Acute mastitis classification diagnosis treatment. What is and how to treat acute mastitis

Many women know what mastitis is, especially those who have carried and fed a child.

This is the name of inflammation of the mammary gland, the causative agent of which in 95% of cases becomes Staphylococcus aureus. It can be acute or chronic, lactational or non-lactational, caused by infection with harmful organisms, or appear due to milk stagnation.

After childbirth, nine out of ten women face it, primiparas are most susceptible to inflammation. Moreover, the disease can appear in men, and even in children, we will describe in detail all the varieties in this article.

Mastitis is usually divided into several forms or stages, which smoothly flow from one to another, if the disease is not treated. Each of them is accompanied by "their" symptoms.

Serous mastitis begins when harmful organisms enter the breast tissue, the symptoms are:

• The temperature rises to 38-38.5 degrees, the patient is shivering;
• The body weakens, appetite is lost, appears headache;
• In the chest area, a constant and pulling pain appears, which intensifies over time;
• The skin in the area of ​​​​inflammation turns red, compacted zones appear.

The infiltrative stage is accompanied by the association of foci of inflammation, edema appears.

Accompanied by:

• high body temperature;
• Increasing pain;
• The mammary glands become dense;
• Lymph nodes are enlarged in the armpits.

Purulent mastitis, the most difficult phase, in which the infiltrate begins to fill with pus.

Symptoms:

• Body temperature rises to 39.5 degrees and above;
• There is a strong and continuous pain in the affected area, often throbbing;
• The lymph nodes in the armpits continue to increase, and become painful.

Inflammation of the mammary glands in a nursing mother is called lactational mastitis, it is often observed shortly after the baby is born, and during feeding. The likelihood of its occurrence during breastfeeding increases if the mother does not properly express milk, or puts the baby to the breast. This leads to stagnation of lactose, the appearance of microtraumas of the nipple, through which microbes enter the body.

The fibrocystic form of the disease can appear not only in lactating women, but also in men. The disease can provoke a disturbed hormonal balance in the body, climatic changes, mechanical damage to the mammary gland, provoking necrosis of fatty tissues. Sick diabetes are also prone to this disease.

Male mastitis is extremely rare, since at birth the glands in men are reduced, and therefore they are not intended for feeding children, and remain as undeveloped rudiments. However, hormonal changes may well provoke mastitis, due to which the glandular tissue begins to grow and then becomes inflamed.

In general, the symptoms resemble those that occur with other breast diseases. It can be confused with inflammation of the skin, subcutaneous tissues or muscles in the chest area, so before starting treatment, you need to be examined by a doctor.

Symptoms in men:

• The mammary glands increase in size;
• Redness appears in the affected area;
• The inflamed area swells and hurts;
• Other signs of inflammation

Due to the fact that the disease is provoked by hormonal imbalance, other symptoms appear, such as reduced potency, voice changes, muscle and fat mass can be redistributed.

In this case, all the symptoms remain mild until the mastitis becomes purulent. The diagnosis becomes obvious, but the only treatment available at this stage is the intervention of a surgeon.

Signs of mastitis

Since inflammation of the mammary glands most often occurs in women, it is they who are best acquainted with all its manifestations. Recognizing it is quite simple - fever, changes in breast size, tissue thickening, pain and increased sensitivity. In a nursing mother, the disease can cause manifestations similar to ordinary flu, the disease develops very quickly, a few days after the first symptoms appear, the skin begins to turn red, and the lactation process causes a burning sensation and pain.

In most cases, the disease affects only one breast, after 6 months after the birth of a child, the threat of inflammation becomes minimal. But in the first two or three weeks immediately after the birth of the baby, the probability of occurrence is quite high, and remains so for three months.

If a woman has already been ill once and has cured mastitis, she still has an increased likelihood of recurrence of the disease. When signs appear, treatment should be started immediately, moreover, “grandmother's remedies”, arbitrarily proven and reliable, must be combined with treatment under the supervision of a doctor, otherwise mastitis may become purulent, after which an operation will be required.

