Plugged Ducts, Clogged Ducts, a Blocked Duct, and Mastitis - Legacy Physical Therapy
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Plugged Ducts, Clogged Ducts, a Blocked Duct, and Mastitis


If you have ever breastfed or are currently breastfeeding, you have probably heard about these and are familiar with them however you may not know the difference between them.

How do you know if you have a plugged duct or mastitis?

A plugged duct/ clogged duct/blocked duct, generally comes on suddenly:

  • It’s firm, tender, and painful along anywhere in the breast area
  • The lump may be warm or red to the touch.

This occurs because milk has become clogged in the duct and it’s causing swelling and discomfort. Sometimes it can become infected. When that’s the case, then this plugged duct has turned into Mastitis.

Signs of Mastitis are pretty much the same as that for a clogged duct, but there is usually the addition of fever and a general feeling of unwell and malaise, it’s often described as having “flu-like symptoms”

The most important thing when treating a plugged duct or mastitis is to start with treating the underlying cause and clearing the blockage itself.

Some common causative factors for plugged ducts include:

  • Wearing really tightly binding clothing such as a bra that doesn’t fit well. If you’re wearing a really tight or ill fitting bra, you want to loosen up the bra or switch to a new one with a better fit.
  • You may not be draining the breast completely when you are breastfeeding. Breast compression or massage may help the baby completely empty the breast while you’re feeding. This can also occur if you have an oversupply of milk which makes it difficult to fully drain the breast. If you are suspecting that you’re having trouble fully draining the breast, it is really important to figure out why and what are some changes that you can do. In this situation, a lactation consultant is a wonderful person to partner with to help with this.

Unfortunately, there is sometimes no particular reason for a plugged duct. They can leave you feeling a little defeated.

If you do have a blockage that comes on, there’s definitely some things that you can do to help clear it on your own. The majority of the time, a clogged duct will clear on its own within the first 24 to 48 hours.

Here’s some things that you can do to help clear that blockage for both mastitis and plugged duct:

  1. Nurse from the affected side first – babies tend to nurse more vigorously on the first side they start on. Nursing helps pull the plug forward and can completely clear the blockage through the nipple. You can also position your baby’s chin to help clear the blockage. If the blockage is on the outside area of the breast, point the baby’s chin back there, try holding the baby in a football hold to make sure the chin is pointed towards the area where the blockage is.
  2. Try to dangle feed, this is when you nurse the baby while he/she is laying on their back and you’re positioned on your hands and knees over the top of them. This allows gravity to help draw the plug through and out.
  3. Use a warm compress to help loosen up the plug prior to breastfeeding or pumping. Either use a warm, damp washcloth or make a rice pillow. To make a rice pillow, put dry rice into an athletic sock, knot it and place it in the microwave for 60 seconds and then lay it on the breast.
  4. Massaging the area before & during breastfeeding or pumping can help loosen up the clog. It can be a little painful, but it can be very effective. Always massage towards the nipples. You can also try massaging with vibration. Try using the blunt end of a vibrating toothbrush.

If you are on antibiotics or its been past 24 hours and things haven’t resolved or plugged ducts are repeatedly recurring every 1-2 weeks then another treatment to consider would be therapeutic ultrasound.

This would be something that only a physical therapist that is trained in using the ultrasound modality for treating plugged ducts would be able to perform. Ultrasound works by pulsing the tissue at the molecular level and being able to create a deep vibration that will help break up the blockage.

Here at legacy physical therapy we see a lot of good results typically within the first 1-3 treatments, where women have come in with blockages that have persisted past the 24-48 hour mark. If you’ve tried all the tricks that we’ve talked about above, and it’s still not resolving you may be an appropriate candidate for therapeutic ultrasound. If this sounds like you, you can give our office a call and see if its a good option for you. You can also contact your OBGYN or midwife, and talk to your lactation consultant to see if therapeutic ultrasound is a good option for you.

Another thing to consider, would be supplementing your breastfeeding with a good quality pump to try to really clear your breasts and empty your breasts at least once a day. Something we also recommend to our patients that have repeated clogs and blockages is taking lecithin. This can be found in health stores, it breaks down fat and clear blockage by making the milk thinner and allows things to come through quicker. Some moms take this on a regular basis if they are susceptible to clogged ducts or some take it on an as needed basis.

If you are dealing with a plugged duct, and think therapeutic ultrasound is a good option, feel free to reach out to our clinic and talk with a therapist.