Has the intimate, powerful experience of breastfeeding been compromised for you by the pain of cracked and bleeding nipples?
You are not alone. In one study, researchers found over 30 percent of women experienced cracked nipples within the first 30 days of giving birth (1).
For many women, the pain caused by this condition leads them to stop breastfeeding altogether.
If you need help and want to know how you can overcome this common breastfeeding hurdle, keep reading! Together, we’ll explore what causes cracked nipples and the various effective treatments at your disposal.
What Causes Cracked Nipples?
Classified as a breast disorder, cracked nipples can result from many factors. You are more likely to experience nipple pain in your early postpartum days as your body grows accustomed to the process of breastfeeding, but cracked skin is a sign that something is not right with feedings.
The ten most common causes for cracked nipples are:
1. Improper Latch
The term “latching” describes how your baby’s mouth connects to your breast as they feed. A poor or improper latch means your baby is not placing their mouth on your breast correctly. Generally, an improper latch occurs when your baby’s latch is too shallow and does not get enough of the breast tissue in their mouth.
With an improper latch, the sensitive nipple area remains in the front of your baby’s mouth. The hard gums and the tongue creating friction on the nipple (rather than massaging the areola as it should) causes the nipples to become irritated, leading to cracking and bleeding.
Thrush is a painful infection caused by the overgrowth of the candida fungus (2). Both babies and moms can contract thrush for a number of reasons, such as improper hygiene, certain medications, and even stress.
If your baby has thrush, they can pass it on to you as you breastfeed. One of the symptoms of thrush is cracked and bleeding nipples.
3. Breast Pumping
Expressing your breast milk with a breast pump can be hard on the sensitive skin of your breasts. Breast pumps act as an artificial latch, using mechanical suction to pump your breast milk into a container.
Breast pumping may lead to cracked nipples if you use your pump incorrectly, have a poor quality pump, have the pump suction turned up too high, or use pump shields that are too small or too large.
4. Skin Conditions
Are you already prone to dry skin? Cracked nipples may simply be the result of changing hormones exacerbating an existing condition. This is especially true if you have a history of more serious skin problems such as eczema or psoriasis.
5. Bottle Feeding
If you are using a bottle to supplement your baby’s feedings, your baby may be learning to use their tongue, gums and jaw in a way that is negatively affecting your nipples.
It takes a different technique to suck milk out of a bottle than from your breast. If your baby gets accustomed to these motions and uses them when breastfeeding, the extra motion and friction can lead to cracked nipples.
6. Tight Clothing
Your bras and breastfeeding pads can lead to cracked nipples if they are too tight. When clothes are too tight, they consistently rub against your skin causing irritation and redness.
You may also want to check the fabric of your bra. If it’s rough or made of low-quality material, it may also be affecting the skin of your nipples.
7. Breast Engorgement
If your breasts are engorged and swollen, it will be harder for your baby to get a proper latch. When your breasts are engorged, the nipple and areola become a lot flatter. The struggle to latch can lead to biting, friction, and damage to the sensitive skin of your breasts.
While leaking itself will not cause damage, if your wet bra or breast pads sit against your skin for prolonged periods, this can lead to bacterial growth and can worsen already chapped or painful nipples.
Are you possibly overfeeding your little one? Or are you feeding more frequently on one breast than the other?
Answering yes may be an indicator as to what’s causing such extreme pain in your nipples. If your nipples are extra sensitive, constant feedings can quickly lead to problems.
10. Tongue Tied
Some babies experience a medical condition known as ankyloglossia, more commonly referred to as tongue-tie (3). More than just an improper latch, this condition means your baby has a band of tissue connecting the tongue to the bottom of their mouth.
This prevents your baby from nursing properly, as they cannot extend their tongue past their gums. Often mom’s nipples are misshapen after feedings from this improper latch.
Mothers with tongue-tied children often experience increased nipple trauma and difficulty breastfeeding.
11. Harsh Soaps
Do you use soaps or other bathing products with heavy scents or harsh chemicals? You may want to check! The use of these products can dry out your already sensitive skin, especially if you use them every day.
Symptoms of Cracked Nipples
At first glance, you may think the symptoms of cracked nipples would be obvious — they’ll be cracked!
However, new mothers experience so many different changes to their body during the postpartum period. What’s normal and what isn’t? Cracked nipples are definitely not a normal condition during the breastfeeding period, and it’s important to know how to identify them.
The most common symptoms of cracked nipples include (4):
- Open cracks on the nipple and areola.
- Bleeding of the nipples.
- Redness and soreness in the entire breast.
- Crusting and scabbing.
- Any oozing of discolored fluids.
Most women are able to diagnose themselves at home. If you’re concerned about extreme pain in your nipples and breasts and aren’t confident about the cause, don’t hesitate to make an appointment with your healthcare provider or with a lactation consultant.
If your nipples are cracked and bleeding, you may be worried about your baby ingesting blood when feeding. This will not harm your baby, though if they spit up it may look pink or red. Also, if you are pumping with cracked, bleeding nipples, it takes only a few drops of blood to make the pumped milk look pretty red – you can still safely feed this to your baby.
Editor's Note:Michelle Roth, BA, IBCLC
How to Treat Cracked Nipples
Treatment options for cracked nipples will depend on the cause.
Thankfully, most of the remedies are simple, cost-effective, and can be implemented without a visit to the doctor.
