The yeast Candida albicans naturally occurs in the human body, but an overgrowth of it causes a nasty set of symptoms known as thrush or candidasis. Thrush, when it occurs, can be found in the vagina, mouth, around the groin, underarms and under breasts. However, this entry deals with thrush exclusively on the nipples and in the milk ducts, a condition that only occurs in lactating women.

This milk-producing area is warm, moist and sugary, which are ideal conditions for thrush to thrive. The condition can be particularly persistent because re-infection very easily occurs. A mother passes the infection onto the baby's mouth in the form of oral thrush during breastfeeding, then just as the mother's symptoms begin to subside the baby passes the infection back to the mother. And so the great cycle begins.

How Do Mothers Get it?

'Good' bacteria usually keep candida in check, but a course of antibiotics can kill the beneficial as well as the bad bacteria in your body. Antibiotics are prescribed for any number of reasons after birth: they're given to post partum mothers, for example, who've had a Caesarean section, in order to minimise the chances of getting an infection in the wound.

There are other factors which contribute to the development of thrush. Even before you've had a baby, in the later stages of pregnancy, hormonal changes alter the sugar levels in the vagina making you more susceptible to an overgrowth of the yeast. If you are one of the unlucky women who develop symptoms of vaginal thrush, your baby can acquire oral thrush on the way out in the birth canal and once breastfeeding is established, the baby can pass candidiasis from his mouth to your nipples. Thrush is also common in women who are tired and run-down (highly likely if you've just had a baby), or are anaemic (this is also common among women who have just had a baby, as women lose a lot of blood in the days and weeks after giving birth).

With thrush in all of the most sensitive areas of the body, you can end up feeling like one big fungus. Not only that, but just as you are getting used to your newborn, he seems unusually irritable as he has thrush too.

Symptoms in the Baby

The baby may show some, all, or none of the following symptoms.

• Pulling and fidgeting while feeding, latching on and off the breast frequently.
• White patches in the mouth that cannot be wiped off.
• A red-raw nappy rash.
• Being more windy than usual, and difficult to settle.

Symptoms in the Mother

Look out for the following:

• When the baby latches on you experience the sort of pain that makes your toes curl and your eyes water. This becomes progressively more acute with each subsequent re-latching, but subsides during the actual feed itself.

• Shooting, stabbing pains (much the same as the pain you get if you have sensitive teeth) can be felt in the breasts for up to two hours after each feed.

• Nipples that are very sensitive to the cold and, unless wrapped up warmly, you'll experience similar shooting, stabbing pains every time you set foot out the door.

• Water from a shower makes your nipples extremely sore and sensitive.

• Your nipples may well be itchy, you may have what look like tiny pinhead blisters and, immediately after a feed, your nipples will look bright red, shiny and/or soggy-looking.

• Cracked nipples that will not heal.

Treatment

With symptoms like these you'll be desperate to do something about it quickly. Make an appointment with your breastfeeding consultant, health visitor and/or doctor, and get those health professionals on the case. It's also important to establish whether or not you do actually have thrush. Some of the symptoms of thrush can be confused with the soreness of cracked nipples. Consider yourself 'lucky' if that's all it is.

The breastfeeding consultant or doctor will advise you to apply an antifungal cream that's safe for your baby. Once you have applied the cream for a couple of days, your symptoms should begin to subside, but be warned that you could feel worse before you get better. Meanwhile your baby should be treated for oral thrush with a liquid treatment. Wash it well around your baby's mouth and make sure it covers the gums, tongue and inside of his cheeks. It is imperative that your baby is treated, too, even if he doesn't have any symptoms, otherwise he will re-infect you at each feed.

Both of you should continue this treatment for seven days after being symptom free. If symptoms do not clear up within a few weeks, you may need to step up treatment and get your doctor to prescribe a strong antifungcide.

Some alternative health practitioners recommend applying a solution of either vinegar and water¹ or baking powder and water². Then air-dry your breasts. If you feel as if you may as well give everything a go, apply the cream, as well.

Another of the most important aspects of treatment is to make the environment as inhospitable as possible. Thrush is persistent and pervasive (spores grow back in 90 minutes). After following the advice below, you'll feel like it would simply be easier to wear a biohazard suit, but do persevere, by tackling the problem head on you will be in a better position to continue breastfeeding.

• Boil or steam sterilise for 20 minutes anything that comes into contact with your milk: all nipple shields, bottle teats, dummies, and pump parts. Boil or steam sterilise any toys that your baby puts into his mouth. Dry all of these objects thoroughly with paper towels as thrush thrives in moist and warm conditions. Store parts in the fridge.

• Replace all nipple shields, bottles teats and dummies once a week.

• Wash your hands thoroughly before and after each feed and nappy change, but avoid using antibacterial soap as this kills the good bacteria that help keep candida at bay. Use paper towels for drying your hands.

• Wash any towels, underwear, washable nursing pads, clothing and bedding at as high a temperature as possible, adding vinegar to the rinse water. Use towels and wear bras only once before washing.

• If possible, dry towels, underwear, washable nursing pads, clothing and bedding in the Sun, as ultraviolet light is thought to be another effective way of keeping the yeast in check. Tumble drying your laundry and ironing it should also help, as heat will kill the spores.

• Change nursing pads as soon as they are damp and after each feed. Avoid using plastic lined ones, as these will keep your breasts warm and moist. Throw away disposable nursing pads and boil wash reusable cotton ones.

• Do not store your milk for future use. It is safe to give your baby expressed milk, but if you store the milk in the freezer and give it to your baby after you have both recovered, then there is a chance that you could re-infect your baby, starting the cycle all over again. Freezing expressed milk will not kill the spores.

• Supplement your diet with acidophilus, a beneficial bacteria which helps to keep the yeast in balance. This can take the form of capsules, or a powder that's added to water, both of which you can find in health food shops. Acidophilus is also found in live yoghurt, widely available in supermarkets.

• In the treatment of thrush anywhere in the body, alternative health practitioners often recommend eliminating sugar and alcohol from your diet, and sometimes wheat, yeast and dairy products, as well as sugary fruits and soya (which doesn't leave much else). It may be wise to cut back on sugary foods and eat a vitamin rich diet that will boost your immune system, but a good, varied, balanced diet is absolutely essential for breastfeeding women. Not only is a good diet necessary to maintain your health while breastfeeding, but your body is still undergoing a slow recovery process, so look after yourself.

Keep Your Spirits Up

Having thrush on your nipples is a really horrible experience. Not only are the symptoms painful, but it can be very difficult to get rid of. In the weeks following your baby's birth, you'll feel very emotional anyway, but for some reason, having thrush leaves you feeling quite fed up. If you make the decision to continue to breastfeed (and there are many reasons why you should) rest assured that you and your baby will be happily breastfeeding before too long. If you do decide to give up breastfeeding (and by the nature of this type of thrush, this may seem like a very good idea) make sure that you give up gradually and get some advice from your health visitor. If you give up breastfeeding over a short period of time, you can get blocked milk ducts, which are also painful and will just add to your problems. Following all the treatment advice above will be time-consuming, so get as much help as you can from your partner, relatives or friends. Also, use the support networks available to you. Contact your local La Leche League or National Childbirth Trust groups and make friends at playgroups. You'll be guaranteed to get a lot of sympathy from everyone. It can be defeated, don't feel defeated, too.

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¹ The solution should be made from one tablespoon of vinegar to one cup of water.
² The solution should be made from one teaspoon of baking powder to one cup of water.