ductal thrush - anyone had it?

[Quietlyalert]

hi all, having a nightmare with what i believe is ductal thrush. started with a blocked duct but i think i damaged nipple trying to clear it and for past couple of weeks have had excruciating pains in that breast that begin after feeding and last for two to three hours. the pain is intense, like a stabbing burning feeling. have spoken to breastfeeding counsellor who thinks its ductal thrush and after three gp visits finally managed to get oral fluconazole (had previously been prescribed nystatin for me and baby but its topical only). i've been taking it for three days but still not let up in the pain. anyone been through this? it's really getting me down and i'd just like to think there is light at the end of the tunnel. if it's not thrush what else could be causing these pains? my baby has no thrush signs in her mouth but i believe that's not uncommon when its in the milk ducts as opposed to on the nipple. thanks

[Yoghurtget]

I had ducal thrush, luckily I was given the oral medication immediately. It took about a week to clear. I hope yours clears quickly

[Quietlyalert]

thanks for the replies. can i ask what dosage you were on? the doctor gave me a 150mg loading dose (the BFN leaflet said 150-400g) then 100mg day for ten days. I'm worried the loading dose wasn't high enough as have been reading about some women for whom it didn't work and had to start treatment again with 400mg dose. Also did you give up wine / sugar / yeast etc? (a glass of red wine is my only comfort at present!) thank you

[Doodler79]

Hi , sorry to jump on your thread, but I am also currently experiencing thrush. I am on a dose of 50mg of Fluconazole, as well as using Daktarin cream on my nipples & the oral gel for DS. I also had it with my DS1 & was in pain and miserable for weeks while breast feeding. I was determined to get sorted ASAP this time. Didn't realise there were higher strengths of the tablets. May investigate this, as have been taking the treatment for 5 days now & really only mild improvement felt.

[Doodler79]

Actually just thought...am taking two of the 50mg tablets daily. But still only 100mg in total. Think I will ask about an increase.

How are you doing QuietlyAlert? I do hope the pain is getting better. I know from first hand experience how bloody awful it is!

[Doodler79]

I also read about giving up sugar, alcohol, caffeine...etc in order to help. But I'm also so hungry and tired from the BF that I don't think I could sacrifice sugar & coffee!! I also have been drinking those Danone yoghurt drinks in order to boost the 'friendly' bacteria.

[Tambajam]

Can I just add that deeper breast pain as you describe can also be because of neuralgia. This is when you get a pain signal deflected along the course of the intercostal nerve from another initial source but resulting in deep breast pain. For breastfeeding mums, the most common cause of deep breast pain is positioning and attachment causing nipple problems. This could be nipple damage or nipple compression that doesn't actually cause damage. Cracked nipples can cause this neuralgia plus tongue tie, high-arched palates and on-going latching problems.

Less common is a bacterial infection like staph aureus. It is possible for mum to have thrush when baby has no symptoms. Usually ductal thrush is accompanied by nipple symptoms though.

Having said all that, if you do have thrush fluconazole often makes no difference at all for the first 2-3 days so hang on around 7 days before you judge. Have you seen the breastfeeding network website's info on thrush?

Lacto acidophilus capsules (probiotics usually stored in the fridge are better quality), grapefruit seed extract, vinegar rinses for the nipples (1 part vinegar to 2 parts water) and use vinegar to rinse bras and muslin cloths too.

[Quietlyalert]

hello thanks for replies the first course of fluconazole hasn't cleared it up so i've just started a new course with a much higher dose. now only feeding on the unaffected breast and expressing on the other as it's just too painful. will be referred to consultant if it doesn't clear up with the new course, have also wondered about staph Tambajam and have been given some antibiotic cream which i've also been using. interesting re neuralgia i'll look into that however my symptoms really tie in to milk duct thrush. i have seen the bfn info thanks, it's how i persuaded my gp to prescribe! good to know it may take a few days, was hoping it may start to improve more quickly but won't be too disheartened if it doesn't.

doodler my new course is 400mg loading dose then 200mg a day for two weeks. i contacted a lactation consultant who said my previous dose was completely inadequate so it may be worth seeing if you can get a higher dose. hope you manage to get rid of it.