Use these twelve remedies to begin the healing process and bring you some relief:
1. Create a Breastfeeding Plan
Your first step to treating cracked nipples is to create a breastfeeding plan. Depending on the severity of your case, you may still be able to breastfeed or you may need to supplement with a bottle until you’re fully healed.
Factors you should consider when making this decision include how painful it is to breastfeed, how long the pain lasts, and if both of your breasts are affected. In extreme cases, it’s possible to just feed on the less sore side and pump the more sore side until it’s healed.
2. Use Nipple Creams
Mothers with cracked nipples find great relief using nipple creams designed for breastfeeding mothers. These creams often use the ingredient lanolin, which is a type of wax secreted by sheep. The substance is added to special creams designed for breastfeeding mothers.
Lanolin has deep soothing and nourishing properties to heal your damaged skin. In one study, mothers with nipple trauma found lanolin to be therapeutic (5). Be careful though: Lanolin should not be used on intact, healthy skin, to reduce the risk of developing an allergy.
3. Apply Warm & Cool Compresses
In between feedings, alternate between warm and cool compresses for relief. While you may have heard the advice to place warm tea bags directly on the nipple, the tannins in tea are astringent and can cause additional drying and cracking. So you may want to avoid this remedy.
4. Go Without a Bra
Does your pain remain even after you’re done nursing? Take the opportunity to remove your bra around the house and wear a soft, flowing t-shirt instead. The free-flowing air will aid in your recovery and the lack of restriction provides comfort and prevents further irritation that may be caused by your bra.
5. Evaluate Your Breast Pump
The improper use or size of a breast pump is one of the leading causes of cracked nipples. Most importantly, you want to make sure you have the right breast shield size. Breast shields are more commonly referred to as flanges.
Flanges look like small cooking funnels. The circular cup fits over your nipple and areola. When the breast pump is turned on, the flange acts as a vacuum as your breast milk is expressed into the provided container.
The size of the flange will determine how much of the areola and nipple is in the smaller end of the funnel. If your flange is too small, your nipple has a higher chance of becoming irritated.
6. Switch Nursing Positions
To help your baby latch correctly and to find a more comfortable nursing position for you, try experimenting with different nursing positions. One may be more comfortable for you than another, especially if you are hoping to continue breastfeeding as you recover from nipple pain.
Sometimes just having your baby’s mouth in a different position on the breast makes feedings more bearable even with nipple pain. For instance, if you always use the cradle hold, consider side lying or football hold instead.
Editor's Note:Michelle Roth, BA, IBCLC
7. Take Mild Pain Relievers
Many new mothers are nervous about taking medication when they breastfeed. However, many over-the-counter pain medicines have been deemed safe for nursing mothers to use.
These include (6):
- Off-brand versions of acetaminophen and ibuprofen.
Take medicine to reduce the pain and inflammation in your breasts. If you’re worried about breastfeeding, make sure to take medicine at least an hour before feeding.
8. Avoid Plastic Nursing Pads
Nursing pads prevent breast milk from leaking through your shirt as you let down during unexpected moments. Unfortunately, the plastic liners used to catch milk can cause moisture to be trapped against your skin, increasing the irritation.
Look for reusable nursing pads made of soft, absorbent materials (such as wool or organic cotton) if you experience nipple pain. You also need to make sure you change your nursing pads as soon as you can after they are soaked.
9. Apply Breast Milk
Did you know your nutrient-rich breast milk has nourishing properties for your skin?
In a study comparing the effects of both breast milk and lanolin, those applying their own breast milk directly to their own nipples improved more quickly and did not experience any negative side effects (7).
After a feeding and with clean hands, rub some breast milk over your nipples. Allow the breast milk to dry. If you are unable to breastfeed, use a pump or hand express a little bit of milk to use.
10. Try a Saline Rinse
Combine ½ teaspoon of table salt or epsom salt with a cup of warm water and stir to dissolve. Dab this onto the nipple with a clean cloth or cotton ball several times per day.
11. Consider Hydrogel Pads
These thin gel-filled discs are like bandages for your nipples. They are placed over the nipple, they stick to your skin, and can be removed before a feeding and replaced afterwards. They allow air in to help with healing, but keep clothes from rubbing against the sore skin.
12. Find a Lactation Consultant
If your baby constantly has trouble latching, it may be time to find a lactation consultant. A lactation consultant is a person who has been professionally trained and certified to teach women how to breastfeed.
A good lactation consultant will assess both you and your baby and provide a one-on-one consultation as you feed.
When to Visit a Doctor
You should schedule a visit with your doctor if your symptoms persist over a period of weeks or if you start to experience any of the following symptoms:
- Spreading rash.
- Nausea and vomiting.
- Any abnormally colored discharge from the broken skin.
Trust your mother’s intuition. If you feel something is wrong or that your cracked nipples may be a sign of something more serious, pay a visit to your doctor for some peace of mind.
Breast and Nipple Hygiene
Hygiene plays an important role in keeping your breasts and nipples healthy as you breastfeed. Clean your breasts and nipples with water and a gentle soap. Some moms find a massage benefits milk flow and can relieve tension in sore breasts.
Avoid any products with heavy perfumes or chemicals. They can dry out your skin and contribute to cracked nipples. You’ll also want to avoid anything that will linger on your skin and come into contact with your baby as you breastfeed.