Lactostasis

Lactostasis is the stasis of milk in the ducts of the breast of a nursing woman. In order to understand the causes of lactostasis, it is necessary to understand how the breast is arranged, what are its main functions in lactogenesis.

[1], [2], [3], [4]

Epidemiology

Most lactostasis occurs with the first lactation. There is also a tendency for lactostasis in nursing women who have already undergone lactostasis during previous births and breastfeeding in anamnesis. Lactostasis can occur if there are cicatricial changes in the mammary gland or mastopathy. Neither the age of the lactating woman nor the race affects the development of lactostasis.

In medical practice, the international classification of diseases is used. In accordance with it, the following forms of the disease are distinguished:

• O92 - Other changes in the mammary gland, as well as lactation disorders, which are associated with the birth of a child.
• O92.7 - Other and unspecified lactation disorders.
• O92.7.0 - Lactostasis.

[5]

Causes of the lactostasis

There are many reasons for this syndrome.

1. The first and most common cause is an incorrect application of the baby to the breast, which leads to incomplete emptying of the breast. As a result of accumulation in a certain area of milk and the absence of its withdrawal through an indefinite period of time, a clot of curdled milk is formed, which is the cause of the torment of a nursing woman.
2. The second frequent cause of lactostasis is a rare application or feeding by the clock. As a result of this type of feeding, lactostasis can develop immediately in both mammary glands. In this process, several channels are usually involved in the process.
3. Incorrect pumping. Very often on the fourth - the fifth day after delivery, when there is a profuse swelling of milk, and the newborn needs only a small amount of food to feed, the mother will begin to express herself on her own, often without even knowing how to do it. These manipulations eventually lead to damage to the tender ducts and the development of lactostasis.
4. Big breasts. Yes, the owners of lush breasts are at risk for developing lactostasis, since they do not always know how to properly adjust lactation.
5. Wearing a tight, synthetic and incorrectly selected bra, which in turn can lead to the transmission of ducts and the stagnation of milk in them.
6. Injuries. Even a small push of a crumb leg into the mother's breast can lead to lactostasis due to damage to the duct.
7. Stress. Chronic lack of sleep, fatigue lead to increased nervousness, which in turn negatively affects the production of milk.

[6], [7]

Risk factors

The main predisposing factors for the occurrence of lactostasis are:

• Feeding is not on demand, but by the hour;
• Incorrect attachment of the baby to the breast;
• Constitutional features: flat or drawn nipple, large breast size;
• Operative interventions on the mammary gland in the anamnesis;
• Obesity;
• Injuries and bruises of the chest;
• Stress and lack of rest and full-nourishment;
• Smoking and drinking alcohol.

[8], [9], [10],

Pathogenesis

The mammary gland is a paired hormone-dependent organ, having a complex lobular structure with alveolar-tubular branching of the milk ducts. It is in the alveoli that milk production takes place under the action of the hormone prolactin. In one gland there can be up to 20 radially arranged lobes. All the excretory ducts of one lobe are connected to the milk duct, which goes to the nipple and terminates at its apex with a small opening - a milk hole. In this case, the network of milk ducts branched closer to the nipple. The skin of the nipple is tuberous, there are many circularly and longitudinally directed muscle fibers in it, which plays an important role in sucking. The content of subcutaneous fat in the base of the nipple is minimal.

The main function of the breast is the synthesis and secretion of milk. Since the mammary gland is a hormone-dependent organ - during pregnancy its structure changes under the action of placental hormones. In the mammary gland there is a rapid increase in the number of ducts and their branches. From the 28th week of pregnancy, the mammary glands begin to produce colostrum. From this moment begins lactogenesis. It is in this period that the composition and quality of the colostrum is formed, which after delivery will be fed by the newborn and therefore the quality of nutrition and the lifestyle of the pregnant woman is important. But lactation itself begins only after the birth and separation of the placenta, when, under the influence of hormones such as prolactin and oxytocin, the colostrum is replaced by milk. This milk is rich for the baby on minerals, vitamins, fats, proteins and carbohydrates, necessary for its growth and development precisely in this period of newborn. First, milk is produced regardless of feeding. Then it is allocated depending on the emptying of the chest.

Now, knowing the structure and physiology of the breast, we will understand the pathogenesis of lactostasis. So at the beginning of lactation, when all the mechanisms of a complex process are not yet established, the pathogenetic link is the lack of interaction between the secretory, accumulative and excretory functions of the breast. Thus, on the second - third day after delivery, when the milk is abundantly produced by the glands, the alveoli are not able to retain a large number of them, and the ducts under the action of hormones do not extract it enough. Here, and stagnation of milk, or lactostasis. In later periods of lactation, the main pathogenetic role is played by the mechanical effect on the release of milk, which creates an obstacle to its full isolation. Now the process of lactation is already well established and the milk is produced under autocrine control, and not because of the direct action of the hormone.

Symptoms of the lactostasis

The main first signs of lactostasis that occur in the initial stage are soreness and discomfort in the mammary gland. When palpating a small, painful patch is examined in the usual mammary gland tissue. The skin above this site becomes hyperemic. First, the development of lactostasis, pain occurs only on contact with the mammary gland, later painful sensations persist. When plugging several ducts, there is swelling of the entire breast tissue, if one duct is damaged, the swelling can be traced locally only over the blockage site. Locally, over the damaged area, the skin temperature rises. Body temperature remains normal and the overall well-being of a nursing woman is usually not disturbed. In the late stage of the disease, when the conditionally pathogenic microflora is involved, the body temperature rises, the mammary gland becomes swollen and painful, the general condition of the patient worsens. There is a chill and weakness.

