Pumping is a mechanical process designed to mimic the stimulation and milk removal of a baby, and when performed correctly, it should not cause pain. Experiencing pain is a clear signal that an adjustment needs to be made, whether in technique, equipment, or health management. Painful pumping can lead to physical damage, cause stress, and potentially inhibit the release of oxytocin, the hormone necessary for the milk-ejection reflex. Troubleshooting the cause of the pain usually involves examining the relationship between the body, the equipment, and the technique used during the session.
The Critical Role of Flange Fit
The flange is the cone-shaped component that creates a seal over the nipple and areola to draw milk out of the breast. Finding the correct flange size is essential to eliminate pain. If the flange size is incorrect, the resulting friction or compression can cause trauma to the delicate nipple tissue.
A flange that is too small will cause the nipple to rub painfully against the sides of the tunnel as the pump draws it in and out. Signs of a flange that is too restrictive include bruising, cracks at the base of the nipple, or the nipple appearing discolored after a session. Conversely, a flange that is too large allows excessive breast tissue to be pulled into the tunnel, which can cause localized discomfort and swelling.
To ensure a proper fit, the nipple should be centered in the tunnel and move freely without rubbing the sides. The areola should remain mostly outside the tunnel, and only the nipple itself should be drawn rhythmically toward the back of the shield. Sizing often requires measuring the diameter of the nipple base after a pumping session, as the size may change due to stimulation.
Optimizing Pumping Technique and Settings
Beyond the equipment fit, the settings and technique used with the pump directly influence comfort and effectiveness. The pump uses a faster cycle speed for stimulation and a slower speed for expression. The stimulation phase uses quick, light pulls to mimic a baby’s initial rapid suckling, which helps trigger the milk-ejection reflex.
Once milk flow begins, the pump should be switched to the expression phase. The suction strength, or vacuum, should always be set to the highest level that remains completely comfortable, not the highest level that can be tolerated. Setting the vacuum too high can cause pain and may actually compress milk ducts, potentially reducing milk flow.
Start the suction at the lowest setting and gradually increase it until a strong but painless tugging sensation is felt. Pumping duration also plays a role in preventing soreness, as pumping for an extended time, often beyond 20 to 30 minutes, can irritate the tissue. Reducing the vacuum setting immediately at the first sign of discomfort is essential to prevent tissue damage.
Pain Caused By Underlying Physical Conditions
If equipment adjustments do not resolve the pain, the issue may stem from an underlying physical condition unrelated to the pump mechanics. One such condition is mastitis, an inflammation of the breast tissue. Symptoms often include a localized, wedge-shaped area of redness, warmth, and tenderness, along with systemic flu-like symptoms such as fever and body aches.
Nipple Blebs and Thrush
A nipple bleb appears as a tiny white or clear dot on the nipple surface. This is a milk duct opening that has become blocked by a small plug of thickened milk or a thin layer of skin, causing milk to back up and resulting in sharp, localized pain.
Pain may also be caused by a yeast overgrowth, often referred to as thrush, which presents as an intense, burning, or stabbing pain that can persist after the pumping session is complete. The pain associated with thrush may sometimes radiate deep into the breast tissue.
Vasospasm
Vasospasm is a temporary constriction of the blood vessels in the nipple. It causes a burning or throbbing pain, especially after the pumping session, when the nipple is exposed to cooler air. A distinguishing characteristic is the nipple turning white, blue, or dark red during or immediately after the pump is removed due to the restricted blood flow.
Recognizing When To Seek Professional Guidance
When initial troubleshooting steps fail to relieve pain, professional help is necessary. Persistent pain is a clear signal to consult an International Board Certified Lactation Consultant (IBCLC) or a physician. These professionals can accurately diagnose issues that are difficult to identify alone, such as subtle signs of infection or incorrect flange sizing.
Immediate consultation is warranted if red flag symptoms appear, including:
- Visible signs of trauma like blisters, cracking, or bleeding on the nipple.
- A fever of 101°F or higher.
- The presence of pus.
- Severe, unresolving redness and swelling in the breast tissue.
These symptoms suggest an infection or other medical complication that requires prompt medical evaluation and treatment.