Engorgement-plugged ducts-mastitis-abscess

Mastitis is an inflammation of the lactating breast, which occurs in 3-20% of all lactating women. The majority of cases occurs in the first 6 weeks postpartum, but it can be observed in all lactational stadia. First cause is milk stasis – milk standing still within the breast, that can thicken, form a clot and prevent more milk from flowing, more milk building up, applying more pressure upon surrounding tissues and then to inflammation symptoms. Factors associated with milk stasis are insufficient, inadequate and irregular empting of the breast, pressure on or pinching off the ducts, fatigue, stress, and poor maternal nutritional status, inadequate suckling techniques and nipple trauma. Mastitis symptoms are pain, swelling, redness and elevated regional and body temperature. Outside of hospital settings a primary bacterial cause is rather less obvious. There seems to be a continuum from engorgement, through non-infectious and infectious mastitis to abscess. The ABM protocol follows the classic treatment path: first of all thorough breast emptying, rest, good nutrition and hydration, and warmth to make the milk flow. After feeding or milk extraction cold may be applied to ease pain and to lessen edema. Medicinal support can be applied in the form of pain medication and anti-inflammation drugs. Antibiotics only enter the picture if conservative treatment does not show progress within 12-24 hours or if the situation worsens. If plugged ducts will not resolve alternative ways to achieve this may be warm salt water baths of the breast (sea salt, medicinal bathing salt of magnesium salt) or green clay or fresh cheese (quark) compresses. The advice to stop breastfeeding may be viewed as a medical flaw in the first degree. To stop breastfeeding in these stages or to inadequately treat mastitis may lead to the formation of an abscess. Multiple recent studies show that MRSA may play a growing role in infected mastitis and breast abscesses. An abscess is a very painful complication that can make continuation of breastfeeding a real challenge. The primary treatment of mastitis is the removal of the cause, which in most cases will be any kind of obstruction in the milk-transporting system. Even better is prevention of blocked ducts and subsequent conditions. An optimal breastfeeding management that helps prevent milk stasis, plugged ducts, mastitis and abscesses is accurate treatment of engorgement, prompt attention to any signs of milk stasis, prompt attention to any breastfeeding problems, rest and good hygiene.
van Veldhuizen-Staas: Hulpmiddelen en technieken bij verstopte melkkanalen en borstontsteking. http://eurolac.net/index.php?p=132
Amir LH: ABM Clinical Protocol #4 : Mastitis. Breastfeeding Medicine,(2008) 3(3): 177-180
Amir LH, IngramJ: Health professionals' advice for breastfeeding problems: Not good enough! International Breastfeeding Journal 2008, 3:22
Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C: The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. International Breastfeeding Journal 2008, 3:6  
Montalto M, Lui B.: MRSA as a cause of postpartum breast abscess in infant and mother. J Hum Lact. 2009 Nov;25(4):448-50.
WHO: Mastitis, causes and management, WHO 2000