Nipple nightmares 2: fissures

mother holding babyHaving been told that my initial breastfeeding difficulties – cracked, bleeding, excruciatingly painful nipples – were quite normal (despite what the official literature said), I was looking forward to the three week deadline after which everything would be functioning as it should. I was, however, slightly perturbed by the fact that as he deadline approached, no improvement was evident. In fact, my nipples were getting much, much worse. My husband expressed genuine concern that C was going to chew one of them off! By this stage, the bleeding had stopped, but it had been replaced by deep, ulcerated gashes on the outside edge of each nipple. I dreaded feeding, and as C wanted to do so 10-12 times a day, I spent all 24 hours either in pain, or anticipating its imminent start.

‘A mother’s guide to breastfeeding’, provided by my health visitor, wasn’t particularly reassuring. The only place it mentioned what I had finally come to recognize as fissures was in the ‘problem solving chart’ on the back cover. Apparently, this meant that C had tongue tie! I thought this was unlikely, as we’d seen her sticking her tongue right out of her mouth. Nevertheless, the information sent me into another panicked state, and I was on the phone yet again to the maternity unit.

On the next visit, the midwife assured me that C didn’t have tongue-tie. In fact, she seemed remarkably unperturbed by what I felt was the pretty horrifying sight of my nipples. Although she didn’t know quite what the problem was, she acknowledged that some mothers have these difficulties, and that many of them give up as a result. She was confident that things would improve, and said that I should consider getting a nipple shield to make things more bearable in the short term. She also suggested I call a breastfeeding helpline. I was sceptical they would be able to tell me anything I didn’t already know, but by this point anything was worth a try.

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21 Responses to “Nipple nightmares 2: fissures”

  1. Ashley Says:

    I’ve just recently read some interesting stories from people who switched from the disposable nursing pads to wool pads such as the Lanacare ones. They claim that the wool pads wick away moisture better than cotton or disposable and stay dry and warm. Many of them said that the disposable made their nipples irritated and sore, and after switching to the wool their problems improved tremendously. I’m really curious if you know anything about this. It would have never dawned on me to use wool pads, but I used disposable and had horrible problems with bleeding nipples for weeks. It never occurred to me that the pads may be contributing to the problem. Thanks for the wonderful site!

    • Elizabeth Jay Says:

      Hi Ashley – I’ve been looking into this and have so far failed to find any recent research looking at breast pads. There is some stuff from about 15 years ago, but the materials used to make pads have changed considerably since then, and no one mentions wool… I’ll keep looking though, and will post anything relevant.

  2. Joanna Says:

    Elizabeth,

    I feel your pain. I breastfed both of my boys for one year and in the first few months, I developed deep fissures on my nipples. Both times it took months for the fissures to finally close up. I don’t think the left nipple healed properly though. It’s been a year since my younger son was weaned but the skin on my left nipple immediate above where the fissure was still feels moist and looks “shiny” and a little “raw”. In fact, for upto 6 months after I weaned my son, the left nipple would still get ichy if it got wet (e.g. after shower). Now it does not itch anymore but the skin does not look like it has completely healed. I wonder if I had/have an infection since my sons did have oral thrush while they were breastfed. Now I have baby #3 on its way and I worry about nipple injuries when I breastfeed again. Did your nipple fissure heal completely and how long did it take?

    • Elizabeth Jay Says:

      Hi Joanna,

      Sorry to hear you have suffered as well! My nipples healed after about 8 weeks, but I still have scars (and it looks like they are there to stay). Scar tissue can be quite itchy as it heals so that in itself would not necessarily indicate an infection, but it doesn’t rule it out either. Fungal infections like thrush tend to go when you stop breastfeeding, but if you feel the skin has not healed properly (especially given that you will be nursing again soon) I would consult a physician or midwife/breastfeeding counsellor if you have the opportunity, and mention your concern about the impact that your sons’ oral thrush may have had. One thing to keep in mind is that the position and attachment of your baby can make quite a difference, so it may be worth trying out different positions (such as those used in biological nurturing) to see if they make life any easier. Good luck with your new baby – I would really like to hear how you get on.

      • Joanna Says:

        Hi Elizabeth,

        I had my baby #3 ten days ago. I was delighted to have a healthy little girl but my worst fear about breastfeeding came true. I developed fissures again on the outer side of both nipples. The pain was so bad that I would have an anxiety attack every time when I heard my baby cry.

