Lactostasis

Lactostasis is the stagnation of milk in the ducts of the mammary gland of a nursing woman. In order to understand the causes of lactostasis, it is necessary to understand how the mammary gland is structured, what are its main functions in lactogenesis.

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Epidemiology

Most often, lactostasis occurs during the first lactation. There is also a tendency for lactostasis to occur in nursing women who have already suffered from lactostasis during previous births and breastfeeding. Lactostasis can occur in the presence of cicatricial changes in the mammary gland or mastopathy. Neither the age of the nursing woman nor the race affect the development of lactostasis.

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

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

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Causes lactostasis

There are many reasons for the occurrence of this syndrome.

1. The first and most common reason is incorrect attachment of the baby to the breast, which leads to incomplete emptying of the mammary gland. As a result of the accumulation of milk in a certain area and the lack of its discharge after an indefinite period of time, a clot of curdled milk is formed, which is the cause of suffering for the nursing woman.
2. The second most common cause of lactostasis is infrequent attachment or feeding by the clock. As a result of this type of feeding, lactostasis can develop in both mammary glands at once. In this case, several ducts are usually involved in the process.
3. Incorrect pumping. Very often on the fourth or fifth day after birth, when there is a large influx of milk, and the newborn needs only a small amount of it for nutrition, the mother begins to pump milk on her own, often without even having an idea of how to do it. These manipulations ultimately lead to damage to the delicate ducts and the development of lactostasis.
4. Large breasts. Yes, owners of large breasts are at risk of developing lactostasis, since they do not always know how to properly establish lactation.
5. Wearing a tight, synthetic or improperly fitted bra, which in turn can lead to compression of the ducts and stagnation of milk in them.
6. Trauma. Even a small push of the baby's foot into the mother's breast can lead to lactostasis due to damage to the duct.
7. Stress. Chronic lack of sleep and fatigue lead to increased nervousness, which in turn negatively affects milk production.

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Risk factors

The main predisposing factors for the occurrence of lactostasis are:

• Feeding not on demand, but by the clock;
• Incorrect attachment of the baby to the breast;
• Constitutional features: flat or inverted nipple, large breast size;
• History of breast surgery;
• Obesity;
• Chest injuries and bruises;
• Stress and lack of rest and proper nutrition;
• Smoking and drinking alcohol.

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Pathogenesis

The mammary gland is a paired hormone-dependent organ with a complex lobular structure with alveolar-tubular branching of milk ducts. It is in the alveoli that milk is produced, under the influence of the hormone prolactin. One gland can have up to 20 radially located lobes. All the excretory ducts of one lobe join into a milk duct, which goes to the nipple and ends at its top with a small opening - the milk pore. In this case, the network of milk ducts branches closer to the nipple. The skin of the nipple is bumpy, it contains many circularly and longitudinally directed muscle fibers, which plays an important role in sucking. The content of subcutaneous fat at the base of the nipple is minimal.

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

Now that we know the structure and physiology of the mammary gland, let's look at the pathogenesis of lactostasis. So, at the beginning of lactation, when all the mechanisms of the complex process are not yet established, the pathogenetic link is the lack of interaction between the secretory, storage and excretory functions of the mammary gland. Thus, on the second - third day after birth, when milk is abundantly produced by the glands, the alveoli are not able to hold a large amount of it, and the ducts, under the influence of hormones, do not secrete it enough. This is where milk stagnation, or lactostasis, occurs. In later periods of lactation, the main pathogenetic role is played by the mechanical effect on milk secretion, creating an obstacle to its full secretion. Now the lactation process has already been established and milk is produced under autocrine control, and not due to the direct action of the hormone.

Symptoms lactostasis

The main first signs of lactostasis, which occur at the initial stage, are pain and discomfort in the mammary gland. When palpating, a small, painful area is felt among the normal tissue of the mammary gland. The skin above this area becomes hyperemic. At the beginning of the development of lactostasis, pain occurs only upon contact with the mammary gland, later the painful sensations remain constant. When several ducts are blocked, there is swelling of the tissues of the entire mammary gland, when one duct is damaged, swelling is locally traced only above the blockage area. Locally, the skin temperature rises above the damaged area. The body temperature remains normal and the general well-being of the nursing woman, as a rule, is not disturbed. In the late stage of the disease, when opportunistic microflora is involved in the process, the body temperature rises, the mammary gland becomes swollen and painful, the general condition of the patient worsens. Chills and weakness appear.

