Nipple Pain While Pumping – What Every Mom Should Know

You might expect breastfeeding to be painful, especially when babies start teething – but it might surprise you to find you’re experiencing nipple pain while pumping.

On its own, pumping shouldn’t cause pain. Unfortunately, though, many moms experience uncomfortable and downright excruciating symptoms while expressing breast milk.

Fortunately, we’re here to share what every mom should know about nipple pain and pumping, from the causes of this discomfort to solutions for alleviating the pain.

We’ll also discuss when you should visit the doctor for help, and when enough is enough on your painful pumping journey.

Photo by Beukbeuk, Public Domain

Causes of Nipple Pain while Pumping

While some moms may have overly sensitive skin and always feel discomfort while pumping, there are a few more common causes of nipple pain while pumping.

You may even have multiple underlying causes which combine to create the “perfect storm”.

Incorrect Breast Shield Sizing

If you receive a breast pump as a gift, order one with your insurance (or get a breast pump for free from your insurance), or even purchase a pump online, it likely came with a set of flanges, AKA breast shields.

On occasion, a pump may arrive with multiple sizes of “horns.” Or, you may have an option upon ordering.

For example, the Medela Symphony, a hospital-grade pump, is a closed system pump, so it’s safe for multiple women to use. Each mom gets her own set of flanges, valves, and tubing.

If you obtain a pump from a hospital lactation consultant, she may ask what size flanges you need.

Hopefully, she can also offer sizing help, but sizing assistance is not always possible. Especially if you’re not a patient of the hospital where you rent a pump from, it can be challenging to get the right help.

Too large a flange and you may not produce enough milk from lack of stimulation. Too small, however, and you may feel painful chafing and even develop blisters. Even excessively large breast shields can cause your nipple to rub painfully against the sides of the plastic.

Unfortunately, shield sizing is ultimately the most common cause of nipple pain while pumping.

Dry Conditions Cause Friction

The pump flange environment is a moist one once the milk starts flowing. But before the letdown happens, your nipples are likely dry and vulnerable to the friction of the machine’s movements.

However, if friction is causing you pain, the milk ejection reflex may delay or not happen at all.

Since mom’s comfort is crucial for adequate milk production, you want to be as comfortable as possible while expressing milk.

Friction not only prevents letdown and causes chafing, but can also lead to fissures in the delicate skin on your nipples. By the time the milk starts flowing, you may be in too much pain to continue pumping.

Prior Damage Creates Discomfort

In most cases, moms who have previously had breast surgery go on to produce breast milk successfully, but pumping can present a different set of problems.

Nerve damage from surgery, as well as bruising or abscesses, can affect a mom’s ability to comfortably and efficiently express milk with a pump.

For moms who have had periareolar incisions, both reduced and increased nipple sensitivity are possible side effects.

A periareolar incision is cut right around the mom’s areola where it’s less visible. In contrast, under the breast or arm incisions have fewer risks regarding nerve damage.

If you had breast surgery and still have pain or sensitivity, you may need to start out with slower and gentler pump settings.

In some cases, moms with nerve issues cannot trigger the milk ejection reflex at all. Unfortunately, pumping may prove impossible in those cases.

Selecting the Wrong Suction Setting

Though most pumps come with a range of speed and suction settings, you may be choosing the wrong ones.

You might assume you’ll produce milk faster with a higher speed and suction setting. However, staying safe and comfortable means choosing a suitable level.

Too much suction can cause breast tissue damage, and the same applies to your nipples. Higher suction is not always better, and you should build up to higher speeds and strengths slowly and gradually.

Therefore, if you’re switching your machine on and immediately turning it up to ten, you may be damaging your nipples and lowering your milk supply, too.

Dry Pumping

Often, moms begin pumping while they’re producing colostrum, the concentrated milk babies consume for the first few days.

Pumping sooner and more frequently can help moms’ milk flow in faster – however, it also means mom is starting with a dry breast.

Pumping when there’s no milk coming out can damage your nipples and cause pain.

For the same reason dry nipples are painful, so is dry pumping. There’s no moisture to help with friction, and moms experience stinging and burning as the dry skin rubs.

Thrush

For moms who are both pumping and nursing directly, thrush could be responsible for your pain.

Thrush is a fungal infection which occurs when yeast-like organisms become imbalanced in your body.

The result is painful nipples, areola and breast, plus a fuzzy residue on the nursing baby’s tongue.

Moms who both pump and nurse may find relief from nipple pain once the duo receives treatment for thrush.

Mastitis

Mastitis is another condition which can cause pumping moms to experience nipple pain.

It happens when mom has a blocked milk duct where milk cannot flow out. Most times, moms feel tender or sore spots or lumps, and overall breast pain can extend to the nipples.

Photo by Daniel Lobo Licensed under CC BY 2.0

Solutions for Nipple Pain in Pumping Moms

Whether you suffer from one or more of the conditions above, the following is a list of possible treatments and solutions for each situation.

Hopefully, once you recognize and treat each underlying cause, you’ll experience pain-free pumping.

Reduce Friction

Since friction is a significant cause of contact pain for pumping moms, a pumping salve or balm can help.

As a rule, any type of cream or oil which is safe for babies to consume is okay to use on your nipples.

