Mastitis is an acute purulent infection of the mammary glands, a common condition in the puerperium and one of the causes of postpartum fever, most commonly in breastfeeding women, especially first-time mothers. It can occur at any time during breastfeeding, and the beginning of breastfeeding is the most common.
1, the stagnation of milk: the stagnation of milk is conducive to the growth and reproduction of invasive bacteria. The reasons are: ① nipple is too small or invagination, which hinders breastfeeding, pregnant women fail to correct nipple invagination in time before delivery, and babies have difficulties in sucking milk; ② too much milk, incomplete emptying, mothers do not empty the excess milk from the breast in time. ③ Milk ducts are inaccessible, inflammation of the milk ducts themselves, tumors and external compression, the fibers shed by the bra can also block the milk ducts.
2, the invasion of bacteria nipple invasion when the infant sucking difficulties, easy to cause the nipple around the break, is the main way of bacteria along the lymphatic vessels invasion caused by infection. In addition, the baby often sleeps with the nipple, and can also make the infant oral inflammation directly invade and spread to the milk ducts, and then spread to the interstitial mammary glands to cause purulent infection. Staphylococcus aureus is the common causative organism.
Three stages and their respective characteristics
1, the initial stage: at the beginning there is often nipple rupture, feel nipple tingling when breastfeeding, accompanied by milk stagnation or lumps, sometimes there may be one or two milk ducts blocked. This is followed by painful localized swelling of the breast, with or without lumps, with pressure pain, non-red or slightly red skin, and non-warm or slightly warm skin. The systemic symptoms are not obvious, or accompanied by chills and fever, chest tightness and headache, irritability and easy to lose temper, loss of appetite.
2.Pus-forming stage: The affected breast lump does not disappear or gradually increases in size, with increased local pain, or pulsating pain, or even continuous severe pain, accompanied by obvious tenderness, red skin color, burning skin, and strong fever that does not subside, thirst and drinking, nausea and anorexia, and swollen and painful axillary lymph nodes on the same side. By the 10th day or so of breast redness, swelling and heat pain, the center of the breast lump gradually becomes softer, press it should refer to a fluctuating feeling, local swelling and heat, pressure pain is obvious, puncture aspiration with pus, sometimes pus can flow from the breast orifice, systemic symptoms increased.
3.Post-rupture stage: When the acute abscess is mature, it can break out the pus by itself or be excised by surgery to drain the pus. If the pus comes out freely, the local swelling and pain will be reduced, the fever and cold symptoms will disappear, and the sore will gradually heal. If the pus does not come out smoothly after ulceration, the swelling does not subside, the pain does not decrease, and the fever does not subside, pockets of pus may form, or the pus may spread to other breast ligaments to form transcystic canker sores. There are also cases where milk overflows from the sore after ulceration, and the sore is not healed for a long time, resulting in breast leakage.
Clinical manifestations
Acute simple mastitis is characterized by swelling and pain in the breast, high local skin temperature, pressure pain, and hard nodules with unclear boundaries and tenderness.
2, acute purulent mastitis local skin redness, swelling, heat, pain, the appearance of more obvious hard nodes, tenderness more, while the patient may appear chills, high fever, headache, weakness, rapid pulse and other general symptoms of weakness. At this time, swollen lymph nodes with tenderness may appear in the axilla, and the blood leukocyte count may be elevated in laboratory tests, and sepsis may be combined in severe cases.
3, abscess formation due to ineffective treatment or further aggravation of the disease, local tissue necrosis, liquefaction, foci of infection of different sizes fuse with each other to form an abscess. The abscess may be unicompartmental or multicompartmental. Superficial abscesses are easily detected, while deeper abscesses are not easily detected because they are less volatile. If a patient with mastitis has significant systemic symptoms and local and systemic medications are not effective, attention should be paid to performing a puncture of the painful area and waiting for pus to be drawn or white blood cells to be found in the smear to clarify the diagnosis of an abscess.
Two types.
1. Acute simple mastitis. Initially, it is mainly a swelling and pain in the breast, with high local skin temperature and pressure pain, and the appearance of hard nodes with unclear boundaries and tenderness. This simple mastitis can be avoided by a few massages to avoid the pain of hanging.
