Published on 10th March 2023

While breastfeeding is undeniably a wonderful thing, it’s rarely a walk in the park for mom or baby, especially in the early days: your body’s adjusting to your baby’s needs, you’re trying to work out the best breastfeeding position, and your baby might even need a little help latching onto your breast properly.

But what about when you’re also facing unwelcome complications such as breast engorgement, clogged milk ducts, or, worse still, mastitis? These conditions are common in new moms, but they can make your breastfeeding journey that little bit more challenging — not to mention sore!

Engorgement, mastitis and clogged ducts aren’t too serious, but they’re often painful, uncomfortable, and likely to make feeding your little one more difficult than it should be. But just what are these common breastfeeding-related conditions? The symptoms can be similar, so it’s often hard to tell one from the other.

Let’s delve into these three conditions in more detail, exploring their most common causes, symptoms, treatments, and the key differences between them.

What is engorgement?

Breast engorgement is when milk and fluid build up in the breasts, causing them to become overly full and often resulting in pain, tightness and discomfort. Typically, this happens due to increased blood flow in the breasts after childbirth. It most often occurs during the early stages of breastfeeding — as baby gets accustomed to your breast — but will usually ease after a few days as your milk supply starts to match up with your baby’s needs.

If your baby is having difficulty latching or missing feeds, or they are breastfeeding less frequently because they’re weaning, you’re more likely to suffer from engorgement. Babies can find it difficult to latch if you have engorgement, as the nipple can become flat and stretched. This can also lead to further problems such as a decreased milk ejection reflex, sore or cracked nipples, or a clogged milk duct (more on that shortly). 

Signs you might be suffering from engorgement include:

  • Pain or tenderness in your breasts

  • Your breasts feeling uncomfortably full

  • The skin on your breasts or areola feeling tight or hard

  • A forceful letdown during feeding (possibly causing your baby to gag or choke)

What is a clogged milk duct?

As the name suggests, a clogged or blocked duct occurs when a milk duct in your breast becomes obstructed, preventing breast milk from flowing to the nipple. It often causes a small, hard lump to appear on your breast, which may be accompanied by redness or swelling. The lump will also be painful or tender to the touch, while you may also notice milk blebs — small pimple-like blisters on your nipple.

Like engorgement, a blocked duct is often caused by your baby missing feeds and/or you leaving a long time between feeding or pumping sessions, while it may also be the result of your baby failing to latch properly — which can mean your breasts are not being drained of milk at each feed. In fact, a clogged duct can often occur as a direct result of engorgement, particularly if your breasts are engorged for long periods.

The most common symptoms of a clogged milk duct include:

  • A small, hard lump on the breast which is painful or tender to the touch (the lump may move or become smaller after feeding or pumping)

  • Redness and inflammation around the lump

  • Pain during letdown

  • Discomfort which subsides after feeding or pumping

  • Milk blebs (blisters) on the nipple

What is mastitis?

Mastitis is a painful inflammation of the breast which can often lead to a bacterial infection. It’s most commonly experienced by breastfeeding women, and estimated to affect 30% of breastfeeding people worldwide. Mastitis usually only affects one breast, and is typically characterized by pain, redness, swelling, and a burning sensation in the breast when feeding.

Sufferers of mastitis may also experience flu-like symptoms such as a fever, a high temperature, fatigue, and general aches and pains.

Mastitis is generally caused by hyperlactation (an oversupply of milk), so it can often occur following engorgement or a clogged milk duct — a clogged duct can cause milk to back up, for example, possibly leading to infection.

Most people who have mastitis experience symptoms such as:

  • A painful breast which is warm or tender to the touch

  • Redness and swelling in the breast

  • A burning sensation in the breast (most often when breastfeeding)

  • Flu-like symptoms, with a temperature of 101° F (38° C) or higher

How can you spot the difference?

Engorgement, clogged milk ducts and mastitis share some symptoms, and there’s often crossover between the three as one can sometimes lead to another. However, that’s not always the case, and it’s usually pretty easy to tell whether you’re suffering from engorgement, a blocked milk duct, or mastitis.

For example, mastitis symptoms tend to be more severe than those associated with engorgement or plugged ducts, while mastitis may also be accompanied by a high temperature and a general feeling of malaise. A plugged duct usually causes a small lump in the breast, whereas engorgement and mastitis typically affect a larger area.

Still struggling to tell the difference? Let’s delve a bit deeper into how to distinguish between each condition.

Engorgement vs clogged duct

Engorgement and plugged ducts have similar symptoms — including breast soreness and pain or discomfort when feeding — so they’re often confused. Engorgement may even lead to a clogged duct if it goes untreated for too long.

However, these are different conditions, and there are a few ways to distinguish between the two:

  • With a clogged duct, pain and inflammation is confined to a small lump on the breast, while engorgement typically affects a wider area.

  • The lump caused by a clogged duct will often be red, while engorgement is less likely to cause redness on the skin of the breast. With engorgement, the skin may look stretched and shiny.

  • A clogged duct may be accompanied by small white blisters (milk blebs) on the nipple; these are rarely experienced by women suffering with engorgement.

  • While engorgement can come on fairly quickly and impact both breasts, a clogged duct usually develops more gradually and it will typically affect only one breast.

Does engorgement cause clogged ducts? 

If engorgement persists, it can lead to your milk ducts becoming clogged, which may eventually lead to mastitis. If you know how to identify the symptoms of engorgement, however (such as breast hardness or a forceful letdown during feeding), you can address the condition quickly and avoid it triggering a plugged duct.

