Yeast infections are also commonly referred to as thrush or Candida. Candida is an organism which is present it all our bodies all the time but when there is an overgrowth of Candida it causes a yeast infection. Candida infections of the nipples may occur at any time while a mother is breastfeeding. Candida likes warm, moist, dark areas and is normally present on the human body. Candida becomes a problem when it has the opportunity to overgrow and is most likely to occur where there is a breakdown in the integrity of the skin or mucous membrane.. This is another reason why it is very important to have a proper latch from the first day. Many Candida infections can be prevented by achieving a proper latch right from the beginning thus avoiding nipple breakdown and trauma and giving Candida a place to grow. The presence of vaginal Candida may also contribute the development of mammary Candida.
Diagnosis of Candida infections
There is no diagnostic test that can make the diagnosis of Candida. Since Candida is normally present on the body a positive test does not prove that your nipple pain is due to Candida. The presence or absence of Candida in the baby is also unhelpful. The baby may have thrush all over his mouth (white coating to tongue and gums) but the mother may experience no nipple pain. The mother may have all the classic symptoms while the baby shows no signs of infection. The nipple may show no obvious signs at all, but still be infected. Diagnosis is made when some or all of the signs and symptoms are present and a thorough history and physical assessment by a health care professional, suggests a Candida infection.
Common Signs and Symptoms
Acute breast/nipple pain. This usually occurs after a period of pain-free nursing.
Deep shooting, burning or stabbing pain felt deep in the breast
Burning nipple pain that lasts throughout the feeding and occasionally continues after the feeding has ended.
Burning pain may radiate into the mothers armpit or into her back.
Nipple may appear red, shiny or flakey or the skin of the areola may be smooth and shiny and nipple may crack. However, there may be no obvious changes in the skin of the nipple and areola.
May be associated with the recent use of antibiotics, but not necessarily.
The pain may occur only in the breast and is often said to be worse at night. Although, at the same time the breast itself appears to be normal with no signs of mastitis or other skin condition.
Management of Candida infections is aimed at killing the organism and preventing re-infection. Your doctor may prescribe an antifungal medication such as:
All Purpose Nipple Ointment (APNO) - this cream contains a combination of antibiotic, steroid, anti fungal and anti inflammatory medication. Use this ointment sparingly to the nipple multiple times a day for 3-4 days. If improvement, contact your lactation consultant. If you see improvement within 3-4 days, continue using the cream for the next 2 weeks. If the pain returns after stopping the cream, start using it again and contact your lactation consultant.
Fluconazole – oral medication
Nystatin preparations used to be a drug of choice although recent research has shown a resistance developing to this drug which is now only effective in 54% of cases.
In conjunction with medication the following strategies will also help prevent re-infection:
Ensure your baby is latching correctly and not causing further nipple damage. If you are unsure please contact your lactation consultant for an assessment of breastfeeding.
Attention to hygiene. Wash hands in warm, running soapy water before and after breastfeeding and any time that a potentially infected area has been touched. Dry hands on a paper towel.
If using pacifiers or bottle nipples they should be boiled daily and replaced frequently
Rinse nipple in a weak solution of baking soda and water. Candida grows best in an acidic environment and using baking soda will reverse this and create an alkaline environment on the nipple.
Use cloth nursing pads and cotton bras. Wash them daily and dry in direct sunlight if possible.
Wash and dry all toys especially toys that baby puts in his mouth
Large breasted women are more prone to Candida infections in the moist fold under their breasts. This must also be treated.
Some women report a faster resolution of symptoms when they eliminate simple sugars and yeasts from their diet and consume acidophilus and/or bactobifidus either in yogurt form or in a commercially prepared capsule.