Engorged Breast: Things You Need to Know

Breastfeeding is nature’s way of taking care of the nourishment of the infant and ensuring the health of the baby and the mother. However, there are a few roadblocks in the path of lactation. Breast engorgement is one such roadblock. It is a condition which manifests mostly in the initial period of establishing nursing patterns and can be painful. It is not, however, an insurmountable hurdle and can be managed with patience and simple home remedies.

Video: Breast Engorgement – Symptoms, Causes & Remedies

What is Breast Engorgement

Breast engorgement occurs either when you start nursing or miss many feeds without expressing milk or during pregnancy. It also happens in the transition period when the breasts change over from colostrum to mature milk. This condition is characterised by swollen, warm breasts which feel hard and inflexible. Mild cases of breast engorgement report tingling, oedema and heat while extreme cases report pain with significant discomfort and a throbbing sensation in the breasts, armpit area and hands as well as a low-grade fever.

Signs and Symptoms of Breast Engorgement

During breast engorgement, the skin becomes taut, shiny or transparent and on being pressed with a finger, stays depressed. The nipple may be stretched and flattened by the forward pressure of milk under the areola. Even when the nipple appears normal, it may be hard due to oedema and difficult for the infant to suck from. In extreme cases, the engorgement may extend to under the armpit and cause numbness and tingling in the hands because of pressure on the nerves. In some cases, there may also be a low-grade fever. If left untreated, engorgement can put pressure on the milk ducts, often causing the duct to get plugged. There may be a lump in one part of the breast, accompanied by heat and redness.

What Are the Causes of Breast Engorgement

When breasts are congested with milk they are prone to swelling. This happens because of the slowing down of circulation which results in fluid from the blood vessels seeping into the breast tissues. This is called engorgement, and commonly occurs during the first week of breastfeeding, during weaning or when there is a separation between the mother and the child due to travelling, ill health or other changes in schedules.

Breast engorgement also happens when there is an imbalance in milk production and demand where the child is drinking less milk than what is being produced at that time. It also happens when the breasts are transitioning from colostrum to mature milk. Sometimes, breast engorgement occurs when the breasts are not emptied and milk accumulates in the breast for some time. It may happen during weaning when the body is still not receiving the signal to cease the production of milk.

Engorgement in the first week is generally a sign that nursing is posing some challenges for the mother and the child. The challenges are in the areas of:

  • Difficulty in latching
  • Delayed and incomplete removal of milk from the breast
  • Oedema: Congestion and swelling due to water retention in the area

This engorgement in most cases resolves itself as the bodies of both the baby and the mother learn their functions. The baby learns to latch on well and takes regular feeds. The mother’s body regulates milk production as amount of milk produced is determined by the amount that the baby drinks. Thus, there is less milk accumulation and edema and the build-up of fluids in the area. As a result, engorgement is less likely to happen in later stages.

Engorgement During Pregnancy

In some cases, engorgement happens before giving birth as breasts gear up for nursing. There is a build-up of fluid and milk, which is not being drained since the baby is yet to come, leading to engorgement. You can cope with the issue using home remedies such as cold compresses and cold cabbage leaf compresses. These help bring down the engorgement gradually.

Complications from Engorgement

Though engorgement is a transient phenomenon, ignoring it completely may not be the best idea because it can be painful and uncomfortable. Engorgement also can lead to complications like:

  • A hungry child because of inability to nurse properly
  • Sore nipples due to many incorrect efforts at latching on properly
  • Insufficient flow of milk and higher pressure in the breast tissues can lead to infection in the milk-producing glands, ducts and mastitis
  • Edema can lead to damage of milk-producing cells and a decrease in milk supply

If engorgement persists for more than 2 days and is accompanied by a fever, it is advisable to consult a medical practitioner to rule out other issues like an infection or mastitis.

How Long Do Your Breasts Stay Engorged?

Engorgement typically resolves itself in 1 – 2 days. There may be significant discomfort in that period. If it does not resolve itself within two days, there are chances that the plugged duct can lead to a breast infection and a fever with flu-like symptoms.

Treatment to Get Relief from Engorged Breasts

Engorgement can be managed with many simple home remedies like:

  • Applying cold compresses, cold cabbage leaves, a pack of cold peas during pregnancy and between feeds
  • Nursing frequently and on demand
  • Positioning the baby for proper sucking
  • Softening the nipple and areola before a feed by expressing a little milk to help the baby latch on
  • Applying mild heat with warm showers, warm towels before a feed
  • Massaging your breasts with your fingertips in a circular motion down toward the nipple as the baby nurses

Managing Breast Engorgement

You can use simple techniques and home remedies to manage breast engorgement before nursing and while you nurse.

Managing Breast Engorgement: Before Nursing

Nipple stimulation and expressing fluid for engorgement is not advisable during pregnancy since this can stimulate labour. It is best to apply cold compresses and wait for the situation to resolve naturally.

Managing Breast Engorgement: While Nursing

To avoid breast engorgement, do the following when you nurse:

    • Nurse on demand, nurse frequently, stop only when the baby is satisfied
    • Do not limit the feeds according to time or the number of feeds per day
    • Help the baby to latch on properly and position him/her for optimal feeding
    • Soften the nipple and areola by expressing a little milk to help the baby latch on
    • If there is nipple soreness, do not stop nursing. Express milk that is building up while nipples become less sore
    • Apply heat to the area with warm showers, warm wet towels along with massage in a circular motion from the sides to the nipple
    • Massage your breast with your fingertips in a circular motion down toward the nipple as the baby nurses

Managing Breast Engorgement: Between Feedings

The following remedies and techniques in-between feeds can help you avoid breast engorgement:

      • If the baby does not nurse long enough to soften both breasts, hand-express or pump out a little milk after nursing
      • Apply a cold compress or towel or chilled cabbage leaves to your breasts between feedings to reduce swelling

How to Prevent Breast Engorgement?

The best way to manage breast engorgement is to avoid it altogether – by getting your baby latched on and feeding on demand right after birth and by continuing to feed till possible. If breast engorgement presents itself at times like recovery from surgery, weaning and travelling, implementing the methods mentioned in the Managing Breast Engorgement section would help ensure that the problem does not exacerbate.

Is it OK to Breastfeed My Baby When I Have Engorged Breasts?

Breastfeeding is, in fact, the best way to treat the engorgement. The fluid buildup goes down as you feed. When compared to expressing milk, nursing is a more efficient method and serves to accelerate the baby’s feeding learning curve and building a better bond between the mother and the child. Expressing is a better option when there is significant nipple discomfort or when the baby’s appetite is much less than the milk produced.

What to Avoid When Your Breasts Are Engorged

Avoid cold compresses before feeding. Nipple stimulation at non-feeding times should be avoided as this may cause more milk to flow, which if not consumed by the baby will need to be expressed.

Last but not the least, avoid worrying about breast engorgement. Nursing is a job which infants have been accomplishing efficiently since the evolution of mammals. Engorgement is a temporary hiccup and typically resolves itself in a day or two.

Conclusion: Breast engorgement is a temporary condition that occurs in the early phase of nursing. In some cases, the condition occurs during pregnancy as well. In most cases, engorgement can be avoided and controlled by massages and home remedies. However, in extreme cases where engorgement leads to excess pain and fever, it is best to consult a lactation expert.

Note: The subject content on managing breast engorgement and treating breast engorgement is the same and has been slightly altered to avoid complete replication.