Mastitis: Symptoms, Causes, and Treatment via UK Online Doctor

Mastitis is a condition where the breast tissue becomes painful and inflamed. While it can occur in any person, it is most frequently diagnosed in women who are breastfeeding, usually within the first three months after giving birth. This is known as lactational mastitis.

The inflammation is often caused by a build-up of milk within the breast—a process known as milk stasis. If the milk is not expressed effectively, it can be forced into the surrounding breast tissue, causing the immune system to react. In some cases, this stagnant milk can become infected with bacteria, usually Staphylococcus aureus, which enters through a crack or sore in the nipple. According to the NHS, mastitis is common, but with the right management, it usually clears up quickly without affecting the long-term breastfeeding relationship.

Physical Signs in the Breast

The first sign of mastitis is often a specific area of the breast that feels tender or painful. You may notice:

• A swollen area that feels hard or lumpy (often wedge-shaped).
• A red patch of skin that is painful to touch.
• The breast feeling hot or appearing shiny.
• A burning sensation in the breast that may be continuous or occur only during breastfeeding.

Systemic 'Flu-like' Symptoms

What distinguishes mastitis from a simple blocked duct is the presence of systemic symptoms. Patients often report feeling suddenly unwell, with symptoms including:

• A high temperature (fever) of 38C or above.
• Shivering and chills.
• Aches and pains throughout the body.
• Extreme fatigue and a general sense of being unwell (malaise).

NICE clinical knowledge summaries suggest that conservative management is the first line of defence, especially if symptoms have been present for less than 24 hours. The goal is to improve milk drainage.

The Importance of Continued Feeding

One of the most common misconceptions is that you should stop breastfeeding from the affected side. In fact, the opposite is true. Frequent feeding or expressing is the most effective way to clear the blockage. The milk is perfectly safe for your baby, as any bacteria present will be destroyed by the baby's digestive system.

Practical Tips for Relief

• Warmth: Apply a warm, damp cloth or take a warm shower before feeding to help the milk flow.
• Massage: Gently stroke the lumpy area towards the nipple while the baby is feeding.
• Positioning: Ensure your baby is well-attached. Experimenting with different positions, such as the 'rugby ball' hold, can help empty different areas of the breast.
• Pain Relief: Over-the-counter paracetamol or ibuprofen is usually safe to take while breastfeeding and can help manage fever and inflammation. Always check the patient information leaflet or consult a pharmacist.

If your symptoms do not improve within 12 to 24 hours of improving your breastfeeding technique, or if you feel very unwell, you should speak to a GP. Many women find it difficult to leave the house with a newborn and a fever; this is where an online doctor in the UK can provide essential support.

A GP consultation via video or phone can help determine if your mastitis has progressed to a bacterial infection. During the consultation, the doctor will ask about your symptoms, the appearance of the breast, and your temperature. If an infection is suspected, they can issue a prescription for antibiotics that are safe to take while breastfeeding, such as flucloxacillin. These can often be sent directly to a local pharmacy for convenient pick-up.

Early intervention is key. If left untreated, mastitis can lead to a breast abscess, which is a painful collection of pus that may require surgical drainage.

If you have had mastitis once, you may be at higher risk of it recurring. Prevention focuses on avoiding milk stasis. Suggestions from UK health experts include:

• Avoiding tight-fitting clothing or underwired bras that may restrict milk flow.
• Allowing your baby to finish the first breast before offering the second.
• If your breasts feel uncomfortably full after a feed, express a small amount of milk for comfort.
• Checking for any white spots on the nipple (blebs), which can block a duct.