Mastitis vs clogged duct

While mastitis and plugged ducts are different conditions, they’re closely related: in fact, a clogged duct can often be responsible for a mom developing mastitis. 

So, do you have a clogged milk duct, or has it developed to full-blown mastitis? Here are a few ways you can tell the difference:

  • A clogged duct will cause a small lump to appear on the breast, while mastitis normally affects a larger area of the breast.

  • With a clogged duct, the pain and tenderness is generally confined to the immediate area around the lump, whereas mastitis usually causes pain in the whole breast.

  • Though both can cause pain, redness and swelling, these symptoms will typically be far more intense if you’re suffering from mastitis.

  • Pain or discomfort may subside after feeding or pumping if you have a clogged duct, while this is unlikely to provide any relief if you have mastitis.

  • Mastitis may be accompanied by flu-like symptoms such as tiredness and a fever, whereas a clogged duct will not make you feel unwell.

How quickly can a clogged duct turn into mastitis?

If a clogged milk is not cleared, it can lead to mastitis quickly. It might only take a few hours to develop — for example, the first time your baby sleeps through the night without feeding.. By identifying and treating a plugged duct quickly, however, you can avoid it turning into mastitis.

Engorgement vs mastitis

Engorgement and mastitis also have similar symptoms, though the latter is often more severe. Engorgement can contribute to the condition — the inflammation it causes can become mastitis if an infection develops.

How can you tell the difference between breast engorgement and mastitis? Here are a few pointers:

  • Engorged breasts will normally feel tight or hard, while mastitis is more often characterized by redness and inflammation (engorgement does not normally cause redness).

  • Though both can cause pain and tenderness in the breasts, mastitis pain can worsen when your baby feeds, and can feel like burning

  • Like a clogged duct, breast engorgement will not make you feel generally unwell; mastitis, on the other hand, may introduce flu-like symptoms.

Does engorgement always lead to mastitis?

Breast engorgement will not always lead to mastitis, but if it persists untreated it may cause an infection and eventually turn into mastitis. It’s important to recognize the symptoms of engorgement early and know how to treat it, so you can avoid it leading to anything more serious.

How to treat engorgement

Breast engorgement is not a serious condition, and in most cases it will ease on its own as your baby gets used to breastfeeding and your milk supply syncs up with their demand. However, in situations where engorgement persists, it can lead to complications such as plugged ducts, decreased milk ejection, or sore, cracked nipples.

You can ease breast engorgement by trying one or more of the following methods:

  • Hand express or pump a little milk between feeds to relieve pressure (only express a small amount, as expressing too much will only increase milk production).

  • Apply a warm compress before feeding to soften the breasts and stimulate milk flow.

  • Gently massage your breasts before or during a feed or pumping session.

  • Apply a cold compress to the breasts after feeding or pumping to reduce inflammation.

  • Try to stick to a regular feeding schedule; for example, feed your baby every 2 to 3 hours.

  • Take painkillers such as paracetamol or ibuprofen to help with the pain.

Engorgement won’t usually require medical treatment, but if none of the above methods are effective and you’re concerned about lingering engorgement, speak to your doctor or a lactation consultant.

How to treat a clogged duct

Like engorgement, a clogged duct is not usually anything to worry about, and it will usually only take a couple of days to clear if you’re following the right advice. That said, it’s important to try to unclog a plugged duct as quickly as possible to avoid it turning into mastitis.

To unclog a blocked milk duct, try one or more of the following at-home remedies:

  • Try to feed frequently from the breast affected by the clogged duct.

  • Apply a warm compress before feeding to soften the breasts and stimulate milk flow.

  • Gently massage the lump in the direction of your nipple as your baby is feeding.

  • Change breastfeeding positions so that the baby’s nose or chin points toward the blocked duct.

  • Be sure not to skip nursing sessions; if your baby does not want to feed at their regular interval, pump instead.

  • Wear loose-fitting clothing where possible, and avoid wearing underwired bras.

  • Take painkillers such as paracetamol or ibuprofen to help with the pain.

As with engorgement, clogged ducts can usually be treated at home and won’t require a medical appointment. However, if you’re unable to clear the blockage and you’re worried that it might lead to mastitis, consult your doctor or reach out to a lactation consultant

How to treat mastitis

Unlike engorgement and plugged ducts, which typically require no medical treatment, a doctor may prescribe antibiotics (such as Keflex or Dycill) to treat mastitis. While a small amount of the drug may be absorbed into your breast milk, but this is very unlikely to harm your baby, so you can continue breastfeeding them as normal.

In addition to antibiotics, you can relieve the symptoms of mastitis through a number of at-home treatments:

  • Apply an ice pack or cold compress to the breast to reduce swelling (but do not apply any heat).

  • Continue to breastfeed as normal, but try to feed from the sore breast first.

  • Gently massage your breasts before or during a feed or pumping session.

  • Try the reverse pressure softening technique, which involves massaging fluid away from the nipple.

  • Wear loose-fitting clothes and a supportive bra that doesn’t put too much pressure on your breasts.

  • Rest and drink plenty of fluids, particularly if you have flu-like symptoms such as a high temperature and body aches.

  • Take painkillers such as paracetamol or ibuprofen to help with the pain.

A 10-day course of antibiotics in addition to some of the above measures should be sufficient to clear up your mastitis. If it persists, you should book a follow-up appointment with your doctor.

Knowing the difference between common breastfeeding-related conditions such as engorgement, mastitis and clogged milk ducts is essential for a new mom, as it’ll help you recognize the signs early and address them quickly — enabling you to resume your breastfeeding journey without pain or discomfort (because no new mom should have to live with that!).