Women over 30 years of age may experience non-lactational mastitis, which develops against the background of a weakened immune system, and the body as a whole, which causes sluggish pathologies.

Signs at first remain subtle, which makes diagnosis difficult. Between the ages of 40 and 60, symptoms may resemble breast cancer, to determine the cause of the inflammation, excision of tissue in the affected area of ​​\u200b\u200bthe breast is performed.

Signs of mastitis in men compared to women are very small, and therefore inflammatory processes are not able to lead to noticeable malaise. Only if mastitis appears on the background of a hormonal failure, simultaneously with a weakening of the immune system, and if no measures are taken to treat it, the disease can develop to a purulent stage.

The disease can also develop in children, more often in newborns. Appears as a result of an infectious infection in the first few weeks of a baby's life, harmful microorganisms can enter the mammary glands through the blood vessels from other foci of infection, or due to mechanical damage. It proceeds extremely quickly, in a day it can reach the purulent stage. The intensity of inflammation and the likelihood of its occurrence does not depend on the sex of the child.

The symptoms differ little from those mentioned above:

• A sharp increase in temperature;
• Apathy or excessive excitability of the child;
• Refusal to eat;
• The affected gland significantly increases in size;
• On the second day, the affected area swells, turns red, and becomes painful.

If there is even the slightest suspicion of mastitis in an infant, you should immediately seek medical help, the child and mother are most often placed in a hospital where the infant will be treated with antibiotics and vitamins.

Mastitis occurs in girls in adolescence, this is a consequence of the hormonal changes in the young body, due to which the immune system is temporarily weakened. It can develop to complex forms only if nothing is done.

You can learn more about the signs of mastopathy here:

Mastitis treatment

Regardless of the stage of mastitis, it should be treated under the supervision of a physician. As soon as a nursing mother has the first signs of illness, such as malaise, heat, she should contact the attending gynecologist, he will conduct an examination, determine the cause of the disease, and prescribe the appropriate treatment. That is, it is not recommended to treat mastitis at home.

The first thing the doctor will do for the examination is a blood test, the second measure will be the sowing of milk for sterility, this will determine the pathogen by their reaction to the antibiotic. Verification of the diagnosis takes some time, therefore, in the presence of severe symptoms, treatment is started immediately, and subsequently adjusted depending on the pathogen. Breastfeeding is stopped, as this can harm the baby. Milk contains both the pathogen and the medicines introduced into the body. The period for which the child needs to be weaned and transferred to artificial feeding is discussed with the attending physician.

In medical practice, antibiotic treatment is primarily prescribed. To do this, choose those that penetrate the breast tissues as quickly as possible, while they should be as effective as possible against the infectious agent. Such a selection of medicines allows you to create the maximum concentration of the antibiotic in the tissues of the mammary gland, where it can fight harmful microorganisms. The antibiotic is administered intramuscularly or intravenously, the doctor may also prescribe drugs in tablets.

The use of antibacterial drugs lasts 5-10 days, depending on the doctor's prescription.

It is important for breastfeeding women to empty sick milk women to avoid milk stasis, so the doctor may prescribe hormonal preparations designed to accelerate the outflow and release of milk. Pumping is a mandatory procedure in the treatment, it must be carried out every 3-3.5 hours.

Naturally, such measures are not needed in case of mastitis in men. Treatment in this case is reduced to the usual medical intervention using antibiotics.

If the disease has developed to a purulent form, surgical intervention is indicated, and further treatment in a hospital. A purulent abscess is opened in order to prevent further development illness. The doctor may prescribe infusion therapy, which involves the introduction of glucose and saline solutions through a dropper, this reduces intoxication and supports metabolism. If the disease appeared due to weakened immunity, the use of immunomodulators is allowed.

After the treatment of purulent mastitis, the milk formed in the breast is checked for the presence of pathogens or medication residues. The study is carried out for about a week, if it showed a negative result, the mother can feed her child again.

Many think about the treatment of mastitis folk remedies, however, the disease is too serious to self-medicate. By applying various plants and compresses to the chest, one can indeed contribute to healing, but such “medicines” can also be harmful if applied thoughtlessly. They can be used, but only after consulting a doctor.

