A blood vessel disorder that most often affects fingers and toes can also show up in the nipples and cause problems with breast-feeding, according to a new report.
This condition, known as Raynaud's phenomenon (or Raynaud's disease), often goes unrecognized when it affects the nipple, the report authors said. Although Raynaud's of the nipple isn't common, the study authors called for increased awareness and better diagnosis of the condition.
If undetected,"there may be higher rates of discontinuation and losing out on [the] health benefits" of breast-feeding, said Dr. Katherine Sampene, an obstetrician and gynecologist (OB-GYN) at the University of Wisconsin School of Medicine and Public Health, and senior author of the report. "If we can help women to be successful in [breast-feeding], we can improve the health of moms and babies." [9 Uncommon Conditions That Pregnancy May Bring]
Raynaud's phenomenon
Raynaud's phenomenon causes the blood vessels to narrow in response to cold or stress, leading to reduced blood flow to certain areas. The disorder most often affects the fingers and toes, but in rare cases, it can affect the nose, ears, lips and nipples, according to the National Institutes of Health.
That reduced blood flow typically causes the affected areas to turn white or blue for short periods. When blood flow returns, the affected areas may turn red, and people may feel a throbbing, tingling or burning sensation in the area, the NIH says. In general, treatments can range from lifestyle changes — such as making sure to bundle up when it's cold outside — to, in more severe cases, medications that improve blood flow.
The new report, published in the May issue of the journal Obstetrics & Gynecology, describes two recent cases of Raynaud's phenomenon of the nipple.
In one case, a 32-year-old woman went to her doctor shortly after having a baby; she reported that her nipples sometimes were very purple. She wanted to know if this was normal; she also said she sometimes experienced pain while pumping her breast milk. Her doctors observed that, indeed, her nipples appeared a deep purple color during a breast exam, according to the report. But after the patient closed her examination gown for a few minutes, the discoloration almost completely disappeared. This rapid change in color after warming under the gown allowed doctors to make a clear diagnosis of Raynaud's phenomenon of the nipple.
Doctors recommended that the woman take some simple steps to treat her condition, such as making sure to keep her breasts warm while pumping milk, which did improve her symptoms.
In the second case, a pregnant woman told her doctors that she sometimes experienced a stabbing and debilitating pain in her nipple, as well as nipple discoloration. She said she had first experienced these symptoms when she had her first child, but that the symptoms went away after she stopped nursing. Now, at 17 weeks pregnant, she was having the same symptoms again, she said.
Doctors suspected she might have Raynaud's phenomenon of the nipple and decided to try switching the medication she was taking for high blood pressure to a different drug that works by relaxing blood vessels and treats both high blood pressure and Raynaud's. With this new medication, she experienced quick symptom relief, and when her baby arrived, she was able to breastfeed without pain.
Underdiagnosed condition
Sampene said that OB-GYNs rarely have intensive training on how to manage breast complaints. "[It] hasn't been an area of focus" in medical training programs, Sampene told Live Science. Instead, issues of nursing and breast pain are often referred to nurses or lactation consultants.
Although nurses and lactation consultants are "wonderful resources" for women, patients may still relay their symptoms to their doctor first, Sampene said. If a doctor doesn't have training on the issue, it "may be a missed opportunity to help those patients," she said.
When patients report nipple pain, the new report authors encourage OB-GYNs to take a thorough history of these patients, which would include asking questions about whether their symptoms are related to temperature changes. (Although a link with temperature changes isn't always necessary to diagnose Reynaud's.)
"A careful history and physical must be obtained in women presenting with breast pain, because diagnosis and treatment allows breastfeeding continuation and mitigation of symptoms," the report concludes.
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Originally published on Live Science.
