Thrush/cracked nipples - urgent advice needed

[FlipFantasia]

Hi ladies

I saw a BFing midwife yesterday who diagnosed thrush in my breasts based on my symptoms. So I'm just back from the GP and myself and my 4 week old DS have now started on Daktarin. I'm hoping to get fluconazole as well, but the locum needed to take advice before prescribing it so fingers crossed she calls me in a couple of hours and I can pick up a prescription for it. The fluconazole is because I have pains in my breasts between feeds as well.

I have a deep crack midway up my right nipple (underneath, so I can't see it when I look down) and another at the base of my left nipple (on the top so I can see it when I look down). There was another on my left side that was same as the one on my right, but it's just healed.

My question for you BFing gurus is how to help my cracked nipples to heal?

So far, this is what I'm doing:

• I'm concentrating on my latch - so what little MN time I have is being cut back as I've decided to do nothing else during feeding other than focusing on maintaining a good latch!

• I'm planning to go back to another BFing support group on Monday to get more observation/advice on my latch/feeding technique and am booked to go back to see the BFing midwife again next Wed.

• I'm changing my breast pads after every feed and have hot washed all my nursing bras

• I've cut down on sugar

• I'm rubbing in a little breastmilk and trying to air my nipples at the end of each feed.

I'm also taking some ibuprofen to ease the pain.

Is there anything else I can do? Should I get some nipple shields? I'm kind of nervous of using nipple shields, but at the same time I'm getting desperate! I'm also just getting so tired of BFing being so hard and really need to turn a corner on all this...

TIA

I wanted to add that I've also got those silver cups and lansinoh too (was using the cups exclusively for a week but had just switched back to lansinoh as the cracks hadn't healed). But I've stopped both as I don't think they mix with the topical treatment for the thrush.

I really feel for you, I had thrush/mastitis for 8 weeks before I finally got fluconazole and it is agony. I used nipple shields for a couple of days at a time because it was the only way I was going to keep bfing. I also used copious amounts of lansinoh and lots of air time.
If you've got pains going through your breast rather than just on the nipple I would push for fluconazole simply because the quicker you clear it up, the better it'll be for you. Some people recommend grapefruit seed extract for thrush, I started it at the same time as the fluconazole though so don't know if it helped or not.
Good luck!

Oh yes, and DD had Nystatin which she was supposed to hold in her mouth for 30 seconds...cos of course newborns can do that! I used to seal the Daktarin in with Lansinoh if that makes sense.
You can get rid of it, and bfing is so much easier - stick with it and well done for getting this far!

Thanks Chulita - god, 8 weeks - you poor thing! Good to know I can use lansinoh at the same time as Daktarin.

at the nystatin - who can possibly think a newborn can hold something in their mouth for 30 secs? Am glad we've got the daktarin gel.

I'll look up the grapefruit seed extract too.

Thanks for the thread flip I am in exactly the same boat! I am on daktarin too, one boob seems better already 2 days in. I also have pain between feeds, it makes you want to give up doesn't it? Am determined to persevere, I too only saw a locum gp so am hoping that if not better my regular gp will sort me out at six week check next week.

Really hope you get sorted

(ps love the new name)

Hi ang - sorry to hear you're in the same boat, though it's good to hear the daktarin is helping already. The locum called me back to say she won't prescribe the flucanazole (sad) but I have an app with another GP next week so fingers crossed I get it then. But am also determined to persevere so let's persevere together!

I really hope it gets better soon - sounds like you are doing all the right things!
I personally found that NOT using lansinoh was actually better for thrush (I had bad cracks and thrush). It makes for a moist atmosphere which the yeast infection loves and can make the thrush worse. Breastmilk on boobs helped while airing them is really good and try to actually get some sunshine on them (is there a sunny window in your home?). Keeping them as dry as poss as much of the . Try to go without a bra and pads as much as you can at home, I would wear a loose T-shirt or light loose dressing gown- such a good look!! (making sure to hot wash these too!) and sleep topless (I put muslins on the bed to catch any leaks). Fluconazole and Nystatin (several courses of it) eventually cleared it but gave relief from deep breast pain fairly instantly. Really hope you can get it from your GP soon. Take a copy of the leaflet on treating thrush that you can download from the breastfeeding network website. Has info for health professionals re: prescribing Fluconazole.

Thanks for sharing your experience monkey - I had actually brought the leafleft from the BFN with me to the doctor, but to no avail . I'm hoping the next doctor I see prescribes it.

I'm nervous of going bra less - my nipples are so sensitive, at the moment the thought of a bare t shirt touching them is too ouch to contemplate! And sleeping topless - it's not the leaks as such (I don't leak alot) but the thought of the covers touching my nipples. Will have to try to get over this though. Actually, a dressing gown during the day may be better...

I see your point about the wet environment and lansinoh - it's why I had stopped it already myself.

You could try taking grapefruit seed extract which some people suggest (although I have no idea if it is any good) and taking live bacteria (acidophilus capsules for example).

I found the nipple cream helped very quickly.

As for nystatin for the baby (I know you're not on this, but wanted to post as it might help someone), don't bother faffing with the spoon or dropper. Instead put it on a clean finger, sweep in around the baby's mouth and repeat until you've used the dose up.

I think I will try the grapefruit seed extract and live bacteria - just need to get to a health food shop type place to see what's on offer.

Just to say mu health visitor was able to prescribe me fluconazole, so maybe you could try that instead of a GP? (then I double checked that it was ok to use after feeding, with the pharmacist).

Thanks for the HV tip Bumble - I couldn't get to speak to a HV yesterday but I'm going to try them again on Monday.