[Tambajam]

Did you say 'unaffected breast'? If you read the Breastfeeding Network info you'll see ductal thrush doesn't present in only one breast! Thrush is far more rampant than that! It goes bi-lateral almost immediately. That should have been something picked up in by everyone you have spoken to previously. Really really points to it being something else.

[Tambajam]

www.breastfeedingnetwork.org.uk/wp-content/dibm/Thrush_and_Breastfeeding_Feb_2013.pdf

[Quietlyalert]

hi tambajam, i think the breastfeeding network leaflet is a bit confusing. my understanding is nipple thrush usually presents on both but ductal thrush may just be one; that's what i've been advised by the lactation consultant / breastfeeding counsellors also. but who knows - the problem with ductal thrush is there are no outward symptoms. if the medication doesn't work I guess that will be the answer.

[Tambajam]

That's interesting you read it that way. I read the bilateral pain criteria as pretty clear. I'm also a lactation consultant and I train breastfeeding counsellors using this leaflet! I'm going to get in touch with Wendy Jones (who wrote the leaflet) and ask her more about this.

[Quietlyalert]

just read it again and it does seem pretty clear you're right. interesting thread here www.mumsnet.com/Talk/breast_and_bottle_feeding/a1425282-New-Breastfeeding-Network-Thrush-FAQ-leaflet-why-the-changes in which wendy responds to other queries about this. i appreciate that if the thrush is on the surface of the nipple it could be easily transferred but if it's in the milk ducts would it be as easy? and would a nipple swab show if thrush was in the milk ducts?

i was also planning to write to the bfn about the dosing advice as the my gp gave me the lowest loading dose as stated in the leaflet, and as i said i've been advised by an LC that that dose wouldn't touch ductal thrush - she said 400mg is needed as does a lot of other online info. so i wonder how many women are being prescribed the lowest dose by their gps who are reluctant to prescribe anyway, and then suffering needlessly until they can get a higher dose.

anyway be interested to hear any further input - thanks. i'm not 100% convinced it is thrush but the burning / stabbing that comes on ONLY after feeding and lasts for hours makes me think it is. if it's not thrush i did wonder if i may just have some very blocked ducts within the breast - i am having recurring milk blebs on the affected breast which make it virtually impossible to express until i've spent a lot of time trying to clear them. it's all just a bit of a mess really!

[Quietlyalert]

nb my nipples were very cracked and bleeding for a while which perhaps ties in a bit more with thrush and are still not in great shape. i forgot to ask my LC so do you mind if I ask if you tambajam if you recommend against lansinoh use with thrush?

[Tambajam]

The blebs alone could cause the neuralgia that results in this burning/ stabbing only after a feed.

I've drawn Wendy's attention to this thread and she may pop along. She used the phrase 'utter rubbish' in her message discussing some of the information you've received so far. You can read this on her FaceBook page 'Breastfeeding and Medications'.

I agree with Wendy that it would unethical for a doctor to continue to prescribe fluconazole (particularly with a young baby - how old is your baby?) in the situation you describe. The doses you describe are extremely high. I'm afraid I don't agree that 400mg is needed. Nor perhaps any fluconazole at all based on what you describe.

Re: lansinoh. We don't have concrete evidence on this either way but there is some anecdotal evidence that lansinoh may not be great for thrush. It encourages the moist darker environment that thrush likes. There is some suggestion that Virgin coconut oil may work well here due to natural anti-fungal and anti-bacterial properties. Perhaps also jelonet as a preference.

What you are describing could be based on mechanical damage. Could be bacterial. Thrush really isn't likely.

