Dealing With Milk Blebs or Nipple Blisters
Milk Blebs / Nipple Blisters / Milk Blisters
Milk blebs (or milk blisters) often resemble a tiny pimple and can be white, yellow, clear, or flesh tones. The skin surrounding the bleb or blister might appear red or swollen and cause mild discomfort or pain.
A thin layer of skin has in actual fact blocked one of the openings (pores) on your nipple, where milk normal flows out freely!
This causes swelling and a small amount of milk to build up under the skin. It can also cause pain when feeding on the affected side. The good news is that the majority of milk blebs can be effectively managed at home.
If you have a milk bleb, not only is it possible to continue to breastfeed, but it is actually encouraged.
Causes of Milk Blisters
There are a number of possible factors that can cause the development of milk blebs:
- Poor positioning (1) and latching (2) during breastfeeding: When your baby doesn’t latch properly onto your breast, it can create pressure on certain areas of the nipple and lead to blockages in the milk ducts, resulting in the formation of blebs.
- Sometimes expressing milk via a breast pump may be the culprit: Milk blebs can be caused due to the suction pressure from poorly fitting flanges or incorrect usage of the breast pumps. When using a pump, it’s essential to ensure proper fit and suction level according to your comfort level. Using a breast flange or shield that is too small can create friction on your nipple, resulting in a milk bleb. A flange or shield is the plastic part that covers your breast when you’re pumping milk.
- Overproduction of breast milk: If you produce more milk than your baby can consume, this can potentially lead to engorged breasts, which can lead to blocked ducts (3) and sometimes, milk blebs too.
- Tongue-ties are sometimes the culprit. Although some babies have a tongue-tie which don’t appear to cause any issues with breastfeeding, for some babies, a tongue-tie may cause difficulties latching, which in turn can, in some cases, cause nipple blebs.
- Tight clothing or pressure on your breast: Underwired bras, handbag straps which cut into the breast on a regular basis, or even sleeping on your stomach can exert pressure on your breasts and nipples. This pressure can lead to blocked milk ducts and sometimes milk blebs.
Identification of milk blebs
What does a breast bleb look like? Identifying and treating milk blebs can be a frustrating experience for breastfeeding mothers. These small, white, pimple-like bumps on the nipple or areola can cause pain during feeding and make it difficult to continue providing breast milk for your baby. The good news is you generally don’t require a diagnosis from a healthcare provider. However, if you’re uncertain whether the bump on your nipple is a milk blister, you should reach out to your healthcare provider for an examination.
Several indicative signs that you’re dealing with a milk bleb include:
- The presence of a spot that resembles a pimple on your nipple. The blister may be small or large and may appear alone or in clusters.
- Experiencing mild pain or sometimes a stronger, more intense shooting pain on the affected side, while feeding, without the presence of a fever.
- The spot is not accompanied by a rash or dry patches of skin.
- The bleb protrudes when pressure is applied to your breast.
It’s important to note that milk blisters or blebs can be mistaken for other breastfeeding-related symptoms e.g. thrush.
Thrush(4) is a type of fungal infection that triggers a burning or stinging feeling in your breasts, along with itchy, red, or pink nipples. Reach out to your doctor or Lactation Consultant if you believe that you or your baby might have thrush.
Treatment of milk blebs
Nipple blisters often resolve naturally within a span of 24 to 48 hours. However, this isn’t always the case — some individuals may endure discomfort from a bleb for days or even weeks until the skin over the pore sheds off.
Frequent nursing or pumping: It’s important to continue breastfeeding or pumping regularly if you have a milk blister. The action of feeding or pumping will help relieve pressure on your breasts, keeping the breast as soft as possible, improve overall comfort while nursing, and can often dislodge the difficult area, naturally, so allowing milk to flow freely.
Try different positions for feeding: It can be a really good strategy to ‘think outside the box’ for positioning – try many different positions to aid breast emptying. Babies can potentially feed all around the clock-face of the breast, so there are hundreds of variations of positions to try. It’s important to know that as your baby gets bigger and changes shape and size, positions that may have worked well in the past, may not work as well as baby grows and changes – so always important to keep trying new positions. You may also find it helpful to place your baby on the floor and to lean over your baby on all fours. Allow your baby to attach, and then massage the breast while your baby is feeding.