As you know, it is much easier to prevent the development of the disease than to treat it. A woman may well exclude the appearance of mastitis after the birth of a child, or minimize the likelihood of its occurrence, for this you can:

By following the correct feeding regimen so that it remains natural, avoiding stress, the likelihood of breast inflammation can be minimized.

While carrying a child, the mammary glands are prepared for future lactation, in the presence of mastopathy, or if a woman has previously undergone breast surgery, it is necessary to consult a mammologist.

In the second half of pregnancy, you need to wash your breasts every day with cool water, and wipe it dry with a hard towel, massaging the nipples. It is allowed to use special ointments and creams. Hygiene should not be neglected even after childbirth, the mammary glands should be washed every day up to 3-4 times, the bra should be comfortable. The mother should be able to walk regularly and eat right.

By following these simple rules, you can avoid the appearance of mastitis, and ensure the normal feeding of the child.

Mastitis, or, as it is also defined, the breast, is a disease in which the mammary gland is exposed to inflammation. Mastitis, the symptoms of which can be observed in women aged 15-45 years, in the vast majority of cases of occurrence is associated with breastfeeding, however, the possibility of the appearance of this disease immediately before childbirth or without any connection with them and with pregnancy is not excluded.

general description

Mastitis is noted in about 70% of cases in women who have given birth for the first time, in 27% - in women who have given birth for the second time, and, accordingly, in 3% of cases - in women with multiple births. It is noteworthy that mastitis can also develop not only in women without a corresponding connection with pregnancy, but also in girls, and even in men.

Mastitis not associated with pregnancy and breastfeeding is defined as non-lactational mastitis, it appears mainly due to trauma to the mammary gland, is not excluded as a cause and a variant of the development of this disease as a result of relevance for female body hormonal disorders.

Causes of mastitis

As the main reason for the development of mastitis, the bacteria enter directly into the breast tissue. This can happen through cracks in the nipples, which in this case act as an open gate for penetration into the indicated infection environment, as well as through blood, which occurs in the presence of chronic infectious foci in the body. In the latter case, such foci include pyelonephritis, chronic tonsillitis and other diseases.

It should be noted that in a normal state of health, the entry of a certain amount of bacteria into the mammary gland leads to their corresponding destruction, carried out by the immune system. Meanwhile, the vast majority of cases indicate a weakening of the female body after childbirth, respectively, the immune system ceases to properly fight infections.

As important point, contributing to the development of the disease we are considering, we should highlight lactostasis, in which stagnation occurs in the ducts of the milk glands, which occurs due to insufficient decantation of milk, incomplete decantation, or due to rare feedings. Stagnation of milk in the ducts provides a favorable environment for the process of reproduction of bacteria, because milk as a whole has a mass of nutrients.

Mastitis: types

There are the following main types of mastitis:

• lactational mastitis (postpartum mastitis) - the most common variant of the disease (about 85%), associated with breastfeeding;
• non-lactational mastitis (fibrocystic mastitis) - accordingly, it occurs due to the influence of causes not related to breastfeeding;
• mastitis (breast) of newborns - manifests itself in the form of breast engorgement in a newborn baby, and gender is not a determining factor in this case, respectively, the disease can develop in both boys and girls. The reason for its development is the transition from the maternal blood of lactogenic hormones (that is, hormones that stimulate lactation).

Based on the characteristics of the current inflammatory process, the following types of mastitis are determined:

• acute lactostasis, in which there is no milk secretion;
• serous mastitis;
• acute infiltrative mastitis;
• destructive mastitis;
• chronic mastitis (in purulent or non-purulent form).

In accordance with the specific area of ​​localization, the following types of mastitis are distinguished:

• subcutaneous mastitis;
• subareolar mastitis (that is, concentrated in the area under the areola);
• intramammary mastitis (focused directly on the mammary gland);
• retromammary mastitis (focused outside the mammary gland).

