Treating thrush over and over? Maybe it's Raynaud's.
July 10, 2012
But if you’ve been treating it with effective treatments for a while and your pain hasn’t improved, it might be time to consider whether it’s thrush after all. It might be a relatively common condition called Raynaud’s vasospasm of the nipple.
Raynaud’s is a sudden constriction of blood vessels which limits blood flow and causes color changes. It’s thought that up to 20% of women of childbearing age may experience Raynaud’s. Because the burning pain of thrush and Raynaud’s is similar, they are easily confused, and mothers are sometimes treated repeatedly for thrush when the culprit is Raynaud’s.
Typical symptoms in breastfeeding are:
- A burning pain, felt during and sometimes after the feeding, that isn’t improved by correcting the latch. This pain is similar to the burning pain experienced by mothers with thrush.
- Nipples that turn white, blue, or red (or some combination of these colors) after or in between feedings, especially when exposed to cold air.
- For some women (but not all), the symptoms start during pregnancy. And for some women, a similar reaction occurs in their hands or feet when exposed to cold.
Raynaud’s is seen more often in women who have an autoimmune diseases such as rheumatoid arthritis, and symptoms may be more common during colder times of the year.
Before you suspect that Raynaud’s may be the cause of your pain, make sure that your baby’s latch is good. A poor latch is the most common cause of pain with breastfeeding, and compression of the nipple can cause it to blanch after a feeding. To make sure that the latch is good, have a lactation consultant or another person who is very skilled at helping achieve a good latch help you get the baby on the breast well. There are many causes of breastfeeding pain (shallow latch, tongue tie, blebs), and a good breastfeeding support person will run through them with you.
The symptoms of Raynaud’s often go away on their own - by about 10 weeks postpartum, according to Dr. Jack Newman. If they don’t, there are treatments for Raynaud’s which appear to be effective. Here are some treatment options:
- Reduce exposure of the nipple to cold, as cold often triggers a painful reaction. When the nipple comes out of the baby’s mouth, use a dry warm compress - even your hand or arm, if it’s warm - to reduce the cold shock. Some mothers report an improvement in symptoms when the weather becomes warmer. See this page on kellymom.com for a good description of how to make a “rice sock” for a warm compress.
- Avoid nicotine and vasoconstrictive drugs.
- B6 and/or magnesium supplements. See Dr. Jack Newman’s handout for information on supplements and Nifedipene.
- A low dose prescription for Nifedipene, a medication considered “usually compatible with breastfeeding” by the American Academy of Pediatrics.
- It’s possible to have both Raynaud’s and thrush, so if you haven’t treated for thrush it’s worth considering as well.
If you’d like to seek help from your physician, you may want to print out studies from Pediatrics and Obstetrics and Gynecology, and the Journal of Human Lactation which discuss treatment with Nifedipene.
This information is presented for educational purposes, and should not substitute for medical advice from your health care provider.