Warm Compress and Warm Bath: One of the most effective ways to alleviate discomfort and pain associated with milk blisters, as well as helping to soften the skin of the bleb, is through the use of a warm compress, heating pad or a warm bath. The heat from the compress or bath can also help reduce inflammation, promote healing, and provide relief from the pain caused by the milk blister.
To make a warm compress, soak a clean cloth in warm water and place it over the affected area for 10-15 minutes. Ideally, do this just before a feeding session, if possible. Repeat this process several times a day until you feel relief.
Olive Oil or Coconut Oil: Another natural remedy that can be used to soften the area (and ultimately dislodge the bleb), as well as helping to alleviate discomfort and pain associated with milk blebs, is to use a cotton ball soaked in olive oil or coconut oil. Both contain anti-inflammatory properties that can help reduce inflammation, prevent infection, promote healing, while moisturizing dry skin.
Leave the cotton ball inside your bra 20-30 minutes before nursing or pumping to help soften the skin and reduce inflammation around the bleb. Remember, oil can stain your clothes, so put a towel or breast pad between your nipple and shirt. After the elapsed time, utilize a clean washcloth to gently scrub the milk bleb. If needed, the cotton wool ball can be left overnight inside a comfortable fit nursing bra.
Exfoliation: After applying heat and softening your skin, use a clean, warm washcloth to gently rub the area (in circular motions). This helps to eliminate any skin causing the blockage.
Lanolin: One popular option is lanolin cream, which is made from sheep’s wool and helps soothe sore nipples while also providing protection against infection.
Silicone pads: Medical-grade silicone pads are another effective option for treating milk blisters. These pads can be placed over the nipple to protect it from friction and help promote healing.
Saline Solution: A saline solution is a mixture of salt and water that helps to disinfect the area and promote healing. To use this method, simply mix one teaspoon of salt with eight ounces of warm water until dissolved. Soak a cotton ball in the solution and apply it to the affected area for five minutes, three times a day. This will help soften the milk blister and reduce inflammation, and hopefully dislodging the bleb, making it easier to nurse your baby without discomfort.
Epsom Salt: This is another natural remedy that can be used to alleviate discomfort and pain associated with milk blisters. It contains magnesium sulphate, which has been shown to reduce inflammation and promote healing. To use Epsom salt, add 1-2 cups to your warm bath and soak for 20-30 minutes. You can also make a warm compress by dissolving Epsom salt in warm water and soaking a clean cloth in the solution before applying it to the affected area.
Grapefruit Seed Extract: This is another natural remedy that has been shown to be effective in treating milk blisters. It contains antimicrobial properties that can help prevent infection and promote healing. To use grapefruit seed extract for milk blebs dilute a few drops in water and apply it to the affected area using a clean cloth. Repeat this process several times a day until you feel relief.
These steps may need to be repeated several times to loosen or soften the milk bleb.
If you are experiencing significant pain or swelling caused by milk blisters, taking ibuprofen may be helpful in reducing these symptoms. Ibuprofen is an over-the-counter medication that works by reducing inflammation in the body.
It’s important to note that while ibuprofen can provide temporary relief from symptoms, it does not address the underlying cause of milk blisters. If you continue to experience symptoms despite taking ibuprofen, consult with your healthcare provider for further treatment options.
If all of the above measures have not resolved the situation, it may be useful to reach out to your healthcare provider. In some situations it may be necessary to use a fine, sterile needle to very carefully create a tiny nick in the skin of the blister, which will allow milk to freely flow from this area, and so release the pressure and pain. Although this can be carried out as a self-help measure, it is very important to prevent infection, and guidance as to how to do this safely should always be sought. Ideally, a healthcare provider should be sought to do this procedure.
How do I know if the milk bleb has disappeared?
Once the skin has loosened, you may observe a thick, string-like piece of milk emerging from the blocked pore. If this occurs, you can remove it using clean hands. Additionally, you may notice the absence of the white pimple-like spot and the cessation of pain. It might be necessary to apply an antibiotic ointment or maintain the area clean and dry for several days to facilitate the healing of the pore.
