Breastfeeding and thrush: it’s complicated

woman-doing-mathI sometimes feel as if I’ve experienced pretty much every breastfeeding problem going: sore/bleeding/fissured nipples; mastitis (although fortunately only the early stages); not enough milk; too much milk; and a very temperamental let-down reflex. One of the only things I haven’t suffered from is thrush – a fungal or yeast (candida) infection that allegedly causes excruciating nipple and breast pain. I use the word ‘allegedly’ simply because it is not always easy to determine whether the symptoms associated with thrush are definitely caused by a fungal infection, or whether they are in fact down to something else. I am not a thrush doubter – I think there is sufficient evidence to justify taking it very seriously, as does the NHS. Many health professionals who do not specialize in breastfeeding are yet to be convinced, however, as the Mumsnet discussions below testify:

(These are just a drop in the ocean – you will find all manner of breastfeeding ignorance from health professionals on these noticeboards. The GP who suggested a mother might pass mastitis on to her baby deserves a special mention.)

It isn’t just those outside the field who disagree about thrush: within the scientific literature there are conflicting results and opinions, as well as holes in clinical knowledge because the relevant research simply hasn’t been conducted. I’m currently wading through the published work in this area, and am finding it’s actually quite difficult to get to the bottom of the relationship between yeast infections and breastfeeding problems. As it’s important to try to make sense of it though, I’ll be writing several posts on it over the next few weeks, starting with one that attempts to address the controversy that still surrounds the diagnosis.

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13 Responses to “Breastfeeding and thrush: it’s complicated”

  1. Breastfeeding and thrush: the difficulty getting a diagnosis « The Truth About Breastfeeding Says:

    […] Breastfeeding and thrush: the difficulty getting a diagnosis August 6, 2009 — Elizabeth Jay Although many lactation specialists agree that breasts are susceptible to thrush (the candida fungus) when a woman is nursing, others feel that the yeast infection is ‘overdiagnosed and overtreated1.’ A quick perusal of the Mumsnet discussion forum shows that some health professionals are prepared to go a step further, and deny it is a problem at all (see breastfeeding and thrush: it’s complicated). […]

  2. Breastfeeding and thrush: what are the treatment options? « The Truth About Breastfeeding Says:

    […] always straightforward, particularly if you are unlucky enough to have an unsympathetic doctor (see breastfeeding and thrush: it’s complicated). Health professionals who are reluctant to diagnose thrush, are naturally hesitant to prescribe […]

  3. Mónica Pina Says:

    I am a lactation consultant and a doctor and i have doubts that intruductal thrush exists…
    There is no really good investigation done, it is all clinical, and no double blind study proving to me that treating with fluconazol really helps.
    Until now i never had to treat a mother with fluconazol. Topical treatment was enough.
    Besides, “Candida albicans” grows in acidic environment, and milk is not an acidic environment. Ducts are places that are subjected to a constant flux of milk, why should Candida grow there? It is the same as the urethra versus th vagina. Different pH, frequent flux of urine, hardly ever urethral thrush.
    So, this time, maybe the GP that doens’t believe in ductal thrush is not so wrong after all…

    • Elizabeth Jay Says:

      Thanks for your comments Monica – it’s great to hear from a professional who works directly in this area. I accept that intra-ductal thrush may not exist (presumably milk containing spores can be infected by thrush on the surface of the breast), but I’m really interested to know what might cause the ‘deep’ pain associated with thrush. Bacterial infection is one possibility, but would it be possible for pain from nerve endings in infected skin to cause this level of discomfort? If you or anyone else has an opinion on this I would be really interested to know.

  4. Mónica Pina Says:

    hi.
    well, i can give you an opinion, but it is just that: an opinion. it is based in my reasoning, thinking of what i know of pathophysiology and so on.
    1st: bacterial infection of the skin doesn’t look like candida. baterial infections have pus, crusts, of are deep like cellulitis, and give extreme pain. not very common complaints in breastfeeding women. so i don’t believe red flaky skin in the nipple and areola are due to bacteria. besides, human milk has anti-bacterial and anti-inflammatory properties.
    2nd nipple and areola are very sensitive areas. deep pain is most probably irradiating pain from the nipple and areola.
    what we all lack if information and support. a good latch would prevent most of these problems.
    besides, many times, after a candida infection and other nipple problems like cracks, there is inflammation that remains and causes pain. a topical corticosteroid often does the trick. it is amazing how the mothers feel the relive of all pain… latch has to be ok for that to work, otherwise traumatic pressure persists.
    these are my thoughts, but again, i could be wrong… my practice is only a small quantity of women and i don’t study them in a scientific way, i just have some perceptions…
    what i think it is important is to question our certainties all the time. and try to find a reasoning in our thoughts. this is science, not religion…