In the meantime, I thought I'd update to say that things are definitely improving for me . I even managed to feed in public today, entirely pain free and feeling like a normal breastfeeding mum

I used a nipple shield on my right nipple for 24 hours Thurs night to Fri night and it's really helped the healing. I'll still use it intermittently if I need to, but DS definitely doesn't get enough milk out leading to some engorgement pain (my right boob is the more productive one I think).

But the good news is that the pain in my nipples has significantly reduced on just day 3 of using the Daktarin and the cracks are healing nicely. DS also seems to have less white in his mouth and seems to be getting less windy/hard to settle.

I also realised that you can in fact buy fluconazole over the counter so today I bought a couple of doses of 150 mg (for ten pounds) and have taken the first one. If the health visitor on Monday can't prescribe me them then I'll buy more (possibly online, which is cheaper). I can't wait til next Wednesday to see the GP when I'm not even guaranteed to get a prescription so have decided that spending up to fifty pounds is a price worth paying for being able to breast feed without pain!

I also thought I'd link to this excellent NHS site on fluconazole and thrush in breasts. I wish I'd had this info to hand when dealing with the locum last week, as I think it would have carried more weight than the Breastfeeding Network leaflet! So if anyone else has a GP that needs convincing to prescribe fluconazole, I'd recommend showing them this site.

NHS Scotland site on thrush and breatfeeding here

NHS Scotland site on thrush and oral fluconazole here

Just wanted to offer my condolences really. I went through a period like this when Bfing DS that seemed to last forever but it did get better.
The most useful thing I found was treating DS mouth with Daktarin immediately before the feed (some rubbed off on nipple?) and applying Lansinoh immediately after every feed.
I was also given some oral anti-biotics, but I can't remember if this was for thrush or mastitis TBH.
Stick with it though, and keep hassling your HV/GP for advice. They might be able to suggest something new.

big hug

Glad its getting better for you too flip, I also had a pain free feed just now, isn't it lovely?!!

Didnt realise you could get the drugs over the counter too. Interesting about the nipple shields, I have been reluctant to try them but may pick some up tomorrow and see if they continue the healing process. I have a fast let down so perhaps they will be ok.

Which sheilds did you buy? I have been told that the medela ones are the best?

Ang well done on the pain free feed! It is great...and makes me feel a lot better about being able to continue breastfeeding. I'm still taking it week by week (which is better than feed by feed, so I'm making progress!) but my DS is 5 weeks on Tue and I'm feeling more much confident that I'll still be breastfeeding then (and well beyond then ).

I was also reluctant about the shields. In fact, my DH just bought them when I sent him to Mothercare on Thurs to buy me more lansinoh breast pads (was sick of seeing me in pain I think). They're Avent ones - just standard. I think Medela do different sized ones, which would probably be much better (the Avent ones are quite big for my baby's mouth). I'd recommend them as a temporary measure to give your cracks some time to heal (although I'm not using them at every feed as my DS wasn't draining my breast as efficiently, which left me uncomfortably full). Bit of a faff to sterilise them after each feed (I'm boiling them) but definitely a good temporary fix to promote healing.

I'm still avoiding the lansinoh, until the surface thrush clears up a bit. Are you using it? If so, is it helping?

Also, the pain in my breasts after feeds is significantly less after just one fluconzole pill so I'm glad I bought them over the counter.

Gracie thanks for sharing your experience - it is pretty horrible alright. Though I'm glad you stuck with it and got over the problems - it gives me hope!

Hi ladies. I am in the same boat as you.
My ds and i are also both on daktarin and it is reucing the pain but it hasn't gone completely yet after a week's use. I am also going to try to get the tablets from the gp this week. Fingers crossed!

Let me know how you get on with the tablets!

ah, didn't realise you meant the capsule. I've bought things off chemist direct before, they have fairly cheap thrush tablets.... here the post is quite quick too, but if you buy in bulk you have to send them a message as to why you want so many...

BelgianMummy hope you're getting on OK. The tablets really helped me - I bought them over the counter and from various online chemists (you can only buy two at a time) as my GP wouldn't prescribe them. But the pain in my breasts between feeds is now gone (thank god!).

Ang how are you getting on? Did you get the medela shields? I just ordered some off mothercare, as my right side just isn't healing. The daktarin kind of stings so I really want it to heal up!

Bumble thanks for the link. I found one site (pharmacy first I think) that charged only 16p for the tablets! Of course postage was about 4 pounds but still...bargain!

I just wanted to update this thread to say that the only thing that's worked for me in healing the deep crack on the underside of my right nipple is jelonet.

I found out about jelonet - sterile gauze dressing - by searching the MN talk archive and it's magic stuff. It keeps the crack moist and so it heals from the inside out. I stick a little square over the crack on the underside of my right nipple, seal it in with lansinoh and just remove it before a feed. And then repeat after the feed.

I think the crack will leave my nipple scarred (it was so deep that at times I worried my DS would suck a section of my nipple off!) but it's healing well after 8 days of using jelonet & lansinoh. The good news is that feeding is no longer painful (finally!) and my DS is nearly 7 weeks - here's to many more weeks of pain-free feeding .

Ooh poor you. It really hurts. And it's tough on top of all the other discomforts and challenges of BF.

I had the fluconzole tablets (I got the dose upped to two tablets twice a day after a week or so of not much change), plus Daktarin gel for DD, miconazole (anti-fungal) cream for my nipples and then Kamillosan (camomile ointment).. all of these on prescription. I found the Camomile better than lansinoh, which I had been using, as it absorbed better into the nipples and was just less gloopy.

I got thrush at about 5 weeks, and now DD is 12 weeks I still have it a bit I think, but much much milder. When I saw the doctor last week she suggested that since it wasn't really a problem any more to stop the fluconzole and see if it just clears up, taking paracetamol if the pain gets worse (but it hasn't been as bad as needing painkillers for a while now).

Good luck.