Sore nipples are the bane of breastfeeding mothers. Nipple pain and/or damage ranks in the first two or three reasons for the early discontinuation of breastfeeding. Discovering and correcting the underlying cause of the pain is certainly the primary goal of treatment. But it is also crucial to manage the pain from feed to feed, and expediting healing should be a priority. When sore nipples are not attended to quickly, tissue breakdown can progress rapidly and, in some cases, nipple injury can be extensive. Click Here for Causes of Sore and Cracked Nipples during Breastfeeding.
Treatment of nipple pain and trauma has been approached in a variety of ways over the years, confusing both breastfeeding mothers and medical professionals alike. Many mothers with sore nipples reply on outdated breastfeeding literature and on anecdotal remedies passed down from one generation to another. Unfortunately, self-care based on inaccurate information is likely to continue as long as professional advice is viewed as conflicting. As a result, researchers have dedicated years of study to determining the most effective of these treatments and the results can be summarised as follows:
WOUND HEALING AND HYDRATION
Optimal wound healing is very dependent upon the appropriate level of tissue hydration and it has been suggested to be the single most important external factor. Skin wounding results in an imbalance of the skin’s hydration status and exposure of tissues to air leads to tissue drying. Maintaining the skin’s hydration/moisture balance is essential to optimize wound healing. There are 2 types of wound healing, Dry and Moist wound healing.
- DRY WOUND HEALING
In the past, medical professionals encouraged wound healing nipples by drying, often advising the use of sunlight, hair dryers and air drying, among others. Exposing a wound to the air is no longer recommended as it creates a dry environment that promotes dehydration and cell death. It is now well known that this drying only delays the healing process due to lack of moisture, causing cracks in the outer layer of the nipple. The cracks which are formed leaves the nipples vulnerable to bacterial and yeast infections. Scabs are often formed in dry wound healing which are easily dislodged during feeding or expressing, worsening the severity of the wound and significantly delaying healing.
Today, nipple wound care needs treatment approaches consistent with wounds treatment in other body parts (moist wound healing), and which also addresses reduction of pain. Studies have shown that the preservation of moisture accelerates healing and allows epithelization.
- MOIST WOUND HEALING
The principles of moist wound healing entail keeping damaged skin moist (but not wet) enabling better growth and migration of new cells (re-epithelialization) across the traumatised surface. A moist environment has been proven to facilitate the healing process of a wound by preventing tissue dehydration and cell death, accelerating the development of new blood vessels and collagen synthesis, together with increased breakdown of dead tissue and fibrin. Moist wound healing eliminates scab formation and encourages re-epithelialization up to 50% faster. This improves the aesthetics of the wound, while significantly decreasing pain. The many benefits of moist wound healing are as follows:
- Faster wound healing
- Promote epithelialisation rate
- Promote dermal/wound bed healing responses
- Reduced scarring
- Retention of growth factors to wound site
- Lower infection rates
- Reduced pain perception
- Reduced inflammation as well as higher quality in the newly regenerated epidermis
- Enhanced autolytic debridement
The moisture barrier may be an emollient, occlusive or semi-occlusive dressing, but does not include oil or petroleum products. Purified Lanolin is often recommended to promote moist wound healing for Stage 1 (superficial trauma, no broken skin) and Stage 2 (superficial with some tissue breakdown) nipple trauma. It can also be used early on in breastfeeding to prevent cracks or damage from occurring due to excessive friction.
Lanolin is considered a pure and safe intervention aimed at creating a moist healing environment for nipple trauma, providing a semi-occlusive barrier that promotes retention of internal moisture and prevents dryness. The moist dermal environment created by the use of lanolin prevents scab formation, promotes epithelial regrowth and decreases nipple pain. Lanolin is proven to have anti-inflammatory, antimicrobial, skin-protecting and barrier repair properties.
Click Here to find out more about lanolin and why some products claim to be lanolin free.
MOIST WOUND DRESSINGS
Studies indicate that the use of hydrogel dressings provides a safe and effective treatment for limiting the pain and discomfort associated with breastfeeding. By providing moisture to the wound, hydrogel dressings create a moist healing environment which promotes healing. Studies have highlighted several advantages of using hydrogel dressings for nipple wounds and these are:
- The high water content of hydrogel dressings cools the wound, producing pain relief that can last up to 6 hours
- Dressing-change discomfort is reduced because hydrogels don’t adhere to the wound surface
- The dressings provide a mechanical barrier to contamination, decreasing the risk of bacterial infection
- Abrasion (friction) and adherence of the wound to clothing or breast pad is prevented
- Are reusable and cost-effective as one dressing lasts several days
Hydrogel dressings are either glycerine or water based. Higher infection rates (mastitis, breast abscesses, and fungal infection) are associated with the use of the glycerine based hydrogels. Conversely, a lower infection rate has been observed using water-based hydrogel dressings over other conventional treatments such as creams and ointments. Studies on water-based hydrogels have been very positive, indicating lower rates of breast infections and superior pain management over conventional therapies. Hydrogel dressings are an effective option for any stage of nipple trauma but are most effective in severe cases of trauma (Stage 3 and 4) involving open sores or cracks with exudate (fluid that is released from the wound).
Breast shells are fitted between the nipple and the bra and not only allow circulation of air around the tender nipple, but stop further trauma by preventing the nipples rubbing against or adhering to clothing. Some studies have found that the use of breast shells and the application of lanolin between feedings relieves pain and promotes healing. Breast shells are particularly useful for Stage 2 – 4 nipple wounds with exudate (fluid that is released from the wound) as they prevent the open wound adhering to clothing or breast pads.
EXPRESSED BREAST MILK
Expressed breast milk (EBM) continues to be widely recommended for the prevention and treatment of sore and/or damaged nipples, despite a lack of evidence-based research on its efficacy. The studies that have been conducted on EBM have produced conflicting results. One study found that applying expressed breast milk was found to be less effective in preventing cracked nipples than simply keeping the nipples dry and clean. The same study also found that the number of cases with nipple pain was less in the group that applied expressed breast milk. Five other studies have found that topical treatment with lanolin is more effective than EBM for faster healing of nipple trauma and reducing nipple pain. EBM is often recommended for Stage 1 nipple trauma (superficial trauma, no broken/cracked skin) as it is readily free and available and has antibacterial properties. EBM is however not an appropriate solution if there is broken/cracked skin as EBM dries quickly and does not provide moist wound healing. EBM is also sticky when dry which may cause adherence of the nipples to clothing resulting in more trauma to nipples.
Did you try any of the methods mentioned above? I would love to hear if you were successful at healing your sore nipples!
Our Nipple Crème is 100% ultrapure medical grade lanolin that will help ease the discomfort of cracked and sore nipples associated with breastfeeding. It is the ideal treatment for Stages 1 and 2 of nipple damage and is also excellent for early protection of sensitive and dry nipples during pregnancy.
Thanks for reading. If you have any questions or queries please feel free to leave a comment below. For more tips and advice on maternity skin care check out the Expert Advice section of the Natralogic website.
All the best
Lauren Lamont - Natralogic Founder
MSc Chemistry, Dip.Cos.Sci (SA)