Breastfeeding Knots? Let’s Talk Clogs, Mastitis & Other Troubles

Breastfeeding is often described as a beautiful bonding experience—but let’s be real, it can also come with its fair share of ouch. If you’ve ever felt a lump, a sharp sting, or a deep, throbbing pain in your breast, you’re not alone.

The words “breastfeeding knots” were alien to me when I started breastfeeding. I can remember the first time I felt a painful lump on the side of my breast and I noticed a white blob on my nipple. I was 2 months into my exclusive breastfeeding journey, a first-time mum, and very much “winging it” because breastfeeding chose us, rather than we chose to breastfeed.

As I started to google my “white mark on nipple” symptoms, I was quickly reassured that it was a milk blister which is common in breastfeeding mums. From that day on, I learned all kinds of new breastfeeding lingo! 

Nothing really prepares you for the emotional and physical challenges that breastfeeding can throw your way. Although we are taught that breastfeeding is established on a supply-and-demand rhythm, it’s important to remember that it’s also about comfort and well-being for your little one.

Understanding Breastfeeding Knots: What’s Happening in Your Breasts?

What are breastfeeding knots?

A breastfeeding knot refers to a tight, painful lump in your breast that is caused by a blocked milk duct or inflammation. If you’ve ever had engorged breasts, the feeling is similar to this but on just one small area of the breast. It can feel sore, tender, and painful to touch when you’re feeding or expressing.

Some women describe it as “It’s like a marble under the skin” or, “It’s a sharp, shooting pain out of nowhere”. Describing the feeling and your symptoms to your doctor can help them identify what type of breastfeeding knot you are experiencing. 

The Biology Behind Breastfeeding Knots

Behind your nipple are lots of thin tubes that web off to the mammary ducts, where your breast milk feeds from. When the surrounding breast tissue gets inflamed or something obstructs the milk flow, the breast milk builds up inside the milk duct and can be at risk of infection.

Common Triggers for Breastfeeding Knots

There are a few reasons why inflammation and blocked milk ducts occur and more often than not, it’s due to your baby’s latch or it’s linked to oversupply. If your baby isn’t latched onto the breast correctly, they won’t be able to drain the breast fully leaving milk to sit and harden inside the milk ducts. Remember to avoid wearing tight clothing and wired bras so that your milk flow isn’t restricted.

Infrequent feeding can happen as your baby’s routine changes. They may be ready to drop a feed at nap time or they have started weaning onto solid foods. Breastfeeding knots are more likely if your breasts are engorged and the milk supply has nowhere to go. Over time, your body will adjust to the demands of your baby but it is wise to express a little breast milk to relieve engorgement. 

Thrush or infections causing inflammation in the breast tissue and blood vessels can lead to breastfeeding knots. You can relieve any discomfort with breastfeeding-friendly pain relief (paracetamol or ibuprofen). If you start to experience fever-like symptoms or the pain doesn’t subside, you must consult your doctor for further treatment.

Dysphoric Milk Ejection Reflex (D-MER)

D-MER and other hormone imbalances can cause nursing mums to feel negative emotions just before their letdown starts. It can put mothers off breastfeeding which can lead to breastfeeding knots if they go cold turkey. 

There is nothing that breastfeeding mums have done to cause the dysphoria and the feeling quickly dissipates as the feed continues. Speak to a breastfeeding consultant or your doctor if this condition is causing you to want to wean from breastfeeding or experience common breastfeeding challenges, such as breastfeeding knots.

The 5 Most Common Types of Breastfeeding Knots & Their Symptoms

We have identified 5 common types of breastfeeding knots and steps you can take to treat them and reduce your chances of it happening again.

1. Clogged Milk Ducts

Signs that you could be developing a blocked milk duct can be feeling a shooting pain in the breast, feeling a hard/sore lump in the breast, and discomfort whilst nursing. Sometimes when the breast isn’t being drained of milk efficiently or the milk flow is clogging up, it can cause these symptoms. 

The best way to treat a clogged milk duct is to gently massage the lump while you’re nursing. Massage it in a small circular motion and avoid pushing too hard on it. Applying a warm compress can help to soothe any discomfort and also to help break down the blocked milk duct and get the milk flowing again.

You can also use a smart electric breast pump to efficiently withdraw milk and effectively reduce the breastfeeding knot.

2. Engorgement

If your breasts are engorged they will feel rock-hard and swollen. Your skin will feel stretched tight and it can be painful to touch or nurse through. Mums may experience engorgement for the first time in the early days of breastfeeding when their breast milk starts to come in. 