Mastitis and lactostasis

One of the reasons that provokes lactostasis is the "irregularity" of the shape of the nipples (which is important with inverted or flat nipples), which makes it difficult for the baby to suckle the breast, and also leads to incomplete emptying when feeding the mammary glands, which, in turn, leads to lactostasis .

As we have already noted, lactostasis in general implies stagnation in the ducts of the milk glands due to insufficient expression. As a result of this condition, the mammary gland becomes painful, focal seals appear in it, disappearing under the influence of massage. From the painful area of ​​​​the gland, milk flows unevenly. Mostly without a combination with mastitis, lactostasis is not accompanied by a temperature, however, if lactostasis is not eliminated within a few days, then it will inevitably move to mastitis. Mastitis in this case is accompanied by a temperature of up to 39 degrees.

Accordingly, the basis for the development of mastitis is precisely lactostasis, which acts as the root cause. In addition to these factors, lactostasis is also caused by a number of other options:

• improper attachment of the baby to the chest;
• the process of feeding the baby when taking only one position;
• giving the baby a nipple, which leads to subsequent tactics on his part as a "passive smooch";
• the use of a special lining on the nipple when feeding the baby;
• sleep on the stomach;
• stress;
• tight clothing, bras;
• restrictions in the frequency of feeding the baby, temporary restrictions in this process, as a result of which the breast is not emptied properly;
• excessive physical exercise spasmodic gland ducts;
• bruises and injuries of the chest;
• feeding the baby without warming up after suffering hypothermia;
• sudden transition to artificial feeding child.

Mastitis: symptoms

The clinic of manifestations of mastitis today has the following features:

• late onset, noted after a period of about 1 month from the moment of birth;
• frequent occurrence subclinical and erased forms of the disease, the symptoms of which are not evidence of the true state of affairs regarding the process in question;
• the predominant variant of the appearance of infiltrative-purulent mastitis in patients;
• the duration of the course of purulent mastitis.

The symptomatology of mastitis depends on its specific form, below we will consider their main options.

Serous mastitis. The symptoms of the disease, as, in fact, its course, are characterized by the severity of the manifestation, the onset of this mastitis falls on a period of 2 to 4 weeks from the moment of birth. There is an increase in temperature (up to 39 degrees), chills. There are also symptoms associated with intoxication in the form of weakness, headache, general weakness. First, patients experience heaviness in the mammary gland, and then pain, milk stagnation occurs.

At the same time, there is a certain increase in the volume of the mammary gland, the skin undergoes redness (hyperemia). When trying to express milk, severe pain is felt, the result does not bring relief. The lack of adequate therapy measures, as well as the progression of inflammation, leads to the fact that serous mastitis develops into infiltrative mastitis.

Infiltrative mastitis. In this case, the chill experienced by the patient is strong enough, pronounced tension and pain are felt in the mammary gland. Also relevant are symptoms in the form of loss of appetite, insomnia, headache and general weakness. There is also an increase in the mammary gland, redness of the skin. In addition, patients experience pain in the axillary lymph nodes, which is combined with the pain of their palpation (palpation). The untimely treatment of this form of the disease, as well as the lack of effectiveness in it, leads to the fact that the inflammation becomes purulent, which, in turn, ensures the transition to the corresponding, purulent form.

Purulent mastitis. Here, the patient's condition worsens significantly. Appetite decreases, weakness increases, problems with sleep appear. The temperature rise is mostly kept within 39 degrees. The chill persists, the skin becomes pale, sweating increases. In the mammary gland, tension and pain are still felt, its size is increased, redness has a pronounced manifestation, the skin is swollen. Expression of milk is greatly complicated, often in the resulting small portions of it you can find pus.

Mastitis abscessing. As the predominant options, an abscess of the areola or furunculosis is distinguished, retro- and intramammary abscesses in the form of purulent cavities are somewhat less common.

Phlegmonous mastitis. In this case, the inflammatory process captures a larger area of ​​\u200b\u200bthe mammary gland, followed by melting of its tissues and switching to the surrounding tissue and skin. The patient's condition is generally defined as severe, the temperature is about 40 degrees.

