Plugged Ducts

• Engorgement.
• Missed feedings.
• Inadequate emptying of the breast with feeding or pumping.
• Changes in the baby’s or mother’s schedule.
• Anatomical variations.
• Pressure on a duct.
• Inflammation from an injury or infection.
• Oversupply.

• Usually self-limiting. 
• May resolve with gentle massage or after feeding.
• Correct any identified predisposing factors
• Pump or hand express after feeding to assure complete emptying.
• Cold compresses between feedings to reduce inflammation.
• Vary positions from one feeding to the next.
• An anti-inflammatory analgesic medication may be suggested.
• Imaging may be indicated if plugged ducts are persistent or recurrent at the same location.
• Therapeutic breast massage.
• The use of probiotics for lactation and the use of oral lecithin have been reported to assist in some cases though further study is needed on these interventions. 
• If not resolved in 72 hours, a referral for further investigation should be considered.

Clinical Guidelines

• Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
• Mitchell, K.B., Johnson, H.M., Eglash, A., & Academy of Breastfeeding Medicine (2019). ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeeding Medicine, 14(4), 208-214. 
• Mitchell, K., Johnson, H., Rodriguez, J.,Eglash, A. (2022). ABM Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360-376.

References

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
2. Mangesi, L., & Zakarija-Grkovic, I. (2016). Treatments for breast engorgement during lactation. The Cochrane Database of Systematic Reviews, 2016(6), CD006946. 
3. Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation, 32(1), 123–131. 
4. Zhao, C., Tang, R., Wang, J., Guan, X., Zheng, J., Hu, J., Hu, G., & Song, C. (2014). Six-Step Recanalization Manual Therapy: A Novel Method for Treating Plugged Ducts in Lactating Women. Journal of Human Lactation, 30(3), 324–330.