Updated Research: How to Manage Engorgement

Written By Leva | Updated by Laura Silvas, RN IBCLC

Breastfeeding can be as challenging as it is beneficial for mother and child, particularly in the first few weeks. One of the greatest challenges that a breastfeeding mother can face is engorgement. Most breastfeeding mothers will have experienced engorgement at some stage in their breastfeeding journeys. Engorgement is the swelling of the breasts as they fill with milk, inflammation, increased blood, and lymph fluid. It often presents as overfull, hard, and painful breasts. Although the breasts may seem overly full, some women may find that they cannot express milk from their breasts. This article will outline what engorgement is and how you can manage it.   

What is Engorgement?

Engorgement often occurs at the beginning of your breastfeeding journey, when your milk “comes in.” It can also occur if you miss a feeding or when your baby has periods of cluster feeding.  This buildup of fluid (milk, blood, lymph) in the breast tissue causes swelling, pain, and discomfort. Additionally, once the breast becomes engorged, the swelling prevents the baby from keeping the nipple and areola in their mouth, making it more difficult to nurse and preventing adequate milk flow.  Over time, this cycle can create a negative feedback system whereby milk production is reduced, and it eventually leads to a low milk supply.

Engorgement is generally a challenge faced in the early stages of breastfeeding; it usually peaks on days 3 to 5 but can last up to 2 weeks. Engorgement can lead to other painful symptoms, such as cracked nipples or even more severe conditions like mastitis and abscesses. It is also one of the primary reasons for premature weaning or abandoning breastfeeding in the first two weeks. 

It is essential to treat engorgement early on to promote ongoing breastfeeding, as it is strongly recommended that a baby is fed solely on breastmilk for a minimum of 6 months for optimum immune system development.

What causes Engorgement?

The cause of engorgement is a contentious issue, as several factors contribute to its development. These include:

• Delayed breastfeeding

• Difficulty breastfeeding

• Limited breastfeeding time and frequency

• Not alternating breasts between feeds

• Ineffective drainage, and 

• Lack of direct breast stimulation

How is Engorgement Treated?

Recently, many clinical trials have been conducted to find the best treatment for engorgement. Although there is some contradictory evidence and a need for more extensive testing, some convincing results indicate the usefulness of various treatment methods, with some providing lasting relief after just 5 minutes. As with many other aspects of motherhood, trying several techniques is advisable until you find what works for you.

Below are some of the treatments and their effectiveness and comparative effectiveness:

• Cabbage Leaves: Cabbage leaf application provides some engorgement relief, whether at room temperature or cold. This unusual form of therapy is effective because the cabbage leaves absorb some of the fluid from the glands in the breast area, reducing the fullness of the tissue. In addition, cold cabbage leaves and cold packs have similar effects on relieving engorgement symptoms. 

• Hot/Cold Packs: Previously, warm compresses were used for engorgement. However, according to the updated Mastitis Protocol, ice is more effective than heat therapy. Ice can be applied hourly or as desired to help with discomfort and inflammation. Warm compresses can still be used in short intervals for comfort.

• Acupressure: Another common technique for treating engorgement is Acupressure. However, it is less effective than applying ice packs.

• Massage: Previously, massage was strongly encouraged to help facilitate breast drainage. Studies show that this “deep massage” can increase breast inflammation. Instead, manual lymphatic drainage is recommended to help decrease engorgement. This is done with a “light sweeping” over the breast, up towards your lymph nodes (think collar bone, armpit, neck) instead of down and out of the breast.

• Ultrasound: Ultrasound therapy uses thermal energy to decrease inflammation and edema. According to the ABM, this can be helpful to alleviate engorgement before it turns into mastitis.

• Acupuncture: Acupuncture is also effective in reducing engorgement.

• Anti-inflammatories and pain relievers: Medications such as Acetaminophen/paracetamol and Ibuprofen can easily be purchased over the counter and are generally considered safe during breastfeeding. Ibuprofen not only helps with pain relief but is an anti-inflammatory, helping to reduce swelling in the breasts. Always consult your care provider before starting a new medication.

• Oxytocin: Although it was previously thought to reduce engorgement, oxytocin, a chemically-derived form of the hormone mothers naturally produce to promote breastfeeding, has no effect in relieving engorgement symptoms.

• Serrapeptase: Serrapeptase has been shown to provide some relief; however, side effects must be noted before usage. Serrapeptase is a chemical taken from the silkworm. It is commonly used in Japan and Europe. Serrapeptase helps the body break down protein, which helps decrease inflammation and mucous.

• Protease: Protease is a treatment often prescribed to reduce engorgement. This is because it causes the breakdown of proteins into smaller elements. However, according to studies, its administration provides no relief from engorgement.

• Gua-Sha or Scraping therapy: Gua-Sha or Scraping Therapy is a proven technique to provide significant pain relief, reduction in breast discomfort, and engorgement. It is used widely in Asia by traditional therapy practitioners. Gua-Sha is performed by a technician who scrapes your skin with short or long strokes to stimulate microcirculation of the soft tissue, which increases blood flow. They make these strokes with a smooth-edged instrument known as a gua massage tool. The technician applies massage oil to your skin and then repeatedly uses the tool to scrape your skin in a downward motion. Research shows it is more effective in relieving engorgement symptoms than applying hot packs and massage.

Overall, the most effective techniques for reducing engorgement tend to decrease swelling and allow the opening of the milk ducts. In addition to the above-listed techniques, preventing the engorgement cycle from continuing is the most important.  While it may be tempting to “empty” the breasts frequently due to the fullness, this tells your body to produce more milk. If you are experiencing engorgement post-feeding/pumping or in between sessions, you can try hand expression. Hand expressing until you are comfortable, but not to the point of emptying your breasts, helps to alleviate the edema without increasing your supply and demand.

Conclusion

Engorgement is common and can be uncomfortable and difficult to cope with in the early stages of breastfeeding. Throughout pregnancy, birth, and early parenthood, a mother will be inundated with opinions and advice on every aspect of the process. However, when it comes to engorgement, there are some well-researched solutions that a mother can use to provide some much-needed relief to continue breastfeeding for as long as they had intended.

Reach out to our lactation consultants if you are in the thick of the engorgement and need help!