The chill persists, intoxication has a pronounced character of its manifestations. There is a sharp increase in the volume of the mammary gland, swelling of her skin. In addition to reddening of the skin, cyanosis is also noted in some areas of the affected gland. Feeling (palpation) indicates its pastosity (swelling), as well as pronounced pain. With this form of mastitis, the possibility of developing septic shock is not excluded.

Gangrenous mastitis. The course of the disease is largely complicated, intoxication has an extremely pronounced nature of manifestations. Necrosis of the mammary gland develops (that is, it necrosis occurs). The patient's condition is generally severe, the skin is pale, there is no appetite, insomnia appears.

The temperature is about 40 degrees, there is an increase in the pulse (up to 120 beats / min.). The affected gland is enlarged, its swelling and soreness are noted. Above it, the skin may be pale green or purple-cyanotic, some places have areas of necrosis and blisters. There is no milk, the nipple is retracted. Enlargement and soreness also occur in the region of regional lymph nodes, which is detected by palpation.

Diagnosis

The pronounced manifestations of the symptoms of the disease we are considering do not lead to any difficulties in making a diagnosis, which is based both on the general complaints of the patient and on an objective examination of her mammary glands.

It should be noted that with an underestimation of the symptoms characteristic of a purulent process, as well as with an overestimation of factors in the form of skin hyperemia and the absence of fluctuation by a doctor, it can lead to long-term treatment purulent form of mastitis, which in the end will be simply unjustified. Irrational antibiotic therapy in the case of abscessing mastitis or infiltrative-abscessing mastitis, it leads to a serious threat of the development of the disease in its erased form, in which the symptoms do not determine the actual condition of the patient and the severity relevant to the inflammatory process.

In such patients, the temperature is initially elevated, reddening of the skin and its swelling are often noted, naturally, within the framework of the mammary gland. These signs are eliminated by prescribing antibiotics. As a result, the temperature drops to normal levels during the daytime, with a possible slight increase in the evening. Signs of a local character, indicating purulent inflammation, are absent or very weakly expressed. Painful sensations in the mammary gland are moderate. Palpation reveals an infiltrate with the same size or with the size gradually increasing.

Infiltrative-abscessing mastitis, noted in more than half of the cases, has an infiltrate consisting of a large number of purulent cavities small size, however, when used as a diagnostic method of infiltrate puncture, it is extremely rare to get pus. If, however, the puncture method is applied to the erased form, then it is already expedient to assert its value as a diagnostic method.

As additional diagnostic methods, a blood test is used, as well as echography of the glands.

Mastitis treatment

The treatment of the disease is determined based on the characteristics of its course, form and other factors in a strictly individual order, and its measures are focused primarily on reducing the growth of the number of bacteria while simultaneously affecting the inflammatory process in order to reduce it. In addition, of course, therapy involves the selection of appropriate measures aimed at pain relief.

With non-purulent forms of mastitis, conservative methods of treatment are applicable. Antibiotics are used as the main drugs, the sensitivity of bacteria is the basis for their choice. Basically, these antibiotics belong to the penicillin group, to cephalosporins, etc. They are applicable internally, intravenously or intramuscularly. Anesthetics are used to relieve pain.

Expression of the patient's milk should be done at intervals of three hours and for both mammary glands, this is done to avoid stagnation of milk. The acceleration of the healing process is facilitated by a decrease in milk production or the complete suppression of this process by prescribing appropriate drugs by a doctor. After recovery, lactation can be resumed.

As for the treatment of purulent mastitis, it is carried out exclusively through surgical intervention. As an addition to the treatment, physiotherapeutic procedures are used in the form of UHF and laser therapy, vitamin therapy, antianemic therapy and desensitizing therapy.

If mastitis is suspected, it is necessary to contact the attending gynecologist and mammologist.

Update: December 2018

Mastitis is an inflammatory process in the area of ​​the parenchyma and in the zone of lactating breast tissue. The disease develops only in 2 - 5% of lactating women. Though acute mastitis can occur in women at any time, more often it happens 2 to 3 weeks after birth (82-87% of cases), but may be later.

