What Is Nipple Thrush?

Nipple thrush is a yeast infection that is common during breastfeeding. It causes red, cracked, and itchy nipples and burning or stabbing breast pain after feeds.

Thrush on nipples often occurs alongside oral thrush in the nursing infant. Signs of oral thrush include fussiness during feeds and white spots or patches in and around the baby's mouth. Both oral and nipple thrush are treated with topical antifungal medications.

This article discusses nipple thrush. It explains what thrush on the nipples looks and feels like and how to find relief.

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How Do I Know if I Have Thrush on My Nipples?

Symptoms of nipple thrush generally appear in the first six weeks after giving birth and include:

• Bright red or pink tinge to the whole nipple
• Burning or stabbing pain deep within your breasts during or after breastfeeding
• Cracked nipples
• Dry, flaky skin on the areolas (the darker ring around your nipples)
• Difficulty breastfeeding
• Itchy nipples or areolas
• New or increasing pain related to breastfeeding
• Nipple pain or sensitivity to touch
• Shiny red or pink skin
• Yeast rash 

Nipple thrush often occurs alongside oral thrush in nursing infants. Symptoms of oral thrush include:

• Creamy white spots or patches on baby’s tongue, gums, the roof of the mouth, or insides of the cheeks that can't be wiped off
• Difficulty feeding
• Fussiness
• Possible diaper rash
  

What Causes Nipple Thrush?

Nipple thrush is caused by an overgrowth of Candida, a yeast normally present on the skin. It is most common during the first six weeks of breastfeeding but can occur in non-nursing people as well.

Nursing sets up ideal conditions for nipple thrush. Candida thrives in warm, moist environments and feeds on the sugar found in breast milk. It can pass from the mother's nipple to the child's mouth and vice versa.

Risk factors for developing thrush on your nipple include: 

• Damaged or cracked nipples 
• Gestational or pre-existing diabetes
• Excessive sweating
• Having a weak immune system
  
• Prior vaginal yeast infection, especially during delivery
• Prolonged breast pad use
• Recent use of antibiotics, birth control pills, or steroids

How Is Thrush on Nipples Diagnosed?

Nipple thrush is usually diagnosed based on symptoms of both the parent and child. It is considered a diagnosis of exclusion, meaning healthcare providers eliminate other causes before diagnosing thrush.

The pediatrician will sometimes diagnose and treat nipple thrush in the parent of a baby with oral thrush. It can also be diagnosed by a gynecologist, primary healthcare provider, or dermatologist.

Lab tests are not necessary for diagnosing thrush. However, if your symptoms are resistant to treatment, your healthcare provider may take a skin swab and breastmilk sample to rule out other types of infection or pinpoint the specific Candida strain.

Other Causes of Nipple Pain

Nipple pain and irritation can be caused by something other than thrush. Symptoms of nipple thrush may be mistaken for other types of nipple pain in breastfeeding adults.

Early Breastfeeding Discomfort

Thrush is most common during the first six weeks after childbirth. However, this is also a notoriously uncomfortable period for those new to breastfeeding.

Sore, irritated nipples and breast discomfort are common in the early days of nursing. Milk-duct contractions, commonly referred to as let down, and breast engorgement may be painful in the beginning. However, this pain should be relieved by nursing, pumping, or hand-expressing milk.

Improper Latch

Nipple and breast pain during feeding can be caused by poor positioning or an improper latch. This can also lead to blisters and sores. A lactation consultant can help ensure your baby is latched correctly and offer tips for successful feedings.

Clogged Milk Duct

Breast and nipple pain can also be caused by a clogged milk duct. A clogged duct can often be relieved by nursing or expressing milk while massaging the area.

Mastitis

A clogged milk duct can turn into an infection known as mastitis. See your healthcare provider if you experience nipple or breast pain with any of the following symptoms:

• Fever
• Pain in only one breast or nipple
• The skin on the breast is warm and red
  

Nipple Thrush Treatment

Nipple thrush can be treated with a topical antifungal medication. Common medications used to treat thrush include:

• Clotrimazole
• Miconazole
• Nystatin

Gentian violet is an antiseptic dye with antifungal properties that is also used to treat thrush.

Topical antibiotics may be prescribed if nipple thrush is accompanied by a bacterial infection. This is common in individuals with nipple fissures, which often occur alongside nipple thrush.

Topical steroids may be prescribed to treat very inflamed nipples. Combination antifungal and steroid treatments are also available. However, the American Academy of Family Physicians cautions against the use of high-potency topical steroids in people with thrush.

If topical treatments fail to relieve thrush, oral antifungal medication may be prescribed.

Preventing Yeast Infections on Nipples

Nipple thrush is uncomfortable and can be prevented with the following strategies:

• Air your nipples as much as possible.
• Avoid using breast pads with a waterproof liner and opt for breathable fabrics instead. 
• Change your breast pads often, especially if they are damp.
• Clean breast pump parts that come in contact with your skin, baby bottles, bottle nipples, and pacifiers in hot soapy water after every use. 
• Cut back on sugar in your diet.
• If you have diabetes, try to keep your blood sugar levels as close to normal range as possible.
• Try taking probiotics to restore balance to the flora and bacteria.
• Wash your hands frequently, including before and after nursing and after diaper changes.
• Wear a clean, comfortable cotton bra and wash it in hot, soapy water after each use.
• Wipe nipples with a warm washcloth after feeding to remove breast milk residue.
  

Can You Still Breastfeed With Thrush?

Breastfeeding with nipple thrush is safe for both parent and child, though it may be uncomfortable.

Thrush on nipples is associated with oral thrush in the infant. Oral thrush is a relatively common and generally mild infection and not a reason to stop breastfeeding.

That said, both the parent and baby will need to be treated for thrush. This will reduce the likelihood of the pair repeatedly passing thrush back and forth between them.

Coping With Nipple Thrush

Nipple thrush can make breastfeeding painful. Fortunately, thrush is usually quite responsive to treatment. You should start to feel relief after two or three days of starting antifungal treatment.

In the meantime, the following tips can help:

• Apply a cold or warm compress to sore nipples and breasts for 10 to 15 minutes prior to nursing.
• Check with your healthcare provider about taking over-the-counter pain relievers. Advil (ibuprofen) and Tylenol (acetaminophen) are generally safe to take while breastfeeding.
• If you are unable to tolerate the pain or nursing with thrush, try pumping or hand-expressing milk to keep up your supply and prevent engorgement.
• Make sure you complete the entire course of treatment—don't stop just because the symptoms start to improve.

If your symptoms don't improve after five days of treatment, contact your healthcare provider. Some strains of Candida are resistant to certain medications. You may need to try a different antifungal treatment.