What Is Nipple Fissure?

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So, I recalled when I had my first child (of course I still have one), and it bounced on me that sucking is inevitable. For the first 24 hours after birth, my cute baby was not able to consume breast milk. This was because my breast had delayed releasing milk so he had to struggle with it until it started gushing well. That still seemed like an interesting experience until an unforgettable one overshadowed it. scare-full breast, immensely painful, so hot and in the middle of the stream either to continue breastfeeding or to quit. This is virtually what almost all new nursing mothers have to experience. It is called nipple fissure and this condition has uncommonly been regarded as the first hot, painful cessation of breastfeeding experience before baby teething.

In many tribes in Africa, Nigeria especially, it is a normal belief that the saliva of the baby will do the wondrous cure by sucking it himself. However, in my opinion, I believe the elders only employ this means to quench the fear of the unknown and the discontinuation of breastfeeding for the new mother, in particular. What then are the signs, symptoms, treatment, prevention and management of nipple fissures? Read on!

According to Oliveira and others, breastfeeding is the most crucial, harmless, nutritious and cost-effective means to feed a baby.1 In fact, breastfeeding is naturally free and comes with no external cost, as we know. It also bonds the baby the most to the mother. Breastfeeding is not only beneficial to the baby but also confers some protective measures against ovarian, breast and hemorrhagic cancer, diabetes and hypertension in the mother.1,2  However, nipple fissure or damage is one of the most reported causes of upfront weaning of babies.1,2 This is, of course, a result of the pain and discomfort that breastfeeding poses to mothers.2 Approximately 80 to 90% of women of breastfeeding age, experience nipple fissures in their lifetime. Therefore, such is a profound experience within the women's flocks. Sit a woman down today and hear more about her breastfeeding experience and you will empathise with her.

Signs and symptoms of nipple fissure

Signs and symptoms of nipple fissure may include but are not limited to the following:2

  1. Redness and swelling of the skin around the nipple/s
  2. The nipple/s has different spots of raised, discoloured area
  3. The nipple/s suddenly turn very pale
  4. Breaking or flaking skin that could be referred to as plaques
  5. A yellowish substance of hard crust or exudate embedded within the nipple/s

Causes of nipple fissure

The following are some reported causes of nipple fissure: 3,4

  1. Improper positioning of the baby when latching is  the most common cause
  2. Improper or incorrect breastfeeding
  3. Variation of the nipple with regard, to flatness, inversion or retraction
  4. Blockage of the nipple duct
  5. Biting of the nipple by the baby with their teeth or gums as a means of exploring if the mother will react or not is another common cause 

Other causes include:

  • Inappropriate use of the breast pump to express milk to preserve it
  • Strong latching or strong sucking by the baby
  • Weak sucking or latching 
  • Engorgement of the breast which causes the nipple to flatten up preventing proper latching
  • Non-exposure of the nipple to light or air, this could be the result of the intermittent use of a breast pad or protector.
  • New pregnancy, menstruation and even ovulation are other triggers of hormonal sensitivity
  • On rare occasions, nipple fissures could arise following infections caused by Staphylococcus aureus and Candida albicans 
  • Excessive washing of the nipple with soap could also lead to nipple pain or damage

When this problem is not treated, different kinds of ailments set in, such as:4

General breast fissures, bleeding in different parts of the nipple, and intensive and sharp pain, coupled with inadequate secretion of breast milk ultimately result in distress and discomfort for both mother and baby. This ultimately results in breastfeeding cessation in many cases. Therefore, prompt treatment is encouraged when nipple fissure occurs before it exacerbates.

Treatment of nipple fissure

Copious treatments have been studied, both traditional and conventional, to offer solutions to nipple fissures. Some of which will be discussed below.

Shahrahmani and other investigators reported significant alleviation of nipple fissure pain among the two groups in treatment and placebo (breast milk) after 7 days. Briefly, they grouped the women into two based on the clinical report of nipple fissure. The treatment group was given a lotion made from jujube (Ziziphus jujube) and the other group applied 5 drops of their expressed breastmilk to the areola area. After the 7th day and 14th days, they recorded a significant reduction in pain in the treatment group.5

In addition, Tafazoli and others observed that aloe vera had a significantly greater pain-relieving effect than lanolin after the 7th day of treatment. Therefore, it was concluded that aloe vera is more effective in healing nipple fissure than lanolin ointment.