To treat engorgement and relieve your symptoms, you can try gentle hand expressions before your baby latches for a feed. Collect your initial letdown in a breast milk collection cup and then latch your baby on so your skin and nipple don’t feel so tight when they begin to drink. 

Resting cold gel packs on your engorged breast(s) can help to bring down any swelling and again, you can use a breast pump to relieve the pressure without overstimulating milk production. 

3. Mastitis & Periductal Mastitis

Mastitis occurs in women with breastfeeding knots and their clogged milk ducts become infected. The infection can cause breastfeeding mums to have flu-like symptoms, sharp pain in their boobs, redness, and fever. 

Periductal Mastitis is different from Lactational Mastitis. Periductal Mastitis occurs when the breast tissue around the milk ducts becomes inflamed. The inflammation is normally felt under the nipple and you can experience similar symptoms to Lactational Mastitis, however, this isn’t always the case. You don’t have to be breastfeeding to be diagnosed with Periductal Mastitis.

To treat Mastitis the best thing you can do is to continue breastfeeding and pumping to prevent your condition from getting worse. You can apply cabbage leaves to your breasts for natural relief and take pain-relief medication to alleviate your symptoms.

It goes without saying, if your symptoms get worse or do not go away, you must consult your doctor as you may need antibiotics to remove the infection.

4. Milk Blisters & Blebs

A milk bleb, also known as milk blisters, shows as a little white mark on the nipple. Sometimes, blisters on the nipple while breastfeeding can cause some discomfort. Ensure your baby is latching correctly and ask for a breastfeeding specialist to watch you latch and breastfeed to give you advice.

Saline soaks and warm compresses can help to reduce any pain and help the milk flow. It’s important not to squeeze or “pop” the milk bleb as this can lead to more pain and leave your skin open to infection.

If the milk blister persists or starts to become more painful, seek further medical advice. There are steroid creams and supplements that your doctor can recommend to get rid of milk blebs. 

5. Thrush & Fungal Infections

Breastfeeding knots can also appear as conditions like thrush. Thrush (candida fungus) can develop when the skin or nipple is cracked. The candida fungus gets into the skin causing thrush which can also be passed onto your baby when they breastfeed. 

Symptoms of thrush on your nipple can be:

• A burning sensation after you have breastfed

• Shooting pain in the breast

• White patches on the nipple

• Your baby may have white patches in their mouth that won’t rub off

• A white film over your baby’s mouth after a feed

• Your baby is unsettled at the breast during a feed

To reduce the chances of getting thrush when breastfeeding, ensure that your breast and any breastfeeding equipment are sanitised and sterile. Your doctor can prescribe antifungal cream to apply sparingly to your nipple and babies can be prescribed an oral gel to clear oral thrush.

Best Treatment & Prevention Methods for Breastfeeding Knots

Breastfeeding knots can lead to further complications when they’re left untreated, so it’s best to seek help as soon as they occur. As well as treating breastfeeding knots, prevention is key to avoiding them altogether.

Treatment: What to Do When You Have a Breastfeeding Knot

• Hand expressions to take off excess milk and relieve pressure

• Gentle breast massage in circular motions to break up blockages

• Warm compresses to encourage the milk to flow

• Using a breast pump to fully empty the breast and relieve engorgement

• Stay hydrated to maintain your milk supply and promote milk production

• Rest if breastfeeding knots are making you feel unwell and seek medical help

Prevention: How to Avoid Breastfeeding Knots

Nursing and pumping frequently will not only maintain your milk supply but also prevent the milk ducts from clogging up. Leaving long gaps in between feeds can lead to breastfeeding knots. If your baby is dropping a feed, use a breast pump to express a small amount of milk to take the edge off and let your milk supply decrease gradually over time. 

Use nipple creams and bamboo breast pads to soothe irritations on the skin to prevent it from becoming cracked or damaged. Warm showers can also encourage your milk to flow. 

Avoid wearing tight bras and clothing so that the breast tissue and milk ducts are not restricting the milk flow. When you recognise the early signs and symptoms of clogged milk ducts, you can prevent conditions such as mastitis before the breastfeeding knots worsen. 

Conclusion

With the right approach, breastfeeding knots can be treated quickly. Now you have an awareness of the causes and symptoms of the most common breastfeeding knots, such as milk blebs, mastitis, and engorgement, you can find the right solution to keep unnecessary discomfort at bay. 

Using a smart electric breast pump alongside breastfeeding can make nursing more comfortable for you and your baby by helping with milk flow and preventing engorgement. The best part is that you will feel much better and the expressed milk can then be stored for future use!