Thrush and cracked nipple - help!

[Loobylou77]

Hi,

I don't post here regularly but have found the advice invaluable. I hope someone can help me as I'm in quite a bit of pain.

My LO is 10 weeks old and EBF. I have had a very sore nipple on one side for a few weeks now both during and after a feed and the HV this week said she thought it might be caused by thrush. The main symptoms (shiny, red skin, burning and stabbing pain, very painful latching in particular and white skin on the nipple after a feed). At her suggestion/prescription I'm now using Daktarin cream on my nipples after a feed and Nystatin for my LO.

Today my nipple cracked and has started bleeding. I would usually use Lansinoh but I understand I need to keep my nipples as dry as possible so the thrush goes away.

Can anyone tell me how best to treat the cracked nipple given the thrush complication? Should I express off that side until it heals for example? Or is it possible the thrush may have been misdiagnosed (I'm mainly dubious because I thought you always got it on both sides)? As far as the HV could advise my LO's latch is good and up until a few weeks ago feeding was pain-free and is still fine on the other side.

Thanks!

tricky one.

Take a look at this: www.lalecheleague.org/llleaderweb/lv/lvoctnov98p91.html

and this:

www.lalecheleague.org/faq/thrush.html

One point to note is that Nystatin isn't as effective as Daktarin gel for your baby so that might be worth changing.

In addition what OCC has said about thrush and it's treatment - it might be worth considering another skin infection other than thrush. There was a study done a few years ago and the women in the study that had been diagnosed with thrush had staph. infections, none actually had thrush. Details here.

The study also gives the test/swabs needed to test for it so it might be useful to take to the GP to show what you would like done.

In the meantime moist wound healing using a paraffin wax based dressing like Jelonet (other proprietary brands are available) so that scabs don't form.

If a scab forms on a nipple, it can get sucked off by the baby which leaves a slightly bigger wound, if that then scabs over, then gets sucked off again a slightly bigger wound can form. This can turn a small crack into a big crack quite easily and is very painful.

If you can't get any dressings, slathering lanolin nipple ointment on (keep tube in your pocket or on radiator so it's warmed when you apply it) and cover with a breast pad (make sure you apply plenty as you don't want the wound to stick to the pad).

Thanks both for the useful info. So would it be ok to use the dressings or lanolin cream over top of the Daktarin? My impression was that the options were either dry healing for thrush or wet healing for cracked nipples.

In reading those articles i'm wondering if it is thrush, the pain definitely got worse after I started treatment and now on day 3 in spite of the cracks is improving. I'm thinking I continue for the next couple of days with Daktarin to be sure, does that sound sensible? Obv if no improvement then i'd see the doctor to either switch meds or swab for an alternative infection.

OCC, with regard to switching to Daktarin gel for my DS, is that available over the counter or would I need to see the doctor?

Well, you're right about the rule of thumb being dry for thrush, wet for cracks which does make this tricky :)

Wet healing for cracks is so that any scabbing is protected more than it would be if there was dry scabbing - it's harder for the baby to suck the scabs off if they're wet (sorry).

So if the cracks aren't too bad or scabbing I'd probably err on the dry side myself and see how it goes.

Thrush treatment should be continued for about 2 weeks after symptoms have stopped so if it seems like it was thrush (if the pain goes away) then this is something to be aware of. Otherwise, yes, if it doesn't stop then it's a good idea to go back to the doc.

I'm pretty sure you can get Daktarin gel OTC but of course it's free on prescription :)

Thanks so much occ that helps clear things up, the cracks aren't too bad compared to what I experienced with DS1, definitely sore but bearable with gritted teeth for now at least! And the bleeding seems to have stopped so will follow your advice re: dry healing and see how I get on.

Good point re: getting the gel free on prescription, I'm sure it can wait til Monday to see the doctor

:)

Sounds like it could be thrush to me.

DS2 and myself were just passing it back to each other. Tried Nystan, Daktarin, Clotrimazole etc. After researchig it myself I asked the doc if he could prescribe the capsule you take just the once (just to save me £13-odd), he wouldnt because I was bfing, even though it is safe to take. I ended up buying it over the counter and used it in conjunction with Daktarin gel for DS2. Touch wood it hasnt been back.

It is very painful, you have my total sympathies. I had the scabby situation that Truch speaks of. I used to cry every time he wanted a feed because I knew what was coming.

Hi there. So sorry to hear about what you have been going through. I went through exactly the same and it is very painful.

In my case it was thrush and i was advised by my GP to also rub some of the Nystatin on to the crack.

What really did help me, however, were the Avent breast shells - they were excellent. You wear them in your bra and they kind of mould into the shape of your breast. They have two different types of back - one type has holes in, which allow air to circulate so helping the crack to heal. It's better than wearing a breast pad as they can stick to the nipple and that can be sore when you come to peel it off.

I did also use a small bit of Lansinoh and also bathed the nipple morning and evening in some liquid Calendula in cool boiled water. Sounds a bit fiddly and odd but it all helped. I had been suffering for weeks with the cracks and was nearly at the point of giving up I was so sore.

I also took a break from feeding DS from the bad side for a week and just expressed from that side, making sure I angled the pump so there was no friction on the sore bit!

Not sure if any of that will help you but I would certainly recommend the breast shell. I think it's called Avent Comfort Breast Shell or similar.

Sorry if the above is in any way disjointed but typing in a hurry!

Hope it heals soon.

Best of luck,

Rebel

Thanks Gribble and Rebel for the additional thoughts and suggestions, this gives me loads of things to try and makes me feel so much more positive about the healing process and that things will actually get better!

I wasn't able to bf my DS1 but learned a lot from the experience and things have worked out well with DS2 so am keen to keep going for as long as I can so if I can get rid of this and avoid it coming back I'll be very happy :)

The capsule that gribble mentioned is Fluconazole and it's an oral treatment for internal thrush infection. Meaning, thrush which has invaded your milk ducts as this won't generally be treated by cream alone. If we are still on the thrush line (and I'm not 100% convinced and think that your original plan of seeing how the treatment goes before being sure) then if you are getting stabbing pains in the breast it may be necessary to take a course of Fluc. The one-off treatment is not usually sufficient for ductal thrush and you might need a course of it, plus a one-off high dose.

More information here: www.breastfeedingnetwork.org.uk/thrush-and-breastfeeding.html

Worth reading the nipple pain page, and downloading the thrush PDF. Fluc is not licensed in lactating women but the amount found in milk is less than the dose licensed for use in infants so it's considered safe by the BfN's BFing pharmacists who do that kind of research. You'll need to explain this to your GP though - or point it out in the leaflet.

Thanks again occ I've been reading other posts about thrush on here so had suspected that was the drug Gribble was referring to. The amount of pain I'm experiencing between and during feeds continues to improve although latching and shortly after still hurts a fair amount.

I'm hoping it's thrush from the perspective that it might be actually going away but at the same time don't want it to be given how hard it is to actually get completely rid of it !

Well - yeah - it can be but with the right regime it will go, and quickly.
Like antibiotics, though, you need to be religious with following the course and keeping going for 2 weeks after symptoms stop.