For example, Medela recommends lanolin, a wool-based cream for nipple pain and pumping relief.

Other options include a dab of olive or coconut oil or another baby-safe nursing balm.

Properly Sized Flanges

Breast shield sizing can vary by brand, so each manufacturer has its own sizing guide.

However, measuring your nipples after a few minutes of pumping can help you find the right size flange for the most comfortable and efficient milk making.

Sizes range from 21mm to 40mm in most brands, with the mm size referring to the width of the nipple.

Set a Pumping Timer

Most pumping moms need anywhere from 15 to 30 minutes to empty their breasts.

While you may be tempted to continue pumping to increase your milk supply, pumping a dry breast can damage tissue and cause further nipple pain.

Keep your pumping sessions short and add extra sessions more frequently if your goal is to produce more milk.

Air Out Your Nipples

Breast milk is the ultimate “cream” for helping heal damaged nipples, and many sources suggest leaving some milk on your nipples and letting them air dry.

Staying topless prevents pain from rubbing against clothing and gives your nipples a chance to heal as well, but that’s not a feasible option for everyone at all times (for obvious reasons).

Treat Underlying Conditions

If you suspect thrush, mastitis, or another painful condition, treating those issues should be a priority.

If you have tried every solution above and still have pain, there may be another hidden problem making pumping painful, so please see a doctor for reassurance purposes.

When Should You See a Doctor?

In most cases, mom can troubleshoot her own nipple pain and try out solutions.

But in some cases, you should see a professional doctor or lactation consultant for ongoing nipple pain while pumping.

Mastitis and Other Conditions

For most moms, mastitis is a serious condition you won’t want to mess around with.

Severe cases require antibiotics, although some moms power through without them.

Along with medication, moms must also continue to express milk if they want to maintain a supply – which in and of itself is a nightmare to go through without a medical professional prescribing painkillers to ease you through the process.

Pumping with mastitis can be agonizing, but suffering a recurring infection because of additional clogged ducts is worse.

Also, yeast overgrowth like thrush will not go away on its own, although there are natural thrush remedies to help combat it.

When Nipple Damage Doesn’t Heal

Unfortunately, some moms experience such intense nipple damage they require medical intervention.

Although a baby with latch issues can cause damage to mom’s nipples, so can misusing a pump.

If you have fissures or continuous bleeding in your nipples, you may want to see a doctor for antibiotics or a topical cream. After all, most babies won’t want to drink milk with blood in it.

There’s also the potential for you to wind up with permanent nipple damage from continuing to pump.

If Unexplained Pain Persists

Though many causes of nipple pain are treatable, you may experience continuous pain with no apparent explanation.

One cause of nipple pain which many nursing and pumping moms are unfamiliar with is Raynaud’s.

Raynaud’s of the nipple involves vasospasms, painful nerve responses to pumping.

Women who experience Raynaud’s of the nipple may also see symptoms in other areas of the body, such as the fingers and toes.

Common triggers for pain include cold and wet stimuli, so breastfeeding and even pumping can become painful for no apparent reason.

However, pumping is often less uncomfortable than direct nursing for women with Raynaud’s.

Still, if pain persists despite making the changes above, you may want to see a doctor to determine whether you have this or any other underlying medical condition.

Photo by Marco Verch Licensed under CC BY 2.0

How Much is Too Much Nipple Pain?

When is nipple pain too much during pumping?

Every mom has a unique pain tolerance level, so what’s insufferable for one mom may be a walk in the park for another.

However, there are times when moms should legitimately stop pumping for their own health and well-being.

When It Becomes All-Consuming

If your nipple pain is so persistent and inescapable to the extent that it makes you miserable all the time, no one will blame you for quitting pumping.

If you’re unable to focus on your beautiful baby through painful pumping or even trying to wear a shirt over your sore nipples, it might be time to stop.

When Wounds Refuse to Heal

For mamas with open wounds on their nipples, it’s difficult to continue pumping.

One reason is if there’s blood flowing into the milk each time you pump, your baby will probably refuse a bottle of it. You may also experience scabbing and peeling of your nipples when they dry afterward.

A regular routine of pumping blood can also include pus seeping into the milk.

Even if you hope to continue pumping, you may need a break from milk expression to allow yourself time to heal. However, ceasing pumping can sometimes mean your milk will dry up.

An alternative to stopping pumping is continuing to hand-express milk to whatever point you’re comfortable with it.

It’s a technique you’ll need to work to perfect, but hand expressing breast milk is a reliable and even more natural way to get milk out without causing further damage to your nipples.

Wrapping It Up

When it comes to pumping, nipple pain is no joke.

It can even become so crippling to the point where you dread dragging the pump out and starting the process all over again every few hours.

Like lactation consultants are fond of saying about direct breastfeeding, pumping shouldn’t hurt either.

Fortunately, there are many steps pumping moms can take to alleviate nipple pain while pumping. Still, there are no guarantees regarding milk production or pain relief for any pumping mom.

Although milk production is a top concern of pumping moms, it’s not worth hurting yourself to get a few extra ounces of milk.

The first step you should take is toward maintaining comfort while pumping, which can help you stick with your pumping schedule longer than you might if the pain persisted.

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