Candida / Yeast / Thrush

If you have been diagnosed with a yeast infection, but are not getting better with the treatment given, you first need to make sure that you were given the proper diagnosis. Yeast can be overdiagnosed. This is especially true for women with one-sided nipple pain. Yeast almost always causes pain in both nipples.

Read over the symptoms below and take a look at the photographs. If your symptoms are still consistent with a yeast infection, review the detailed treatment options and consult with your medical provider.

Symptoms

• Pain on latch-on that usually improves during the feeding.
• Burning, stinging or other discomfort of the nipples and areolae between feeds.
• Sensitivity of nipples to anything that lightly brushes against them.
• Both sides are affected.
• If you have one sided pain, the cause is unlikely to be yeast. (See Pain in One Breast article)

The following symptoms are less common, but can be seen with worsening infection:

• Painful or uncomfortable letdown.
• Sharp shooting pains deep in the breast between feeds.
• Vascular spasms or Raynaud's Phenomenon: deep pain or ache associated with a blanching or purple discoloration of the nipple (see Vascular Spasm article)

Physical Findings

• Pink "ring" around the nipple, in the area where the nipple meets the areola. See Photos.
• Nipples may appear pink.
• Areolae may have lighter color that usual.
• Later infections may have dry skin, raised red skin or cracks/ slits where the nipple meets the areola.
• Baby may have white plaques on inner cheeks, upper gums between the gums and cheeks.
• Baby may have a history of oral thrush or diaper rash.
• Even if the baby has no signs of yeast, the mother may still have pain due to a yeast infection.

Risk factors

• History of vaginal or other yeast infection in the mother.
• History of antibiotic use during pregnancy or delivery.
• History of oral thrush in the baby.
• History of baby having been on antibiotics.
• History of other children with oral thrush.
• Significant leaking of milk or rubbing milk on the nipples after feeding.
• Not changing breast pads soaked with milk for long periods of time.
• History of frequent use of lanolin.
• Use of nipple shields for months.

Treatment

Both mother and baby should be treated for yeast, even if baby's mouth looks normal. Many times if the mother is treated without treating the baby, the infection will not improve or will recur.

Treatment should always include treating the baby with an antifungal (Nystatin or Diflucan/fluconazole or Daktarin) and with probiotics on the tongue in order to decrease yeast growth and prevent future overgrowth.Treat mother with a topical antifungal and probiotics on the nipples and areolae even if Diflucan/fluconazole is being used orally. Oral fluconazole without using a topical ointment for the mother may not improve superficial nipple/areolae symptoms.

Prevention

Keep nipples dry from milk. Try not to use lanolin products.

Diet, Hygiene and Frozen Milk

You do not need to cut anything out of your diet when you are treating an infection of your nipples and areolae.

You do not need to wash your clothing in vinegar or boil your bras.

Any milk you stored while you had symptoms of a yeast infection may be given to the baby at a later date. The stored milk will not cause a recurrence of the infection for either the baby or you.