        Did you try using nipple shields? Did they help? I just came across some articles on the web that suggest keeping the baby off the breasts to let the fissures heal. If nothing else will work, I may have to try this as a last resort. I hate pumping (which is also uncomfortable to say the least) and I worry about what the nursing break will do to my milk supply. Despite the fissure nightmares, I still hope to nurse my baby for one year if possible.

        You mentioned different positions used in “biological nurturing”. What does that mean? (Please excuse my ignorance but I have not heard about the term “biological nurturing” before).

      • Elizabeth Jay Says:

        Hi Joanna,

        I’m really sorry to hear about your breastfeeding problems. I didn’t get on with nipple shields, but a lot of other mothers find them very useful – have a look at nipple shields – always a bad thing? and nipple shields and milk yields.

        I’m not a biological nurturing expert (I didn’t really use it with C, although I’m definitely going to try it if I have another baby), but as far as I’m aware it’s about reclining, putting your baby on your tummy, and letting your baby’s reflexes, coupled with gravity, do most of the work. You can see a demonstration of it on the Biological Nurturing website.

      • Elizabeth Jay Says:

        I guess I should also mention that for a short while I pumped on one side, and carried on feeding on the slightly less painful side as normal. Interestingly, my nipples seemed to heal at the same rate, so I’m not sure the ‘resting’ made any difference to the fissures!

    • Sue Says:

      Hi Joanna, I know its been many years since you shared this, but I have a very similar problem. My fissures do seem closed but have a clear line where they were once open, and sometimes seem moist like you described. And every time after foreplay (sucking etc) they get itchy and open up again, sometimes with discharge 😦

      Did your problem ever go away completely ?

      Thanks in advance.

  3. Tina G Says:

    Ladies, your postings have me in tears. No one I know has been through this. They had discomfort but I have literally been in tears. I too feel anxiety when my daugheter wants to nurse. I had never heard of nipple fissures until I began searching to figure out what the heck is wrong with me. We are being treated for thrush and I hope that helps with the healing. I’m going to try nursing on the less painful side and pumping the other as Elizabeth did. Wish me luck!

  4. Shellsea Says:

    Hi Elizabeth,
    I just came across this site after looking into fissures. I didn’t know what they were until a lactation consultant told me that is what I have. I would like to continue nursing, my baby is 3 weeks old. But, I have deep fissures on both nipples on both sides.

    What did you do? Did they ever go away while you were feeding? You mentioned 8 weeks of healing time, but was this after you weaned. I want to know if things will get better for me or if I just have to keep living in pain for the next year.

    • Elizabeth Jay Says:

      Hi Shellsea,

      How horrible for you – I know just how you feel! I continued nursing C throughout the healing process. It probably would have been quicker if I had weaned, but fortunately my nipples (eventually) recovered by themselves, and I went on to breastfeed fissure-free for another 18 months. I found that spending a week pumping a few times a day on the worst side helped, but this was mainly because I found it less painful (I don’t know if it actually aided healing). I also tried to vary the position quite a bit. Have you tried biological nurturing? I didn’t do this with C, but have heard good things about it from other mothers, and will definitely be trying it when my second child is born in a few months!

      • Shellsea Says:

        Update:

        My baby is now almost 4 months old. everything healed eventually, i don’t even remember when! My LC advised me to pump for 48 hours and take a break from nursing. As I tried to get back into nursing it was really painful so my 48 hours turned into one week. I only nursed once a day slowly though I was nursing around the clock again. We are still going strong and I feel much better.

      • Elizabeth Jay Says:

        That’s great news – thanks for the update!

  5. jolene Says:

    Nursing my 3 week old 2nd baby and now I know I have a fissured nipples. Never heard of this before and had no problems nursing my 1st baby till 14 months, so this is very frustrating and discouraging. So very painful that I want to cry every time I feed…I need some encouragement that things will get better!!

    • Elizabeth Jay Says:

      I’m really sorry to hear about the trouble you’re having – it’s such a painful thing to have to go through! A friend of mine had no trouble feeding her first two, but developed fissures with the third. She still has no idea why. Things will improve with time. I hope that it doesn’t take too long to turn the corner!

