Breastfeeding is a truly rewarding experience in the early stages of motherhood, but it is not without its challenges. New mothers frequently experience nipple fissures, which are painful cracks or sores on the nipples due to a variety of factors. The discomfort, bleeding, and infections that may result from these fissures could make breastfeeding unpleasant and unwelcome. With the right interventions and strategies nipple fissures can be treated or avoided altogether. Throughout this article, the causes of nipple fissures will be explored as well as exploring preventative methods that can be used.

What are nipple fissures?

Nipple fissures are cracks in the nipple’s skin, they are often appear red and cause breastfeedings to become painful. Breastfeeding is typically recommended from the first four months up to two years of age. Fissures commonly appear during the early stages of breastfeeding. Common symptoms include: pain during breastfeeding, cracked nipples, bleeding nipples, burning sensation and visible cuts.

Causes of nipple fissures

Firstly, the most common cause of nipple fissures is poor latching. This iswhen the baby latches onto the nipple instead of the areola causing the tissue to crack which then results in pain. 

Secondly, improper breastfeeding techniques are the amongst the common causes for nipple fissures, especially when the baby only connects slightly leading to more nipple pressure on hypersensitive nipple areas. This in turn leads to abrasion and skin breakdown, especially for people with dry or sensitive skin.

Thirdly extended or repeated nursing time, especially during the early postpartum period, could irritate the nipple further, as continuous moisture from baby’s saliva and milk, causes weakening in the skin’s natural barrier. Mechanical trauma to the nipple may also be caused by the use of breast pumps, inappropriately sized nipple shields or high suction apparatus. 

In addition, nipple fissures are prone to infections as Candida albicans especially when the cracks in the nipple fail to heal in a warm, wet environment.

Finally, infant-related anatomical issues, such as tongue-tie or a high-arched palate, can hinder proper latching and lead to nipple trauma, necessitating a need for a medical consultation.

Allergic reactions, or being exposed to irritants present in soaps, detergents or topical creams, can agitate the skin and intensify or cause fissures. Hence, nipple fissures are believed to be the consequence of a blend of mechanical, skin susceptibility, germ exposure, and irritation and necessitate a comprehensive process that helps to recognise, address and manage with the definitive cause.

Strategies to prevent nipple fissures

The following strategies will be explored : breastfeeding, positions, moisturising nipples, nipple shields and proper pumping techniques. 

In order to avoid cracks in your nipples, you need to first master the art of proper breastfeeding and maintain nipple health. And when necessary, you should seek advice. 

The first strategy is to establish a good latch. To do this make sure;

• The baby’s mouth not only takes in the nipple, but also a significant area of the areola
• The baby’s lips should be flipped outwards like a fish⁸
• If you hear clicking noises, stop breastfeeding and restart because it can be a sign of fixation failure. Adjust to different angles until you arrive at a suitable position. If you are not sure if your baby is nursing effectively or how his or her latch is, do not hesitate to ask for a lactation consultant’s help⁸

The second strategy is to ensure correct positioning. Some popular positions for breastfeeding include cradle hold, cross-cradle hold, football hold and sidelying. The cradle hold is most commonly used and is a comfortable position especially with older children.⁹ Cross-cradle is useful for mothers who are new to breastfeeding as it gives more control over the baby’s head.⁹The football hold is a great option for women who are recovering from a C section or who have larger breasts.⁹ There is also a side lying option which can be used for long night feeds.⁹Different positions can be tried to see which work best for you and the baby. 

The third strategy is to keep the nipples moisturised to promote healing and prevent more cracking. Natural options of moisturisation include dabbing a few drops of breast milk on the skin, lanolin based creams and coconut oil.¹⁰ Harsh soaps should be avoided as it can irritate both the nipple and the baby.¹⁰After feeding, nipples should air dry as dampness can also contribute to infection. Cotton based breast pads should be changed frequently.

The fourth strategy is to use nipple shields when the nipple damage is severe to allow the baby to feed and protect the skin. Nipple shields should be used under the guidance of a healthcare provider as improper use can lead to further latch issues.¹¹

Another strategy is to ensure proper pumping techniques. In order to do this the correct flange size should be picked to avoid rubbing. The pump should be on low suction to start and then gradually increase. Nipple fissures can occur from improper pumping habits so it should be avoided to pump for too long. 

What to do if fissures appear?

Fissures can appear regardless of how many strategies are implemented. Initial treatment includes visiting a doctor who may prescribe a cream or ointment. If nursing is painful, it may be advisable to pump or hand express the milk so that your baby is still fed. Hydrogel pads can also help cool and relieve the area. If none of these methods work, you should consult a healthcare professional. It may be that you also need emotional support as dealing with nipple fissures can be emotionally draining and a breastfeeding support group could aid with this. 

Summary

Sore nipples are usually one of the early problems that a mother may face when starting to breastfeed. Sore nipples can be for reasons such as nipple fissures, cracked skin to even nipple infections. These can be painful and many breastfeeding mothers with sore nipples and are desperate for quick relief. 

The most common symptom of nipple fissures or nipple infections is the pain and soreness you feel while you are breastfeeding. Reasons behind them can include when the baby's latch is poor, when the baby is tongue-tied, or when the mother has flat nipples. Many mothers think that pain and soreness is just part of breastfeeding, but that is not true. 

Nipple fissures, while painful and frustrating, are usually preventable when; you understand proper latch techniques, you take care of your nipples, and you do not wait to ask for advice about any pain you are experiencing. Finally, finding the right feeding position for you is crucial to a good breastfeeding technique and nipple health.