What Is Mastitis? What Causes Mastitis?

Mastitis is inflammation of tissue in one or both mammary glands inside the breast. Mastitis usually affects lactating women - women who are breastfeeding, producing milk. Hence, it is often referred to as lactation mastitis. The patient feels a hard, sore spot inside the breast. Mastitis can occur as a result of an infection or a blocked milk duct.

According to studies, mastitis seems to affect approximately 10% of all breastfeeding mothers. However, study results have varied significantly, some indicating only 3% while others say 33% of women are affected. Mastitis, when it does occur, tends to emerge during the first three months after giving birth - but it can occur up to two years later. In rare cases mastitis can affect women who are not lactating.

Some mothers mistakenly wean their babies when they develop mastitis. In most cases breastfeeding can continue during mastitis.

The English word "mastitis" comes from the Greek word mastos meaning "breasts", and the suffix "-itis" which comes from Modern Latin itis meaning "inflammation" ("itis" originally comes from Greek).

According to Medilexicon's medical dictionary, mastitis means "Inflammation of the breast."

Two types of mastitis

• Non-infectious mastitis - this is usually caused by breast milk staying within the breast tissue - milk stasis - because of a blocked milk duct or a breastfeeding problem. If left untreated, the milk left in the breast tissue can become infected, leading to infectious mastitis.


• Infectious mastitis - this is caused by bacterial infection. It is important to receive treatment immediately to prevent complications, such as an abscess in the breast.

What are the symptoms of mastitis?

In the vast majority of cases only one breast is affected.

The following signs or symptoms, which may develop rapidly, could be present (a symptom is something the patient feels or reports, while a sign is something other people, including the doctor identify):

• An area of the breast becomes red.
• The affected area of the breast hurts when touched.
• The affected area feels hot when touched.
• A burning sensation in the breast which may be there all the time, or only when breastfeeding.

Sometimes, the following symptoms may also be present:

• Anxiety, feeling stressed
• Chills
• Elevated body temperature
• Fatigue
• General aches and pains
• General feeling of malaise
• Shivering

What are the causes of mastitis?

• Causes of non-infectious mastitis
  
  Doctors say non-infectious mastitis is usually caused by milk stasis (milk is produced, but then remains in the breast, rather than coming out during feeding). Milk stasis may have the following causes:
  
  
  • The baby is not attaching to the breast properly during feeding.
  • The baby has difficulties suckling the milk out of the breast.
  • The baby is being breastfed infrequently.
  • Milk ducts may be blocked because of pressure on the breast caused by, for example, tight clothing.
  
  Anything which stops the milk from being properly expressed will usually result in milk stasis, which often leads to milk duct blockage.
  
  Experts believe breast tissue becomes inflamed because of cytokines - special proteins present in milk that the immune system uses and are passed on to the baby. They say that the mother's immune system mistakenly attacks these cytokines as if they were bacteria or viruses, inflaming the breast tissue in order to stop the spread of a supposed infection. However, nobody is really sure.


• Causes of infectious mastitis
  
  Bacteria do not generally thrive in fresh human milk. However, if the milk ducts are blocked and the milk stagnates the likelihood of infection grows. Experts believe that bacteria which exist on the surface of breast skin enter the breast through small cracks or breaks in the skin. They also suggest that bacteria in the baby's mouth may get into the mother's breast during a breastfeed. However, nobody is completely sure how bacteria get into the breast.


• Infectious mastitis in women who are not lactating
  
  Women who are not lactating (not producing milk, not breastfeeding) may develop infectious mastitis - this is not common. Those who do develop non-lactating infectious mastitis tend to be regular smokers in their late 20s to early 30s. Experts believe that smoking may damage the milk ducts, making them more susceptible to infection.


• Mastitis after nipple piercing
  
  Nipple piercing that is carried out by non-professional, unregistered piercing studios may raise the risk of mastitis occurring.

How is mastitis diagnosed?

Mastitis is fairly easy to diagnose. A GP (general practitioner, primary care physician) will carry out a physical examination and ask the patient questions about her symptoms.

When symptoms are severe, or if the woman does not respond to treatment, the doctor may take a small sample of breast milk for testing. Tests will usually determine whether there is a bacterial infection, as well as the type of bacteria. Identifying the type of bacteria helps the doctor select the most targeted treatment.

If the health care professional believes the mastitis is caused by a breastfeeding problem, the patient may be asked to demonstrate how she breastfeeds. It is important that the mother does not feel she is being blamed or judged. Breastfeeding sometimes requires some practice.

Inflammatory breast cancer, a rare form of breast cancer, can also have similar symptoms of redness and swelling. In some rare cases a biopsy may be taken to rule out breast cancer.

What are the treatment options for mastitis?

• Non-infectious mastitis - some self-care techniques usually resolve non-infectious mastitis. These include:
  
  
  • The mother needs to make sure she is drinking plenty of liquids.
  
  
  • The mother needs to make sure she is resting enough.
  
  
  • Symptoms of pain and/or fever can be alleviated with OTC (over the counter) acetaminophen (paracetamol, Tylenol). Some of it will pass through the breast milk, but not enough to harm the baby. Do not take Aspirin while breastfeeding.
  
  
  • Feed the baby more frequently.
  
  
  • If you cannot feed the baby more frequently, express the milk more often if the breasts feel full.
  
  
  • During a feed, start with the affected breast. This will drain it more.
  
  
  • After a feed gently express any leftover milk.
  
  
  • Ask a midwife, social worker, nurse or doctor to make sure you are positioning your baby and/or yourself properly when feeding. Also, ask them whether the baby is attaching to the breast properly.
  
  
  • Try out different feeding positions until you find one that is more effective at draining the breast fully.
  
  
  • Warming the breast before a feed can sometimes make it easier for the baby to get the milk out.
  
  
  • Some stroking techniques can help with milk flow. Ask your medical team for advice.
  
  
  • Make sure you wear very loose-fitting clothes until the mastitis has gone. When it has gone, avoid tight-fitting clothes.
  
  If you still have problems, see your doctor, nurse or midwife.


• Infectious mastitis - treatment includes an antibiotic, as well as the techniques listed above for non-infectious mastitis. The antibiotic may be passed on through the breast milk to the baby. The baby may produce runny stools and become restless. Doctors say this does not damage the baby, and the effects will disappear as soon as treatment is completed.
  
  If the mastitis does not get better you should see your doctor again.

What are the complications of mastitis?

• Recurrence - women who have had mastitis are more likely to get it again, compared to other women. In most cases recurrence is due to late or inadequate treatment.


• Abscess - if the mastitis is not treated properly there is a risk that a collection of pus (abscess) can develop in the breast. Abscesses usually require surgical draining.