Nipple pain is pain that occurs in the breast tissue around the nipple of the breast. It can result from a simple physical cause such as surface abrasion caused by breastfeeding, or by physical activity without a bra, or wearing a poorly fitted bra. These activities produce rubbing on the skin of the breast, which leads to nipple soreness and sharp pain in one or both nipples.

Nipple pain can also result from pathological causes such as mastitis (infection of the ducts of the breast) and breast abscess.

Paget’s disease is another rare cause of localized nipple pain. It is a malignant condition that causes inflammation of the nipple.

The normal hormonal changes during a woman’s menstrual cycle can also cause nipple and breast pain and soreness during the days just before her period. The rise in estrogen and progesterone levels is responsible for this pain. The breasts swell due to more liquid being formed during this time.

Pain due to physical causes clears up in a few days while that due to pathological causes needs medical intervention.

Symptoms associated with nipple pain

Nipple pain may be accompanied by other symptoms affecting the nipple and breast, which will vary depending on the underlying cause.  Such symptoms include:

  • Bleeding from the nipple
  • Lump in the breast
  • Breast tenderness
  • Changes  in the skin of the breast, such as dimpling or puckering
  • Change in the size, shape, or appearance of the breast
  • Hardening of a part of the breast
  • Discharge from the nipple
  • Rash or sore on the breast or nipple
  • Cracking or itching of the breast
  • Redness or swelling of the nipple
  • Retracted nipple

Other  generalized symptoms that can occur include:

  • Fever
  • Nausea with or without vomiting

Other symptoms that indicate a serious underlying condition include:

  • An untreated breast abscess caused by mastitis can lead to sepsis and later to multi-organ failure.

Other serious symptoms indicating sepsis include:

  • Confusion or transient loss of consciousness
  • Lethargy
  • Shortness of breath
  • Significant fall in urine output indicating kidney dysfunction

What are the causes of nipple pain?

As mentioned above, nipple pain may be due to simple soreness caused by friction or due to an underlying cause, which may or may not be serious.

It may occur even as a symptom of the menstrual cycle caused by normal hormonal changes that make the breasts and the nipples more sensitive.

Pain caused by simple reasons resolves on its own while the more serious reasons will need medical or surgical intervention.

Causes of soreness and pain of the nipple due to friction

  • Not wearing a bra, particularly during physical activity. This causes friction between the nipple and your top clothing.
  • Trauma due to rough handling
  • Wearing an ill-fitting bra

Physical causes

  • Breastfeeding
  • Drying and development of cracks in the nipple and areola
  • Hormonal changes during the menstrual cycle
  • Onset of puberty
  • Breast surgery

Disorder-related causes 

In some cases, nipple pain may be caused by a specific health condition. These include:

  • Fibromyalgia is a disorder that causes muscles and tissues of and around the breasts to become tender or sore. It can also result in nipple pain.
  • Subareolar breast abscess is a rare type of breast infection that occurs mostly in nonlactating women. The infection is caused by a blocked duct or gland inside the breast.
  • Mastitis (breast and nipple inflammation ). Sharp pain in one nipple is usually due to mastitis.
  • Nipple candidiasis or thrush is a fungal infection caused by the organism Candida albicans, which can occur in the nipples or breast tissue and can cause strong nipple and breast pain
  • Contact dermatitis or eczema of the nipple are localized lesions of the areola and/or nipple. They are often associated with breastfeeding, friction with fabrics from jogging, and other contact irritants such as soaps, detergents, or chlorine.  These lesions can occur on one or both nipples. The lesions are itchy and cause burning pain especially if breastfeeding.
  • Galactocele is a benign retention cyst caused by the blockage of a lactiferous duct and is filled with milk instead of clear fluid. It causes more discomfort than pain.
  • Galactorrhea is the spontaneous discharge of milk in a non-breastfeeding woman. It can also occur in men and children.

Serious causes 

Certain serious or life-threatening diseases can cause nipple pain. They include:

  • Breast cancer
  • Paget’s disease

Diagnostic tests to identify cause of nipple pain

Your doctor will ask you detailed questions about the timing of your painful nipple(s). He will do this to arrive at the cause of your pain. This helps greatly in treating the pain symptom.

Is it related to your periods or is an ill-fitting bra or fabric causing the pain or does it pain when you breastfeed. These simple questions will help him to identify whether the pain is due to simple physical or friction causes.

  • Examination of the breast and nipple will help to identify any local skin condition such as dermatitis or eczema or thrush.
  • An ultrasound will help to rule out breast causes such as a lump in the breast or a breast abscess.
  • A mammogram will help to rule out any breast cancer. Breast cancer can cause breast and nipple pain, discharge from the nipple, and nipple retraction.
  • If cancer is suspected, a breast biopsy is done to remove a sample tissue from the lump, which is sent to the histopathology lab for identification of the type, whether malignant or nonmalignant.

Treatment of nipple pain

Treatment of nipple pain relies on treating the cause.

  • If the pain is due to friction, switching to a better-fitting bra or shirt will help.
  • Dermatitis is treated with steroid creams and lotions that control the inflammation.
  • Take pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) are advised for pain relief
  • Hold a warm, moist compress to your breasts to soothe sore, cracked nipples.
  • Use a lanolin nipple cream for relief as well as to prevent nipple cracking
  • A breast abscess is incised and the pus drained out. It is further treated with parenteral or oral antibiotics and anti-inflammatory drugs
  • Breast cancer is treated with surgery (lumpectomy or radical mastectomy). Other options which can be a follow-up or treatment include radiotherapy, chemotherapy, hormonal therapy, and targeted therapy.

Nipple pain during pregnancy and breastfeeding

The cause of nipple pain during pregnancy is the surging hormones and a change in breast shape and size, which can make your nipples and breasts more sensitive and tender from as early as the first three or four weeks of pregnancy.

During pregnancy, one of the functions of the hormones in your body is to prepare your breasts for lactation. The milk ducts develop and are stretched as they fill with milk during early pregnancy. The nipples and areola turn dark and ache, and small raised areas may develop around the nipples. All this makes your nipples more sensitive and may cause nipple discomfort.

Some women may experience sore breasts and nipples throughout pregnancy till childbirth. For most women, however, this pain and soreness subside after the first trimester.

A warm compress is one of the best ways to ease nipple soreness both during pregnancy and breastfeeding. A well-fitting support bra will be of great help to reduce friction and soreness.

While breastfeeding, make sure your baby latches properly onto your nipple and break the suction before detaching your baby from your breast

Prevention

To prevent nipple pain due to breastfeeding

  • Feed your baby regularly or pump out the breast milk to prevent your breasts from getting engorged with milk.
  • Feed your baby on the sore side first to relieve the pressure of milk in the breast.
  • Make sure your baby latches on properly.

To prevent nipple pain due to other causes

  • Avoid caffeine, which may contribute to the development of cysts in your breasts.
  • Limit salt during your period because it can cause fluid retention in your body.
  • Exercise more often with comfortable fitting bra and clothes.
  • Ask your doctor about starting birth control pills, which can help prevent soreness.

And, of course, consult your doctor who could be either your primary care physician or your gynecologist, for further prevention advice.


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