A nipple fissure is a painful crack, tear, or split in the delicate skin of the nipple and areola. This condition is frequently encountered by new parents who are chest- or breast-feeding, with many experiencing some degree of nipple pain or trauma in the early weeks. The physical discomfort caused by these lesions can make feeding sessions intensely painful, often described as a sharp, burning, or pinching sensation that persists beyond the initial moments of latching. Finding a quick and safe path to resolution is important for maintaining the feeding relationship and ensuring adequate milk transfer. Addressing the issue requires a dual approach: immediate steps to soothe the existing wound and long-term adjustments to prevent its return.
Identifying the Root Cause
Effective healing begins with understanding the origin of the skin trauma, which is often mechanical in nature. The most frequent cause of a nipple fissure is repetitive, excessive stretching or friction against the tissue. This mechanical force is typically the result of an inadequate or shallow latch during a feeding session, where the infant is sucking primarily on the nipple tip rather than taking a deep mouthful of areolar tissue. Improper use of milk expression equipment is another common mechanical factor that causes damage. This includes using pump flanges that are incorrectly sized, leading to friction against the sides of the tunnel, or setting the vacuum suction level too high. Fissures can also result from underlying issues, such as skin conditions like eczema or general dermatitis, which predispose the skin to cracking. Finally, fissures can be a symptom of a localized infection like candidiasis (thrush), which presents as burning pain and shiny, flaky skin, or a bacterial infection that may develop if the skin barrier is compromised.
Immediate Relief and Protection Strategies
While the underlying cause is being addressed, immediate strategies can be employed to manage pain and protect the open wound from further damage. For systemic pain relief, over-the-counter anti-inflammatory medications like ibuprofen or acetaminophen are generally compatible with nursing and can help reduce local inflammation and discomfort. A cool compress or a hydrogel pad placed on the nipple between feedings provides a soothing effect and creates a moist, protective barrier. When cleansing the area, avoid harsh soaps, which can strip the skin of its natural moisture and worsen dryness or cracking. Instead, gently rinse the nipple with clean, warm water after each feeding. A temporary measure to prevent the tender tissue from adhering to clothing or a nursing pad is to wear a breast shell, which is a dome-shaped device that forms a protective space around the nipple.
Accelerating Tissue Repair
Promoting rapid tissue regeneration relies on the principle of moist wound healing, which has been shown to accelerate the healing process compared to air-drying the wound. Maintaining a consistently moist environment helps prevent the formation of a dry scab, which can impede the migration of new skin cells across the wound bed. A small amount of purified, medical-grade lanolin or a specialized barrier cream can be applied to the fissure after a feeding to maintain this optimal healing state. Expressed breast milk can also be gently massaged onto the nipple and allowed to dry, as it contains natural antibodies and healing factors that support skin health. If the pain makes direct feeding unbearable, the affected breast can be rested temporarily by exclusively hand-expressing or pumping milk for a few days to maintain milk supply. If choosing to pump, ensure the correct flange size is used and that the suction is set to a comfortable level to avoid perpetuating the trauma.
Preventing Recurrence Through Technique
Long-term prevention depends on correcting the mechanical factors that initially led to the fissure. The most significant adjustment involves achieving a deep, comfortable latch during feedings. A proper latch requires the infant to take a large amount of the areola into their mouth, not just the nipple tip. This ensures the nipple is positioned far back near the junction of the hard and soft palate, minimizing friction and distributing the pressure across the less sensitive areolar tissue.
Optimizing Feeding Positions
Experimenting with various feeding positions can help distribute the pressure on the nipple tissue, preventing trauma from being concentrated in the same spot at every feed. Positions such as the laid-back, side-lying, or football hold allow the parent to maximize comfort and help the infant achieve a more asymmetrical latch.
Correct Pumping Technique
When using a pump, it is important to confirm that the flange size is appropriate, meaning the nipple moves freely within the tunnel without rubbing against the sides. Adjusting the pump suction to the lowest setting that still achieves effective milk removal is equally important to avoid damaging the delicate skin.
Recognizing Warning Signs and Complications
While many fissures heal with home care, certain signs indicate the need for professional medical intervention. These include escalating pain that does not improve within a few days of implementing treatment strategies, or the presence of visible signs of infection. Signs of a bacterial infection include:
- Localized redness.
- Warmth and swelling.
- The discharge of pus.
- A fever.
A persistent, burning, or shooting pain that radiates through the breast, often accompanied by shiny or flaky skin, may suggest a fungal infection like thrush. If a fissure is actively bleeding or causing severe pain that makes feeding impossible, a consultation with a healthcare provider or a lactation consultant is necessary. Prompt attention to these warning signs is important to prevent complications such as mastitis or a breast abscess.