  6. Corrie Says:

    I developed fissures on both nipples with my daughter, who is moderately tongue-tied, during the first 2 weeks of breastfeeding. I was determined to keep breastfeeding but I was in excruciating pain and would often cry during latch-on and sometimes even have to bite down on something so I wouldn’t scream. What made them heal was being topless 24 hours a day (or at least as much as was humanly possible). By keeping fabric or breastpads off of my nipples they stayed erect and were able to heal (the constant flattening while wearing a bra and then protruding of the nipples during feeding was making it impossible for the fissures to heal and the moisture from breastpads was making it even worse) within about 10 days. I also started nursing her in the opposite position than the one I was using when the fissures developed (football hold instead of cross-cradle) so that her mouth was not rubbing the wound at all. Finally I used expressed breastmilk and lansinoh in between feedings so that scabs wouldn’t develop. It was a huge undertaking to heal them completely but my daughter is now 5 1/2 months old and still exclusively breastfed 🙂 Once I was healed up and she got a bit bigger and better at nursing everything has been wonderful. Hang in there!

  7. Tlewis Says:

    Someone please help! I have not been breastfeeding our son for over a year and my nipples are NOT healed! It was devestating when I only BF for 2 weeks, pumped for 1.5 months and then had doctors telling me to quit after trying two rounds of expensive meds and 2 different nipple ointments. I am expecting #2 now and desperately want them to be healed so our next baby can have the best chance of being breastfed. I have seen 5 seperate doctors and had one ultrasound. I have not gotten any answers with what to do. Baby #2 is due in 5.5 months and I want this time to be so much better!

  8. JB Says:

    I had a beautiful baby about a month ago. After the delivery I learned, by the midwife that she was tongue tied. I tried and tried for hours to get her to nurse. This went on for about four or five days. After having no success I started pumping. During this time I developed deep fissure wounds on both breasts. Very painful. Since this initial attempt at nursing the baby had a simple procedure done that would allow her to latch on. I was all set and ready to go again. Well for the last week and 1/2 I have been nursing and she latches on so well. The pain though sends me through the roof. I didn’t know I had the fissures until a week and 1/2 into my second attempt at nursing. The baby has developed Thrush, which makes nursing so much more painful. Right now I am just pumping and hoping these open sores heal quickly. If you are having difficulties nursing…I feel for you! If you have sores, and have experiences pain from Thrush as well…all at the same time I really feel for you!

  9. Lins Says:

    I’ve had fissures on both nipples for about 3 weeks. My lactation consultant suggested coconut oil and my dr. suggested pumping for most feedings for a few days and going topless as much as possible. The coconut oil has been amazing. I only pumped for a day, but it seemed to be enough, in combination with the coconut oil, to give my nipples a break. In just two days I went from cracked & bleeding and sobbing over every feeding to healing and very little pain. Fingers crossed that they keep healing!

  10. Pete Says:

    We had a similar sort of experience. My wife experienced severe pain for 6-7 weeks of breastfeeding. We had all sorts of advice, but really the latch seemed exactly right, and the baby was putting on weight fine (which was all most of the midwives seemed to care about). And it didn’t seem to be thrush, or mastisis, or anything else obvious. My wife is pale-skinned, so we did wonder whether she just had sensitive nipples. This led us to think the pain would ease in time, which is why we were able to continue for 6-7 weeks. But by then nobody had given us any real suggestions or solutions, except ‘hang in there’, and the pain never eased. I can fully understand one of the above comments concerning an ‘anxiety attack’ every time the baby cried, and having to bite down on something to stop yourself screaming. I saw this indirectly, of course, but trust me it’s no fun being the man in that situation either. So what we had expected to be a magical time was a time of extreme sleep deprivation (bad enough), combined with terrible breastfeeding pain for about 1 hour in 3, 24 hours a day. At 7 weeks we were doing combined feeding – expressed breast milk with formula – and that was instantly much better. We could actually enjoy our baby for the first time then. Of course, it’s easy for someone to say that you should carry on breastfeeding for the sake of the baby, however painful. But when you’re right there in the middle of the pain, week after week, you can’t help wondering just how much difference the breastfeeding is making to the baby’s general health and well-being, long term. He is now 2, and is a happy, healthy little man.

    Another possibility here: perhaps my wife had blocked ducts? When she expressed milk, the milk came out in a small dribble, as opposed to some of our friends where the milk spurted out much more freely. For anyone in a similar position I would recommend hiring/buying an electric breast pump, just to see how freely the milk is leaving the nipple. This could give a clue as to what is happening. (Perhaps this is also why breastfeeds often lasted a whole hour.)


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