[Quietlyalert]

wow, i'm afraid i'm hearing quite different things from everyone i speak to. two different lactation consultants have told me i need the 400mg loading dose. this is also suggested in a number of online treatment protocols such as this www.stgeorges.nhs.uk/wp-content/uploads/2013/10/48_Community+services+Wandsworth_Breastfeeding+with+thrush.pdf
now i'm worried. my baby is 10 months old. will definitely get some coconut oil and have some jelonet oil too. thanks.

[Quietlyalert]

if it is a case of mechanical damage / neuralgia, what are the treatment options? have been breastfeeding for 10 months without any problems thus far so not sure latch is at fault.

[Tambajam]

This is one the hardest things in your situation or in being a new mum generally! You hear different stuff even from HCPs who focus on evidence-based information. All you can do is sift through the different opinions you receive and go with your gut. I know the higher dose is advocated by some but even then, not in the situation you describe with unilateral pain and nipple damage which points to other causes of deeper pain.

I would start with a swab to look for staph.

I assume you're already getting good face-to-face support with attachment. It can change even after several months of no issues. This can be due to teething, babies getting heavier, various factors.

It's positive that your baby isn't teeny as the concerns around the toxicity of fluconazole (which particularly worries Wendy) is focused on smaller babies. That's good news.

[NotCitrus]

Might be worth getting your baby checked for thrush again - I got told twice my Ds didn't have it, then a lactation consultant said he did and showed me the patches. I saw a GP an hour later and she was saying she couldn't see it, until he screamed and she apologized, as it was obvious but only at the back of his mouth.

That's the extent of my knowledge though. Good luck!

[Quietlyalert]

Thanks tambajam. Am awaiting swab results. My gut doesn't know what to think anymore, have seen so many doctors and spoken to so many people and am just desperate to resolve this so I can carry on breastfeeding. I'm worried my daughter isn't getting enough milk and formula isn't an option as she's allergic. I haven't had anyone examine her attachment as yet so I'm going to see someone about this asap. Looking back the problems with the nipple did start just after she got her first teeth - but I was told by a bfc the two wouldn't be linked!

[Quietlyalert]

Thanks not citrus. I'll check again next time I see someone.

[Tambajam]

The arrival of new teeth can take an adjustment. Sometimes we also find previous issues existed but only become apparent when teeth arrive e.g. A baby not properly covering the lower gum ridge or a baby using their upper gum to compress the breast.
Really hope you get sorted and pain-free soon.

[Quietlyalert]

how are you getting on doodler? i'm on day 4 of the higher dose fluconazole and no improvement yet, the severe pain after feeds is still there (it can last for up to five hours), so I'm beginning to doubt my problem is thrush and may be due to the milk blebs on my nipple that started this all off and are still there. have also been referred to breast consultant so hopefully they'll give me a definitive answer. hope your symptoms are easing.

[Quietlyalert]

just an update for anyone interested. the thrush medication didn't seem to make any difference so i came off it. i basically gave up feeding on the affected breast for about two weeks as I couldn't cope with the pain any more. i was referred for a breast scan which showed no problems with the breast. whilst feeding on the right breast only this too started getting repeated nipple blebs which i had to treat daily with sterile needle. i slowly started reintroducing feeds on the left breast and to my utmost relief the pain had disappeared. i spent a lot of time in the bath / shower hand expressing before feeds as the blebs were making it really hard to get the milk out, and bought some lansinoh heat pads which i put in my bra for 10 min or so before feeding which really seemed to help - after a few days of this the blebs cleared up, but it took a couple more weeks for my boobs to feel more normal again and even now almost three months after the initial problems they still don't feel quite right. however i'm pleased to say that i'm still pain free and have resumed breastfeeding my daughter twice a day. have no idea what was causing the pain, still wondering if there wasn't some sort of infection, or whether it was related to the nipple blebs affecting milk flow and causing it to back up in the breast (i also had a bout of mastitis as i just couldn't get the milk out of the breast due to the blebs). thanks again for the advice.