Thrush
What is Thrush?
Thrush is a fungal infection of the mouth that occurs most often in premature babies who may be immunosuppressed. However, it can affect anyone. Thrush can result in creamy white lesions on your tongue or inner cheeks. Medications and/or health conditions, such as dry mouth or diabetes, can cause thrush. Fungal infections like thrush are often called yeast infections when they occur in other parts of the body such as the vagina or folds of the skin. Treatment usually involves antifungal medications.
Nipple pain, itching and rashes are common breastfeeding issues that often get mistaken for thrush. Research shows there’s little to no evidence that yeast infections can occur on your nipple or in your breast. Rather, nipples do not typically grow yeast at all. More commonly, yeast can grow in the skin folds underneath your breast, or near your armpit.
What are the most common causes of nipple pain, itching and rashes?
If it isn’t thrush, then what is? The latest research shows that the following conditions are often the cause of these symptoms and not yeast/thrush:
- It is important that you and your baby are positioned well to ensure your baby gets the most effective latch. There are many ways to position yourself and hold your baby while breastfeeding. What’s most important is figuring out what works for you.
- The latch should be comfortable and pain-free.
- Your baby’s chest and stomach rest against your body, so that baby’s head is straight, not turned to the side.
- Your baby’s chin touches your breast.
- Your baby’s mouth opens wide around your areola not just the nipple.
- Your baby’s tongue cups under your breast.
- You hear or see swallowing.
- Check out the positioning and latching information from Le Leche League Canada to learn more.
- Dermatitis is a broad term for several different conditions that cause skin inflammation and irritation. Your primary care provider may diagnose one of these conditions as eczema. When breastfeeding, you may develop dermatitis. This is when something irritates your nipples or causes an allergic reaction. Allergic reactions may make your nipples very itchy, while irritations typically cause stinging and pain.
- Many different substances and materials can cause dermatitis, including:
- Nipple creams/ointments (prescription or non-prescription)
- Breast pads
- Nursing bras
- Soaps or detergents
- Antifungal creams, Gentian Violet which you may have been advised to take to treat a nipple yeast infection
- Breast pump parts
- Things your baby touches or eats that is in contact with your breast
- Also known as milk blisters, these are raised white dots on the surface of your nipple. This happens when your nipple pore becomes blocked.
- Research shows that even though they’re white and might look like yeast, there’s no connection between nipple blebs and fungus.
- They can cause no trouble, or they might be very painful (often described as ‘stinging’ pain).
- They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help.
- Speak to your public health nurse or primary care provider for self-treatment options.
- A vasospasm occurs when the muscles inside the nipple tighten or constrict. This causes the blood to leave the nipple, turning the tip white.
- When your baby comes off the breast, the blood flows back into the nipple. Vasospasms can cause a stinging or burning feeling and can cause colour changes in the nipple once the blood flow returns.
- Breast inflammation can be caused by a number of things, including:
- Hyperlactation (increased milk production)
- This is also called overproduction. It can happen when your breasts make more milk than your baby needs. Using a breast pump a lot as in to ‘fill the freezer’ can lead to overproduction. Overproduction can cause continuous pain in your breasts, and they may feel lumpy and appear red with or without nipple blebs.
- Mastitis
- This is a painful inflammation of breast tissue. Symptoms can include pain, swelling, warmth, and redness in the affected breast. Most of the time, it is not infection and can be treated with ice and over-the-counter anti-inflammatory/pain medication as well as not overfeeding or over pumping. Very few cases of mastitis need antibiotics when the issue is treated appropriately from the very beginning. However, if symptoms worsen or inflammation is not settling after 24-48 hours you should seek medical attention.
- Hyperlactation (increased milk production)
Please seek support from your public health nurse or primary care provider if you are experiencing any of these issues.
How are nipple pain, itching and rashes treated?
Treatments can vary depending on the cause. The traditional treatment for an apparent nipple yeast infection includes topical antifungal creams and sometimes oral antifungal medication. In some cases, these treatments seem to work. That’s because antifungal medications may help reduce inflammation and bring about some relief even if yeast is not the cause of the pain, itching or rash. So, they might ease your symptoms for a short time but can contribute to more inflammation and irritation. Traditionally, your doctor may have prescribed multi-ingredient prescription creams such as an All-Purpose Nipple Ointment (APNO), however these are no longer recommended by many providers.
Possible treatments, depending on the cause of the issue, might involve:
- Topical steroid cream, to treat dermatitis, eczema or nipple blebs
- Heat to treat nipple vasospasm
- Ice / cool compress to relieve inflammation
Yeast will not pass from your baby’s mouth to your nipple therefore you do not require antifungal treatment at the same time as your baby.
Your health-care provider will recommend the best treatment for you based on the cause of your symptoms.