Other natural plants that have been successfully used in treating and relieving nipple fissure pain include, but are not limited to the following:

  1. Marigold (Calendula officinalis)
  2. Mint gel (Mentha spicata)
  3. Guaiazulene ointment

Management and preventive measures of nipple fissure

Here is a list of actions that can be taken to prevent and manage nipple fissure:3,7

  1. Massaging the breast first when engorged to soften will allow the baby to grab well and latch satisfactorily
  2. It is best practice to offer/use the breast that’s not too painful first
  3. If engorgement is chronic, it is better treated by visiting the physicians
  4. Warm massage or compress of the breast for at least 5 minutes after breastfeeding for pain relief
  5. Proper positioning of the baby by being very close, skin to skin, with the mother, while the baby is directly opposite the breast, enhances good grabbing of the breast and a better latch experience.
  6. The mother should make sure that the baby opens their mouth widely to gape the breast to have enough breast tissue in their mouth and avoid fissures
  7. Usage of natural or prescribed antibiotics in case of infections
  8. It is a common practice to apply expressed breast milk to relieve the pain and heal the nipple fissure
  9. When soreness sets in, it is recommended for the nursing mother to express the affected nipple’s breast to render relief and rest
  10. Appropriate use of a breast pump to fit in perfectly with the size of the breastfeeding mom’s nipple/s
  11. Adequate expression of breastmilk is encouraged to avoid recurring engorgement and hence, flattened nipple/s
  12. Expressed milk can then be given to the baby with a sterile spoon
  13. Using a cotton bra is always encouraged, and it should fit the exact size of the breast, not too tight nor too loose
  14. It is recommended to avoid hot showers or baths and soap on the nipples
  15. Good personal hygiene practices are prescribed: nipples must always be kept aerated and dry, bras must be changed daily and washed in hot water to kill any disease-causing organisms (pathogens) that could cause infections
  16. New and/or nursing mothers should be enlightened on proper positioning of their babies and proper latching
  17. And most importantly, breastfeeding moms should be supported all around by spouses/partners and family members. Should any of them have had a bad experience, they should curb the recurrence of such with the new mothers, as they say, “experience is a good teacher”

References

  1. Oliveira FS, Vieira F, Cecilio JO, Guimarães JV, Campbell SH. The effectiveness on health education to prevent nipple trauma from breastfeeding: A systematic review. Vol. 20, Revista Brasileira de Saude Materno Infantil. Instituto Materno Infantil Professor Fernando Figueira; 2020. p. 333–45.
  2. Koberling A, Kopcik K, Koper J, Bichalska-Lach M, Rudzki M. Nipple trauma in lactation - literature review. Journal of Pre-Clinical and Clinical Research. 2023 Aug 8;
  3. Local Operating Procedure-Clinical. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007366.pub2/full
  4. Niazi A, Rahimi VB, Soheili-Far S, Askari N, Rahmanian-Devin P, Sanei-Far Z, et al. A systematic review on prevention and treatment of nipple pain and fissure: Are they curable? J Pharmacopuncture. 2018;21(3):139–50.
  5. Shahrahmani N, Amir S, Akbari A, Mojab F, Mirzai M, Shahrahmani H. The Effect of Zizyphus Jujube Fruit Lotion on Breast Fissure in Breastfeeding Women. Shaheed Beheshti University of Medical Sciences and Health Services Iranian Journal of Pharmaceutical Research. 2018.
  6. Tafazoli M, Saeedi R, Gholami robatsangi M, Mazloom R. Aloevera gel Vs. lanolin ointment in the treatment of nipple sore: a randomized clinical trial. Tehran University Medical Journal. 2010;67(10):699–704.
  7. Lv X, Feng R, Zhai J. A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: Protocol for a randomised, double-blind, controlled trial. BMJ Open. 2019 Mar 1;9(3).

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Morufat Oluwatosin Olaitan

Masters of Science – M.Sc. Microbiology (Environmental), University of Ibadan, Ibadan, Nigeria

Morufat is a Research-oriented Scientist; sulphite and inquisitive Microbiologist; an Antimicrobial Resistance enthusiast and One Health Advocate. Morufat has interned with different Public Health Organizations affiliated with Nigeria, South Africa and Australia. She is an academically certified Scientific Writer with Honours at Stanford University. She completed her Masters of Science degree with a Ph.D. Grade. She’s a First-Class Graduate of Microbiology. She has some publications to her name and serves as a Reviewer to International Research Journal of Public and Environmental Health, and Open journals Nigeria. Morufat currently lectures at the Nile University of Nigeria, located in the heart of Nigeria’s capital, Abuja.

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