Definition

Cracked nipple, or nipple fissure, is a painful sore that forms on the nipple and areola, or the area around the nipple. While anyone can develop cracked nipples, it most commonly occurs in mothers breastfeeding for the first time. Cracked nipples can be very painful and may cause mothers to stop breastfeeding. Approximately 90% of breastfeeding mothers experience cracked nipples, typically starting in the second and third weeks after the baby is born. Despite being common, this condition must be properly treated to prevent complications.

In addition to breastfeeding mothers, cracked nipples can also occur in runners, cyclists, and surfers, known as "jogger’s nipple." This happens due to excessive friction between the nipple and another object, such as clothing or between skin surfaces.

Causes

During pregnancy, hormonal changes in the body lead to breast and nipple enlargement in preparation for breastfeeding. Cracked nipples can develop during pregnancy or breastfeeding due to these anatomical changes. Other causes of cracked nipples include:

• Enlarged breast size

During pregnancy and breastfeeding, breasts fill with milk. Excessive milk production can cause the nipples to stretch. Rapid stretching of the nipples can lead to cracks and soreness.

• Improper breastfeeding technique

Proper latching of the baby’s mouth to the breast is crucial. Incorrect latching can result in inadequate milk intake, causing the baby to bite the nipple, leading to pain and sores.

• Inappropriate breast pump size

Using a breast pump that does not fit the nipple properly can cause friction and sores.

• Friction during exercise

Athletes such as runners, cyclists, and surfers may experience nipple fissures due to friction between the nipples and clothing or sports equipment.

• Certain skin conditions

Certain soaps, creams, and detergents containing chemicals can cause allergic reactions on the sensitive nipple skin. Conditions like eczema can also cause dry, cracked nipples.

Risk Factor

Risk factors for cracked nipples include being pregnant or breastfeeding, especially for the first time, being an athlete in sports such as running, cycling, or surfing, living in a four-season climate, and having a history of eczema or atopic dermatitis.

Symptoms

Symptoms of cracked nipples include:

• Redness of the nipples
• Painful nipples
• Peeling and dry nipples
• Presence of pus on the nipples
• Bleeding nipples
• Visible open sores and cracks on the nipples

Diagnosis

To diagnose cracked nipples, the doctor will conduct a medical interview and physical examination.

Medical Interview

The doctor will ask about the main complaint, associated symptoms, condition duration, daily activities, past medical history, medications, and family history.

Physical Examination

The doctor will check general health indicators such as blood pressure, respiratory rate, pulse, and body temperature. The doctor will also examine the condition of the nipples, looking for redness, pus, bleeding, swelling, and skin condition and assessing pain. If a milk duct blockage is suspected, the doctor may recommend an ultrasound for further evaluation.

Management

You can manage nipple fissures at home on your own, unless you experience serious complications. If the condition does not heal after doing so, you should see a doctor. The management includes the following:

Treatment for breastfeeding mothers

• Apply a moisturizing ointment on the nipples
• Use warm compresses on the nipples and breasts to relieve pain
• Use nipple shields to protect the nipples
• Use organic, chemical-free skincare products
• Apply peppermint oil when not breastfeeding
• Avoid tight bras and clothing
• Massage the breasts to reduce pain
• Consult a lactation specialist for proper breastfeeding techniques and prescribed ointments if needed

Treatment for running, cycling and surfing athletes

• Use antibacterial creams to prevent infection
• Cover the nipples with protective shields to prevent friction
• Avoid tight bras or clothing

Complications

Complications of cracked nipples include bleeding, a lack of nutritional intake in babies due to obstructed breastfeeding, and infection. Because open wounds caused by cracked nipples can allow germs to enter the body, they increase the risk of other infections such as mastitis or breast inflammation. Furthermore, it can cause Candida fungal infections on the baby's tongue as a result of germs entering the breast through open wounds in cracked nipples.

Prevention

To prevent cracked nipples, you can:

• Use nipple shields before breastfeeding or exercising to prevent excessive friction.
• Wear loose-fitting clothing or bras.
• Learn proper breastfeeding positions during pregnancy.
• Use skincare products designed for dry skin, especially if you have a history of eczema or atopic dermatitis.
• Support the breasts with your hand while breastfeeding to ensure optimal latch between the baby's mouth and the breast.

When to See a Doctor?

See a doctor if you experience fever, bleeding nipples, pus, or blocked milk ducts. For further advice and treatment, consult a lactation consultant or a pediatrician

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