Can milk blebs self-heal?
Yes. Milk blisters can very often heal themselves. If your baby continues nursing from the nipple with the bleb, the overlaying skin can sometimes peel off. This frequent nursing releases the milk and unclogs the pore. Additionally, employing the above-mentioned home treatment methods can assist.
Prevention Tips for milk blebs
If you have already experienced a nipple blister, and it has now resolved, and you want to know how to prevent a reoccurrence, there are some generally effective strategies:
- Feed frequently, following your baby’s feeding cues: This helps ensure that milk continue to flow through the ducts and freely out of the breast, and does not build up and harden in the nipple area, which can lead to the formation of a bleb.Following the disappearance of a milk bleb, your nipple pores remain vulnerable to infection due to the potential break in the skin. Ensuring your nipple is clean and dry or applying saline on the affected area for a few days should assist in recovery.
- Ensure a proper latch: Your baby should be positioned in a way that allows them to take your entire areola (the skin surrounding your nipple) into their mouth. They should establish a firm seal with their mouth and should not be sucking solely on your nipple.
- Alternate breastfeeding positions regularly: It can be a really good strategy to ‘think outside the box’ for positioning – try many different positions to aid breast emptying. Babies can potentially feed all around the clock face of the breast, so there are hundreds of variations of positions to try. It’s important to know that as your baby gets bigger and changes shape and size, positions that may have worked well in the past, may not work as well as baby grows and changes – so always important to keep trying new positions.
- Breast compressions: If you feel that your breasts are not draining properly during feeding, you could use breast compressions (5) to increase breast emptying if you feel that your baby is either falling asleep too quickly at the breast, or pulling off the breast quite early into the feed. This will help your baby to swallow more milk, and to stay on the breast longer, thereby ensuring that the breast is emptied more efficiently.
- Use a washcloth: Cleaning your nipples with a saline washcloth can help prevent the pores from getting blocked.
- Maintain a balanced diet: Try to eat at least 5 portions of a variety of fruit and vegetables every day, and base meals on higher fibre starchy foods like potatoes, bread, rice or pasta. Have some dairy or dairy alternatives (such as soya drinks). Eat some beans, pulses, fish, eggs, meat and other protein. Diets rich in saturated fats, such as processed or fast foods, can contribute to the formation of blebs.
- Avoid tight-fitting bras: or clothing to avoid direct pressure on the breast.
- Breast Massage: Massage breasts before breastfeeding/pumping to promote milk flow.
- Breast Pumps: Use a breast pump with correct suction and flange size.
- Lecithin: Another way to prevent milk blisters from forming is by improving milk flow. One safe supplement that can help with this is lecithin(6). Lecithin is actually a natural substance, whose components are found in breast milk that helps to emulsify fats, making them easier to digest. Taking extra lecithin supplements can sometimes help improve milk flow by reducing the stickiness of breast milk, preventing blocked ducts that can lead to milk blebs. The recommended dose is 1200-2400mg per day, divided into three doses.
Facing challenges during breastfeeding is quite common, even if you have prior experience, and milk blebs are one such challenge. Once you have identified a nipple bleb and used the suggested home remedies, for most people this will work well. Often, immediate relief is felt once a blocked nipple pore is unclogged and no additional intervention is needed. Following the prevention strategies in the following weeks, can help enormously to prevent a reoccurrence. However, if you are persistently encountering milk blebs, it’s really important to seek advice from a lactation consultant or your local healthcare provider.
Reach out, especially if a milk bleb:
- Inflicts severe pain and discomfort (compelling you to consider discontinuing breastfeeding).
- Persists for more than a few days.
- If the milk blister does not respond to home treatments.
Fortunately, most milk blebs can be handled at home, and good preventative measures can ward off future milk blebs.
Review Date & References
Version 1.4 published in 1st June 2023. Next review date: May 2025
2) Re-thinking lactation-related nipple pain and damage. Women’s Health Volume 18: 1–29 2022
6) (https://www.ncbi.nlm.nih.gov/books/NBK501772/) 2021 Sep 20. In: Drugs and Lactation Database (LactMed) [Internet]. Bethesda, MD: National Library of Medicine (US); 2006