Treatments for nipple pain
There are a lot of treatments for nipple pain out there - and they are not all created equal!
I am going to go over the different treatment options for nipple pain, rating them from my least to most favorite with explanations for each!
All Purpose Nipple Ointment
All purpose nipple ointment (APNO) is a prescribed nipple cream that typically contains an antibiotic, corticosteroid and antifungal. Unfortunately it is not research based and is often used when nipple pain is not improving and the breastfeeding mother is desperate for a solution. There is no evidence that is is effective, and ultimately it needs to be researched more, especially when considering baby will also be exposed to this cream. When APNO was used versus lanolin in a randomized controlled study trial, there was no significant difference in pain.
Breast shells
Breast shells are hollow plastic discs worn over nipples to protect sore nipples and supposedly promote healing. They have also been used to help “correct” flat or inverted nipples (there is no evidence that this is an effective treatment). Further studies are needed on the efficacy of breast shells. While some studies show no evidence that the use of breast shells will improve nipple pain when compared to other methods such as lanolin or gel pads, other studies have shown that breast shell use did protect sore nipples against friction, which allowed faster healing. Unfortunately, breast shells use can be a risk factor for developing mastitis.
Lanolin
Lanolin is a natural oil from sheep’s wool and is a commonly used nipple cream for sore nipples. Studies that have compared lanolin to other methods of nipple pain treatment such as gel pads, breast shells, APNO and breastmilk found that there is no statistical difference in pain. Lanolin should not be used by those with a known allergy to wool. I do see the benefit of lanolin in moisturizing the nipple, but it will not heal damage.
Nipple butter
Nipple butter is similar to lanolin but is not made from sheep’s wool. Rather it is typically made out of ingredients like cocoa butter, shea butter, calendula, and plant oils, which are known for their moisturizing and soothing properties. Unfortunately, just like lanolin, studies do not support that it actually makes a difference in pain or healing. Again, I see it’s benefit in moisturizing a painful nipple but it does not necessarily heal.
Gel Pads
Gel pads are one of my personal preferred methods for nipple pain. NOT for treating, but for managing pain while the root cause of the nipple pain is addressed. Again, studies do not support that gel pads actually promote healing, but they do support that gel pads can help with pain management. “Hydrogel dressings are a safe, available treatment that provided more effective pain management for nipple soreness than the common intervention of lanolin ointment”. That being said, I do see the benefit of creating a barrier between a sore nipple and friction when it is healing. I personally experienced nipple pain for months (during my first breastfeeding journey before I became a CLC), and I can’t tell you how many gel pads I went through! Eventually I did resolve my nipple pain, but until I did gel pads provided a much needed barrier between my very sore nipples and my bra.
Silverettes
Silverettes are one of the preferred methods of treating pain in breastfeeding mothers. I could only find one study on ‘silver caps’, and it found: “Results of treatment with Silver Cap were more effective than standard care of nipple fissure treatment in term of resolution of painful symptoms. It promoted the healing process of lesions, and it was well tolerated and accepted by participants.” According to the Silverette website, silver is “a naturally antimicrobial, antifungal, and antibacterial metal – contains potent anti-inflammatory properties that can be used to soothe and prevent soreness and pain during the breastfeeding journey.” While I have not used them personally, I have heard mixed reviews. Some breastfeeding mothers swear by them, and others felt they did not make a difference. Unfortunately they are on the more expensive side, and again I will always recommend finding and addressing the root cause of pain above all else.
If you choose to use silverettes, it is important to not wear them 24/7! When skin, especially damaged skin, is constantly damp and in a dark environment, this could be a breeding ground for bacteria! Wet skin is also more susceptible to breakdown! This is why it is important to allow your nipples to completely dry. When using silverettes, especially if you leak, this can prevent the nipple from drying. This is why I would recommend using silverettes after every other feeding. What this means is using silverettes after one feeding, and then using another nipple treatment such as lanolin or gel pads after the next feeding, alternating back and forth. I would also recommend allowing your nipples to dry completely after feeding or pumping before putting the silverettes on!
Breastmilk
Using your own breastmilk is another method of treating sore nipples. Simply express a little extra milk on your nipple at the end of a feeding or pumping session and let it air dry. This technique can also be used with silverettes. This is one of my top picks because it is free, there are no potential side effects because this is coming directly from your breast, and studies have actually found it to be more effective than lanolin use. “The healing time in the lanolin group was longer than the breast milk group and the control group . No side effects were noted during the study. This study suggests that, due to the better healing of the sore nipple with breast milk, its availability, without payment and side effect, breast milk is recommended for the treatment of sore nipples.”
The BEST treatment for nipple pain?
Addressing the root cause of nipple pain will always be the goal when treating nipple pain. Nipples will not have a chance to heal if what is damaging them is not corrected.
Different ways to address pain when breastfeeding:
correcting the latching
this is the biggest one - consider working with lactation consultant if you are unable to correct latching issues on your own
adjusting flange size and/or pump settings
using the incorrect flange size can lead to swelling, redness, pain and damage (check out my flange sizing post)
pumping should never be painful - you should not be pumping on the highest suction level, this can cause damage and higher suction does not mean more milk removal
in rare cases nipple pain can be caused by an infection - consider contacting your medical provider if you have concerns of an infection
Important note: Raynaud’s can cause nipple pain when breastfeeding - the same vasospasms that turn fingers and toes white/blue can also occur in the nipples (see my post on Raynaud’s and Breastfeeding for ways to treat this pain specifically)
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Studies Cited:
Effect of a breast shell on postpartum nipple pain: An exploratory study
Prevention of and Therapies for Nipple Pain: A Systematic Review
Breast shells for pain and nipple injury prevention: A non-randomized clinical trial
Dennis, Cindy-Lee et al. “Interventions for treating painful nipples among breastfeeding women.”
“Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers.”