After detecting the site of the blockage of the breast, you must immediately proceed with its removal. The best thing here is the frequent and correct application of the baby, so that his chin was directed towards the formed lactostasis. Since no apparatus for expressing, no hands can cope better than the baby's mouth. And you need to apply as often as possible, it is better to lie down with a baby for a day in bed, and all the household chores to entrust to the other household members. In this case, the position for feeding should be chosen the most convenient, in which nothing should interfere and possibly relax as much as possible. If there is a prolonged blockage and painfulness or early onset of lactation, it is recommended that warm dry tissue be applied to the affected breast before feeding, and pancreating so that the baby is not saturated with the front milk without reaching the site of the problem. You can also massage the hardened area lightly, but you do not need to apply special forces. The main task of expressing the breast with lactostasis is to release the blocked duct. To do this, you need to place four fingers of the right hand under the breast, and the thumb on the upper surface of the breast. In this case, it is necessary to clearly feel the area of hardening under the fingers. Having grasped the gland in this way, the fingers move forward from the base of the gland to the nipple. These movements will provide a minor soreness, but it will immediately pass after the drainage of the duct. The main thing is not to overdo it with the force of pressure on the gland, as it can damage it and thereby aggravate the situation. If, after doing such a procedure, under the fingers there is a hardening, it is necessary to massage the block of the blockage again and continue to express. After pumping, the baby will be more difficult to suck, but it will definitely empty all the ducts. This procedure is recommended to carry out several feeds in a row. With the disappearance of symptoms, several more feedings should be started from the chest, in which there was lactostasis, and finish with the other breast. In any case, it was possible to cope independently with this problem or not, it is necessary to visit a specialized specialist - mammologist, and in his absence - a surgeon or family doctor. It is the doctor who will put an accurate clinical diagnosis and prescribe the correct treatment, correct the already performed manipulations and advise on the prevention of lactostasis.

[11], [12]

Diagnostics of the lactostasis

Lactostasis is diagnosed immediately with a local examination of 100%. But independently it is impossible to carry out differential diagnostics, since there are a number of other diseases of the breast with similar symptoms with lactostasis. The main difference from mastitis is the absence of body temperature rise to high figures and deterioration of the overall well-being of a nursing woman. With prolonged accumulation of milk in the ducts, cysts can be formed - galactocele, with the treatment of which only the doctor can cope.

As a rule, with lactostasis, a detailed blood test is assigned to assess the process's neglect. The following parameters are evaluated: the erythrocyte sedimentation rate, the number of leukocytes and the leukocyte formula. The main instrumental method of investigation is ultrasound diagnosis. It is on the ultrasound that the doctor can see the number, volume and location of the blocked ducts. The presence of a purulent complication or cystic lesions can also be diagnosed with ultrasound. The procedure is painless, not expensive, absolutely safe for health, and most importantly 100% informative. Sometimes, in rare cases, mammography is prescribed, which is also informative, but carries a radiation load, which is not good for a nursing mother and her baby.

[13]

Treatment of the lactostasis

Medical measures should be taken immediately after the diagnosis of lactostasis. To anesthetize and reduce local edema, the use of "Traumeel" ointment is recommended. It must be applied in small quantities by gentle massaging movements in the place of blockage. Orally it is necessary to take 1-2 tablets of "No-shpa", which has an antispasmodic effect and will expand the ducts, which will facilitate the departure of the clot of milk. A good drainage and anti-edema property is the drug "Lymphomyosot", which is prescribed 10 drops 3 times a day for 15-20 minutes before meals under the tongue. From the means of alternative medicine, the method of treating lactostasis with a leaf of cabbage is well proven. To do this, select a large sheet, cool it and mash it well, and then attach it to the affected area for the night. Cabbage juice has a resolving effect on the occluded part of the gland. With severely curable obstructions of the ducts, UHF and electrophoresis are prescribed, professional massage with a course up to 10 sessions.

Great attention in the treatment of lactostasis should be given to the nutrition and rest of the nursing woman. Rest should be full: night sleep at least 7-8 hours, and daytime sleep 1-2 hours. In the menu it is desirable to limit the amount of protein food, and to diversify the table with vegetables and fruits, seafood, chamomile broths, green tea, compotes.

Prevention

Prevention of lactostasis is the correct and frequent attachment to the baby's breast, feeding on demand, and not on time, full nutrition and rest of the nursing woman. It is also important to wear properly selected underwear. It's also good to get a good counselor on breastfeeding.

[14], [15]

Forecast

The forecast for timely assistance is always favorable. The most common complication of lactostasis is mastitis. It can occur in the absence or incorrect treatment: the use of hot and alcohol compresses, rough and wrong massage, etc. Complication of lactostasis with mastitis occurs due to the presence on the nipples of cracks and wounds, through which pathogenic microorganisms penetrate and cause purulent inflammation of the gland.

Lactostasis usually lasts for 2-3 days of correctly selected treatment and does not leave after itself relapses.