important to get back in touch with your healthcare provider. You might want to have medical tests done to rule out other conditions including anemia and diabetes. Attend a La Leche League Group meeting in your area for additional information and support. Updated January 2023 by Cindy Garrison, LLL Leader, BS, IBCLC LLLI: Positioning LLLGB: Positioning & Attachment LLLI: Medications – A Quick Guide For Parents LLLI: Pain – General LLLI: Persistent Pain When Breastfeeding LLLI: Sore Nipples LLLGB: Nipple Pain LLLI: Cleaning and Sanitizing Pumping Accessories Berens, P., Eglash, A., Malloy, M., et al, ABM Clinical Protocol #26: Persistent Pain with Breastfeeding, Breastfeeding Medicine, 2016, https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/26-persistent-pain-protocol-english.pdf (accessed 30 January 2023) Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic, Nipple vasospasm Patient handout, Jewish General Hospital, 2019, https://cdn.ciussscentreouest.ca/documents/hgj/pfrc/Breastfeeding_clinic/Vasospasm_px_handout_2019.pdf?1561062105 (accessed 30 January 2023) BioSpace: Warning of potential cancer risk associated with gentian violet Ask Lenore: Candida or thrush of the nipple and breast Ask Lenore: Nipple Vasospasm Centers for Disease Control & Prevention: Fungal Diseases International Breastfeeding Centre: Candida Protocol International Breastfeeding Centre: Vasospasm