After detecting the area of blockage of the mammary gland, it is necessary to immediately begin to eliminate it. The best thing here is frequent and correct application of the baby, so that his chin is directed towards the formed lactostasis. Since no pumping machines or hands can do a better job than the baby's mouth. And you need to apply as often as possible, it is better to lie down with the baby in bed for a day, and delegate all household chores to the rest of the household. At the same time, the most comfortable feeding position should be chosen, in which nothing should interfere and it is possible to relax as much as possible. In the presence of a long-term blockage and pain or at the beginning of lactation, before feeding it is recommended to apply a warm dry cloth to the affected breast and express so that the baby does not get saturated with foremilk without ever reaching the problem area. You can also lightly massage the hardened area, while special efforts are not required. The main task of expressing the breast with lactostasis is to free the clogged duct. To do this, place four fingers of the right hand under the breast, and the thumb on the upper surface of the mammary gland. In this case, you need to clearly feel the area of hardening under your fingers. Having captured the gland in this way, the fingers make progressive movements directed from the base of the gland to the nipple. These movements will cause minor pain, but it will immediately pass after the duct is emptied. The main thing is not to overdo it with the force of pressure on the gland, as you can damage it and thereby aggravate the situation. If, after doing this procedure, you feel hardening under your fingers, you need to massage the area of the blockage again and continue expressing. After expressing, it will be more difficult for the baby to suck, but he will definitely empty all the ducts. It is recommended to carry out this procedure for several feedings in a row. When the symptoms disappear, several more feedings should be started from the breast in which there was lactostasis, and finish with the other breast. In any case, whether you managed to cope with this problem on your own or not, you should definitely visit a specialist - a mammologist, and if there is none - a surgeon or family doctor. It is the doctor who will make an accurate clinical diagnosis and prescribe the correct treatment, correct the manipulations already performed and advise on the prevention of lactostasis.

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Diagnostics lactostasis

Lactostasis is diagnosed immediately during a local examination in 100%. But it is impossible to conduct differential diagnostics on your own, since there are a number of other diseases of the mammary gland that have similar symptoms to lactostasis. The main difference from mastitis is the absence of a rise in body temperature to high numbers and deterioration in the general well-being of the nursing woman. With prolonged accumulation of milk in the ducts, cysts can form - galactocele, with the treatment of which only a doctor can cope.

As a rule, with lactostasis, a detailed blood test is prescribed to assess the neglect of the process. The following indicators are assessed: the rate of erythrocyte sedimentation, the number of leukocytes and the leukocyte formula. The main instrumental method of examination is ultrasound diagnostics. It is on ultrasound that the doctor has the opportunity to see the number, volume and location of blocked ducts. The presence of purulent complications or cystic formations can also be diagnosed using ultrasound. At the same time, the procedure is painless, inexpensive, 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 child.

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Treatment lactostasis

Treatment should be taken immediately after diagnosis of lactostasis. To relieve pain and reduce local swelling, it is recommended to use Traumeel ointment. It should be applied in small quantities with gentle massaging movements to the site 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 discharge of the milk clot. The drug Lymphomyosot has good drainage and anti-edematous properties; it is prescribed 10 drops 3 times a day 15-20 minutes before meals under the tongue. Among folk remedies, the method of treating lactostasis with a white cabbage leaf has proven itself well. To do this, you need to choose a large leaf, cool it and crush it well, then apply it to the affected area overnight. Cabbage juice has a resorptive effect on the clogged area of the gland. In case of difficult to treat duct blockages, UHF and electrophoresis, professional massage in a course of up to 10 sessions are prescribed.

When treating lactostasis, much attention should be paid to the nutrition and rest of the nursing woman. Rest should be complete: at least 7-8 hours of night sleep, and 1-2 hours of daytime sleep. It is advisable to limit the amount of protein foods in the menu, and diversify the table with vegetables and fruits, seafood, chamomile decoctions, green tea, and compotes.

Prevention

Prevention of lactostasis is correct and frequent attachment of the baby to the breast, feeding on demand, not by time, proper nutrition and rest of the nursing woman. Wearing properly selected underwear is also important. It is also good to get contacts of a good breastfeeding consultant.

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Forecast

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

Lactostasis usually goes away within 2-3 days of properly selected treatment and does not leave behind any relapses.