2, acute purulent mastitis. The local skin is red, swollen, hot, painful, there are more obvious hard nodes, tenderness more, at the same time the patient can appear chills, high fever, headache, weakness, fast pulse and other general deficiency symptoms. At this time, there may be swollen lymph nodes in the armpit, there is tenderness, blood test leukocyte count to elevated, in serious cases can be combined with sepsis. The actual fact is that you will need to go to the hospital to get an anti-inflammatory shot, and then do the unblocking after the inflammation is gone, because the infusion can only play the role of anti-inflammatory and not unblocking the mammary glands.
Eight ways to treat mastitis.
Mastitis is a common clinical condition, especially in women who are breastfeeding. Generally speaking, if the symptoms of mastitis are not very serious, you can continue to breastfeed, but if it is serious, you should stop breastfeeding. The treatment of mastitis starts with cleaning the breasts. Eight methods combined with each other will be effective.
Pay attention to cleaning
In the early stage, pay attention to rest, suspend breast-feeding of the patient, clean the nipples and areola, promote the discharge of milk (with a breast pump or sucking), and terminate breast-feeding in all cases that require incision and drainage. This is the primary prerequisite for the treatment of mastitis.
Use of lactation return medication
Stop breastfeeding on the affected side and suck out the milk with a breast pump. Lactation-returning medication can be used as appropriate. Take oral vinyl estradiol l mg once, 3 times a day, or bromocriptine 2.5 mg once, 3 times a day.
Antibiotics
Apply antibiotics systemically. To prevent serious infection and sepsis, select antibiotics according to bacterial culture and drug sensitivity, and if necessary, administer antibiotics intravenously.
Hot compress
Local hot compress, or use fresh dandelion, silver flower leaves 60 grams each washed with a little vinegar or wine, pounded and applied externally. Use a wide cloth belt or bra to hold up the breast.
Seal
0.25% procaine 60-80 ml breast closure can reduce inflammation. Choose broad-spectrum antibiotics orally or intravenously. Penicillin 1 million units can be dissolved in 20 ml of saline and injected around the inflamed mass.
Drainage of pus
If an abscess has formed, an incision should be made to drain the abscess. The incision should be made in a radial direction to the nipple, avoiding the areola. For post-mammary abscesses or deep abscesses on the lower side of the breast, an arcuate incision can be made at the breast fold of the lower breast.
Combined with the eight methods of treating mastitis, patients should maintain a good state of mind and treat better with a two-pronged approach.
Prevention
1.Avoid milk stagnation.
2.Prevent nipple injury, and treat any injury promptly.
3.Do not give the child the habit of sleeping with the nipple.
Very mothers are always used to let their children sleep with their nipples when they breastfeed them, and this is an important cause of mastitis in breastfeeding women!
4, eat more coarse food
Eat more whole grain foods, beans and vegetables, control the reporting of animal protein, and pay attention to the supplementation of appropriate trace elements. The trace element selenium is the king of anti-cancer and can effectively inhibit cancer cells!
Treatment of mastitis when there is redness, swelling, heat and pain in the breast but abscesses have not yet formed, the following methods can be used to treat.
①Promote milk evacuation: When you feel pain, swelling or even local skin redness in the breast, breastfeed your child diligently and let your child eat as much milk as possible from the breast, and if necessary, use suction to evacuate the breast. When the inflammation worsens, the skin is edematous, hard and hot, purple-blue, and the nipples are edematous. The swollen, painful hard nodes in the armpits, so that the arms cannot lean into the trunk, are the result of excessive lactation of the parammary glands. Apply manual milking 7 to 8 times a day, emptying the milk as much as possible each time. You can use the back of an oiled wooden comb to massage gently in the direction of the nipple to unclog the mammary glands, and if necessary, ask the surgeon to help with massage, which is the most effective measure to treat early mastitis and prevent further development of inflammation.
② Local physiotherapy and hot compresses: physiotherapy or hot towels can be used for 20-30 minutes each time, 3-4 times a day, which is effective for early inflammation.
③Application of antibiotics: When the above methods are ineffective, penicillin or other antibiotics should be added promptly, either intramuscularly or intravenously by drip.
④Chinese medicine treatment: There are many folk remedies in Chinese medicine that have significant effect in treating mastitis.
Treatment when the mammary gland is locally suppurated
①Let the child take breast milk from only the healthy side of the breast.
②You must go to surgery to treat the local abscess, cut and drain it, and insist on changing medicine to promote healing as soon as possible.
③Combine with physical therapy to promote local blood circulation and wound healing.
④Combine with Chinese medicine treatment.