Mastitis and breast engorgement

Mastitis (parenchymatous inflammation of the mammary glands) and breast engorgement (congestion) are disorders that may affect lactating females. The prognosis for both disorders is good.

Causes and incidence

Mastitis develops when a pathogen that typically originates in the nursing infant’s nose or pharynx invades breast tissue through a fissured or cracked nipple and disrupts normal lactation. The most common pathogen of this type is Staphylococcus aureus; less frequently, it’s S. epidermidis or beta-hemolytic streptococci. Rarely, mastitis may result from disseminated tuberculosis or the mumps virus. Predisposing factors include a fissure or abrasion on the nipple; blocked milk ducts; and an incomplete let-down reflex, usually due to emotional trauma. Blocked milk ducts can result from a tight bra or prolonged intervals between breast-feedings. Causes of breast engorgement include venous and lymphatic stasis, and alveolar milk accumulation. (See Physiology of lactation, page 982.)

Mastitis occurs postpartum in about 1% of pregnant women, mainly in primiparas who are breast-feeding. It occurs occasionally in nonlactating females and rarely in males. All breast-feeding mothers develop some degree of engorgement, which isn’t an infectious process.

Signs and symptoms

Mastitis may develop anytime during lactation but usually begins 1 to 2 weeks postpartum with fever (101° F [38.3° C] or higher in acute mastitis), malaise, and flulike symptoms. The breast (or, occasionally, both breasts) becomes tender, hard, swollen, and warm. Unless mastitis is treated adequately, it may progress to breast abscess.

Breast engorgement generally starts with onset of lactation (day 2 to day 5 postpartum). The breasts undergo changes similar to those in mastitis, and body temperature may be elevated. Engorgement may be mild, causing only slight discomfort, or severe, causing considerable pain. A severely engorged breast can interfere with the infant’s capacity to feed because of his inability to position his mouth properly on the swollen, rigid breast.

Diagnosis

Confirming diagnosis  Diagnosis is usually easily made if pus is expressed from the nipple; culture may be helpful in confirming mastitis.

Treatment

Antibiotic therapy, the primary treatment for mastitis, generally consists of oral cephalosporins, cloxacillin, or dicloxacillin to combat staphylococcus; azithromycin may be used in patients allergic to penicillin. Although symptoms usually subside 2 to 3 days after treatment begins, antibiotic therapy should continue for 10 days. Other appropriate measures include analgesics for pain and, rarely, when antibiotics fail to control the infection and mastitis progresses to breast abscess, incision and drainage of the abscess.

The goal of treatment of breast engorgement is to relieve discomfort and control swelling, and may include analgesics to alleviate pain, and ice packs and an uplift support bra to minimize edema. Rarely, oxytocin nasal spray may be necessary to release milk from the alveoli into the ducts. To facilitate breast-feeding, the mother may manually express excess milk before a feeding so the infant can grasp the nipple properly.

Special considerations

If the patient has mastitis:

❑ Isolate the patient and her infant to prevent the spread of infection to other nursing mothers. Explain mastitis to the patient and why isolation is necessary.

❑ Obtain a complete patient history, including a drug history, especially allergy to penicillin.

❑ Assess and record the cause and amount of discomfort. Give analgesics as needed.

❑ Reassure the mother that breast-feeding during mastitis won’t harm her infant, because he’s the source of the infection. Tell her to offer the infant the affected breast first to promote complete emptying of it and prevent clogged ducts. However, if an open abscess develops, she must stop breast-feeding with this breast and use a breast pump until the abscess heals. She should continue to breast-feed on the unaffected side. Suggest applying a warm, wet towel to the affected breast or taking a warm shower to relax and improve her ability to breast-feed.

❑ To prevent mastitis and relieve its symptoms, teach the patient good health care, breast care, and breast-feeding habits. Advise her to always wash her hands before touching her breasts.

❑ Instruct the patient to combat fever by getting plenty of rest, drinking sufficient fluids, and following the prescribed antibiotic therapy.

If the patient has breast engorgement:

❑ Assess and record the level of discomfort. Give analgesics, and apply ice packs and a compression binder, as needed.

❑ Teach the patient how to express excess breast milk manually. She should do this just before nursing to enable the infant to get the swollen areola into his mouth. Caution against excessive milk expression between feedings because this stimulates milk production and prolongs engorgement.

❑ Explain that because breast engorgement is due to the physiologic processes of lactation, breast-feeding is the best remedy for engorgement. Suggest breast-feeding every 2 to 3 hours and at least once during the night.

❑ Ensure that the mother wears a well-fitted nursing bra, usually a size larger than she normally wears.

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Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

Other Book Chapters Related to Breast symptoms

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Breast symptoms: Introduction (review 210 causes)
• Next Book Extract About Breast symptoms: Nipple discharge (Professional Guide to Signs & Symptoms (Fifth Edition))
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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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