Pumping breast milk should not hurt, though the sensation can feel intense. While a temporary pulling or tingling feeling is a normal sign that milk is beginning to flow, any sustained or sharp pain signals a problem that needs to be addressed. Outright pain is a sign of an issue, and it is almost always correctable through changes in equipment, technique, or by seeking medical attention for an underlying condition.
What Pumping Should Feel Like
The normal sensation of pumping is often described as a rhythmic tugging or pulling on the nipple as the pump cycles. This mimics the natural action of an infant nursing and should not be painful. When the milk ejection reflex, or “let-down,” occurs, many people experience a brief tingling, pins-and-needles feeling, or a sense of warmth within the breast tissue. This transient discomfort typically lasts only about 10 to 15 seconds at the start of a session, indicating that milk is starting to flow efficiently. If discomfort persists past the first minute or is sharp, pinching, or otherwise intolerable, the pumping setup or the body is signaling an issue.
Mechanical Causes of Pumping Pain
The most common source of pumping pain is an incorrect fit between the breast and the pump equipment, particularly the flange or breast shield. The flange should allow the nipple to move freely inside the tunnel without rubbing against the sides. If the flange is too small, the nipple will drag and rub, causing friction, pinching, and potential damage. This can lead to blanching, where the nipple turns white due to compressed blood vessels. Conversely, a flange that is too large can pull too much of the areola into the tunnel, resulting in painful swelling, friction, and poor milk drainage.
Improper pump settings represent another mechanical cause of discomfort and potential injury. Increasing the vacuum strength, or suction, often does not yield more milk and can be counterproductive. Suction that is too high can cause bruising, capillary damage, and significant pain without increasing output, as it may compress milk ducts. Additionally, poor technique, such as holding the flange off-center, causes the nipple to rub unevenly against the tunnel wall, creating painful friction even with a correctly sized shield.
When Pain Signals a Medical Condition
Pain that is deep, sustained, or accompanied by systemic symptoms may indicate an underlying medical condition requiring professional attention. Mastitis is an inflammation of the breast tissue that may involve a bacterial infection. It typically presents with flu-like symptoms, including fever over 101 degrees Fahrenheit, chills, body aches, and a breast that is hot, swollen, and often has a painful, wedge-shaped area of redness. Pumping through mastitis is painful but generally recommended for gentle, routine emptying of the breast.
A clogged milk duct, a common precursor to mastitis, feels like a tender, sore lump or hard knot localized within the breast tissue. This blockage occurs when milk is not fully drained from a section of the breast, causing pressure to build up behind the obstruction. A milk bleb, or blister, is a small, white or yellowish spot on the nipple opening that indicates a localized blockage and can cause a sharp pain during expression.
Another source of deep, burning pain is a fungal infection, commonly known as thrush. Thrush pain is often described as a deep, shooting sensation within the breast that can radiate toward the armpit, persisting after the pumping session has ended. The nipples may appear pink, shiny, flaky, or cracked, and both breasts are often affected simultaneously. Since these conditions are infectious or inflammatory, consulting a healthcare provider or lactation consultant is necessary for proper diagnosis and treatment.
Preventing and Resolving Pumping Discomfort
The most effective preventative measure is ensuring the flange size is correct, which requires measuring the diameter of the nipple base, excluding the areola. Experts recommend selecting a flange size that is 2 to 4 millimeters larger than the nipple’s diameter to allow for swelling during expression. Because nipple size can change over time and may differ between breasts, it is beneficial to measure each side separately and recheck the size periodically.
Adjusting the pump’s settings can immediately alleviate discomfort caused by excessive suction. Start the pump on the lowest vacuum setting and gradually increase it only to the “maximum comfortable level,” which is the highest setting that does not cause pain. Using a pump setting that is too high does not increase milk yield and risks tissue damage.
Applying lubrication, such as a pumping spray or a small amount of food-grade oil, to the inside of the flange can significantly reduce friction and prevent nipple trauma. Additionally, applying moist heat to the breasts before pumping can help stimulate the milk let-down reflex, potentially reducing the initial duration of the tugging sensation. If persistent or worsening pain occurs, or if symptoms like fever, chills, or a visible infection are present, stop pumping and contact a physician or lactation consultant immediately.