  5. Tarra Says:

    I am glad this is being addresssed by some LC’s and medical professionals. I had ductal thrush (I truely truely believe I did as it ONLY got better on diflucan) and I’ve heard of lots of momma’s that nurse for months, if not years w/out any issues (thus no latch issues) and then they or their loved ones go on antibiotics and BAHM! Thrush pain after the treatment. … pain that is improved by antifungals

  6. Mónica Pina Says:

    hi tarra
    about ductal candida, the issue in your answer is that you base yourself in your own experience. and that is not statistically significant.

    i’m not saying you are wrong. but i don’t think one can say also that you are definitely right. science is science.
    your observation is important, but a prospective study with enough people should be done to be able to say that fluconazol helps in your type of situation.
    also, biopsies of the ducts are needed to prove the exitence of a candida infection inside the ducts.
    there are none of these studies, so far.

    but you are right, antibiotics promote the grow of fungus. and that’s why i use them so seldom…

    what i believe is that topical tretament is usually enough.

    i hope you had a nice breatfeeding story after that, having pain during breastfeeding is very very disturbing!

  7. Tarra Says:

    Yes, I know I am only one but I have read and talked to many many mom’s w/ similar experiences, so when and if a proper trial comes a long …. there is momma’s out there to fill the spots. Hopefully it could be with momma’s that aren’t just new momma’s so the possible latch issues would not convolute the findings.
    If its not thrush then let’s figure this out (who will fund such a trial, I have no idea) I do wonder about the possible nerve involvement. The pains were so deep for much of my infection…thru to the back that I cannot imagine anything topical could have helped. I could very easily deal with the surface soreness but literally I could barely walk, take a shower or hold my baby.
    I did go on to nurse 2 yrs w/ my first and am near a year w/ my second so far…so yes, there is a good story but the memory of that horrible time makes me want to help everyone in the world that deals with this.

  8. Mónica Pina Says:

    one of the possible causes for the pain is irradiation. such a sensitive area as the nipple, if inflammed, can cause really strong pain, that can irradiate to you back, as you describe.

    sometimes i wonder if the inflammation remains longer then the infection. you know viral throat pain? it can go on and on long after the infection is gone.

    that is maybe why corticoisteroids can help…

    but no certainties here.

    • thewholesomelife Says:

      i am currently dealing with nipple thrush on one side. It’s only superficial, no deep pain, but it’s very sensitive. I’ve tried apple cider vinegar washes, dr jack newman’s apno cream, nystatin, genetian violet, coconut oil and now tea tree oil. I get some relief, but it’s not going away. My last doctor suggested I stop everything as my problem may be irritation at this point. After following that advice however my baby who showed signs in his mouth and who I treated successfully with oral nystatin and vinegar washes started showing stronger signs again (white coating on tongue). I’m at a loss at this point. No one seems to know anything. I’m back for the oral nystatin for the baby and everything else for me. I nursed my first for 3 years and don’t want to cut it short this time, but the sensitivity is uncomfortable and I’m worried that it’s not good for the baby to be constantly exposed to yeast from me. As they say babies are learning to differentiate between good and bad gut flora, I don’t want to be “teaching” him that yeast is good! Any advice to help get through this would be welcomed! Thank you for touching on this understudied and incredibly important subject for breastfeeding mothers!

  9. thewholesomelife Says:

    i am currently dealing with nipple thrush on one side. It’s only superficial, no deep pain, but it’s very sensitive. I’ve tried apple cider vinegar washes, dr jack newman’s apno cream, nystatin, genetian violet, coconut oil and now tea tree oil. I get some relief, but it’s not going away. My last doctor suggested I stop everything as my problem may be irritation at this point. After following that advice however my baby who showed signs in his mouth and who I treated successfully with oral nystatin and vinegar washes started showing stronger signs again (white coating on tongue). I’m at a loss at this point. No one seems to know anything. I’m back for the oral nystatin for the baby and everything else for me. I nursed my first for 3 years and don’t want to cut it short this time, but the sensitivity is uncomfortable and I’m worried that it’s not good for the baby to be constantly exposed to yeast from me. As they say babies are learning to differentiate between good and bad gut flora, I don’t want to be “teaching” him that yeast is good! Any advice to help get through this would be welcomed! Thank you for touching on this understudied and incredibly important subject for breastfeeding mothers!

    • Julie Hampton Says:

      My nursling and I have been passing thrush back and forth for almost 3 months now. Her and I have both had 2 diflucan treatments and she’s had 2 Nystatin treatments with no luck. I know I have thush myself bc I have a white bump on one nipple.
      The pain was greatest when she was using a poor latch likely because of the discomfort in her own mouth. Another time was when the milk duct became clogged, possibly bc the thrush bump was clogging it. (talk about “deep breast pain”!)
      What I’m suggesting is, could they be experiencing clogged milk ducts bc of the thrush? Does the child have an improper latch that the mother cannot detect?


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