Nipple blanching

Nipple blanching – Transcript

If you are finding that your nipple is turning white, blanching after feeding, then it means generally that the blood flow is being reduced or cut off to your nipple. The good news though is that if your nipple returns to its normal colour fairly soon after, and you’re not experiencing any pain, then it isn’t really a problem. I do suspect however though that if you’re watching this video you may be experiencing pain because of this blanching, and in that situation it’s really important that the cause is identified.Woman holding her breast from pain

So I want to talk you through four possible reasons for this blanching, and the first one is really about getting back to basics -often related to latching at the breast. If your baby isn’t latched well it is likely that your nipple is getting compressed. So please look at the videos relating to good positioning at the breast, comfortable positioning. It’s very likely that one nipple is getting blanched and the other one is fine. Usually this is because your baby is latched well on one side and not on the other.

If this nipple blanching is a result of positioning, then you’re probably finding that your nipple is coming out looking misshapen -certainly coming out a different shape from when it went in. Some women say that the nipple looks like a new lipstick, wedge- shaped or even with a stripe across it, afterwards. What you generally find is that a few seconds after the feed, sometimes even a few minutes, as the blood flow starts to come back, then that pain happens.

Now it may be that you are well aware that your position is absolutely fine, and your nipples are not coming out looking misshapen,   – so another cause can be a fast flow of milk. If you’re experiencing this you baby may also be struggling to control that flow, and actually clamping down and compressing the nipple to control the flow, (to avoid choking and spluttering). Have a good look at the video relating to fast flow, and how you can make that more manageable for your baby.

A third reason why you may be experiencing these blanched nipples, is if your baby has a potential tongue tie. This might be impacting on the actual latch itself and causing a compression of the nipple, and then of course the blood supply gets cut off.

A fourth possibility for this nipple blanching could be caused by something called vasospasm. This is actually a sudden narrowing of a blood vessel within the nipple itself, which can cause quite a severe pain. I’ve certainly come across many ladies who are suffering vasospasm, and what you tend to see is a white circle appearing on the end of the nipple just after the feed, and this vasospasm might occur because you’ve already got damaged nipples (sore nipples video) or even THRUSH. Once those things are resolved, then the vasospasm resolves too.

And it’s sometimes possible that cold can cause this vasospasm – I have come across ladies who’ve gone into a supermarket, into a freezer section for instance, and vasospasm has happened because there has been a sudden change of temperature, a sudden drop actually. So the good news in this situation is that once the cause has been found of the nipple trauma, for instance, then the vasospasm will also disappear too.

And please bear in mind that it may take a little while for the vasospasm to disappear, because sometimes damaged nipples can take a little while (still be a little bit sensitive,) until they’re healed up fully.

I also want to talk about a different type of vasospasm and this is a result of something called Reynaud’s phenomenon, and in this situation you may already have a circulation issue, where you’re aware of your hands, your feet, get very cold or go white when there’s a change of temperature. Sometimes there can be a change of colour to purple even, – but this type of vasospasm can also affect a different type of extremity, and that is the nipple area.

And so you can imagine the pain of that is quite intense. Some women have been on the brink of giving up breastfeeding because of the intense pain relating to this. So if you are experiencing vasospasm due to this phenomena, then you may experience your nipples turning from white to blue to red, sometimes white to purple to red. Sometimes there’s only a two colour change, but it’s a very indicative sign of this condition.

One thing I must note is that if this vasospasm that you have is related to a Raynaud type phenomenon, then you’re likely to be experiencing this on both breasts as opposed to the other types of vasospasm, which can be just related to one breast. So that is quite an indication, and usually the pain is more severe and lasts longer, more than just a few seconds or a few minutes after the feeding.

Woman holding painful breastIt might be that you’re even experiencing pain when your baby hasn’t fed at the breast.

I did meet a lady who said she was in the park one day with her baby, and they went from out in the sun, to under a tree, where there was a lot of shade, and she suddenly experienced the vasospasm because of the change of temperature. So sometimes, just a sudden temperature drop will cause the problem as well.

One of the real difficulties that many women experience is that the symptoms that you get with this type of vasospasm can be very like the symptoms that women experience when they have thrush inside the breast – shooting pains that happen after feeding and lasts for up to an hour, and so many women end up getting treated for thrush, sometimes more than once, in the hope that that’s what it is, when really it was a circulation issue.

So what are some of the measures that you can use to treat this type of vasospasm? There are in fact a few. It’s really important first of all that you keep your breasts as warm as possible, even your whole body actually. It’s also really important to avoid the cold if you can, and certainly avoid changes, very sudden changes of temperature, and very importantly, applying dry heat to the nipple and areola area the end of every feed can be an excellent treatment to enable the blood flow to come back as fast as possible. It’s actually the blood coming back to the nipples that will cause this pain – so if you can get that blood flow coming back faster, all the better. Many women use the microwavable wheat bags to just place the breast after feeding.

Some are now using hand warmers inside the bra, which is another novel idea. But whatever you find, as long as you can bring that heat back at the nipple and areola area all the better. Sometimes it might be necessary to avoid caffeine and drugs like beta blockers, or any other drugs, actually, which could constrict blood vessels.

And it’s also important to know that contraceptives containing oestrogen have also been associated with vasospasm, and things that can help are supplements like vitamin B complex, and even fish oil supplements too.

But sometimes despite your best efforts, you may have tried all of these things, and you’re still experiencing the pain of vasospasm. It may be necessary in that situation to think about medication. There is a medication called Nifedipine 60 mg dose daily, has certainly been found to be effective.

Please look at the videos to try to identify the potential causes of nipple blanching, and do seek out skilled help while you go through this process too – and know that there are lots of ways to go forward.

Review dates, references & further resources

Review Dates

Version 1.1 published in March 2019. Next review date: Jan 2022


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