This is explained by the anatomical and physiological changes that occur in the breast at the beginning of the secretion of colostrum and milk. In 90-92% of patients, only one mammary gland is affected, and the left-sided mastitis is more common than right-sided mastitis (right-sided right hand it is easier to express, so the left breast is better emptied than the right).

The main condition for the development of mastitis is congestion in the chest (see), which can either be accompanied by an infection (often hospital), or not - non-infectious mastitis.

Primiparous women are at risk for mastitis because they:

• there is a physiological imperfection of the ducts of the mammary glands
• underdeveloped glandular tissue that produces milk
• underdeveloped nipple
• besides, there is no experience
• No ().

About the lactation period

The shape, size and position of the breasts are very individual, vary widely within the normal range and depend on:

• age
• phases of the menstrual cycle
• general physique
• lifestyle
• the state of the female reproductive system.

Anatomy of the mammary glands

The breast of a woman has a lobed structure, large lobes are separated by intervals of connective tissue into 20 - 40 segments, each of which consists of alveoli. The alveolus itself is lined with a single-layer epithelium of the glandular type with an excretory duct, which are interconnected into large ducts in which breast milk. The lobar ducts, merging with each other, the excretory ducts open at the tip of the nipple of the breast.

In the region of the border of the halos, the ducts have extensions called the lactiferous sinuses. Around the glandular structures, the space of the breast is filled with adipose tissue, which determines its size and also the shape, along with the development of the glandular lobules themselves. A woman's breast is surrounded by a whole complex of lymph nodes, so when the breast becomes inflamed, they increase in size and are painful. Lymph nodes into which lymph flows from the breast:

• axillary (97% outflow)
• supraclavicular
• subclavian
• peristernal
• mediastinal and bronchopulmonary

What happens to the breast during pregnancy and immediately after the birth of the baby

Synthesis and release of breast milk for feeding the baby starting from the second trimester of pregnancy, when the production of colostrum is gradually activated.

• Colostrum - more like whey than regular milk, with a high protein and fat content, is secreted until the first 2-3 days after the baby is born, and then is replaced by transitional and mature milk.
• Maximum amount of milk matures by 6 - 12 days of the postpartum period.
• Stabilization period- when the formation of the optimal amount of milk allocated for the nutrition of the child occurs, this period lasts for the first 3-6 months of breastfeeding.
• Average duration of lactation ranges from 5 to 24 months.

Why does mastitis occur?

causative agents of mastitis

There are 3 main causative agents of lactational mastitis, first of all:

• 70% of lactating women with mastitis have Staphylococcus aureus
• staphylococcus albus
• streptococcus

As a rule, these infectious agents are resistant to penicillins. Less often, β-hemolytic streptococcus, fecal enterococcus, E. coli, Klebsiella pneumonia, up to 1% of Mycobacterium tuberculosis are sown. Most often, anaerobes are detected, which are mainly represented by staphylococci. Also, epidermal staphylococcus aureus can be sown in the crops, but it is not pathogenic, it enters the milk from the nipples that were not processed before the sowing, and does not cause any purulent process in the chest.

infection

Infection can be both community-acquired and nosocomial - it occurs by contact with infected linen, care items, etc. The prognosis for nosocomial infection will be worse than for community-acquired infection.

Adult carriers- with classic mastitis after childbirth, the source of infection can be latent bacteria carriers (more often from medical personnel, roommates, their relatives), who become ill with mild, erased manifestations of purulent or infectious inflammatory pathologies. It is believed that 20-30% of people are carriers of Staphylococcus aureus.

A newborn - a baby can also become a source of infection, which can be both a bacillus carrier and a patient with inflammatory diseases nasopharynx, oral cavity, pharynx or pyoderma (pustular skin disease).

One hit of Staphylococcus aureus on the skin of the chest is not enough for the occurrence of mastitis, for its development, the presence of provoking factors is necessary:

Local anatomical factors provoking mastitis:

• nipple defects - lobed nipple, inverted flat nipple, etc.
• mastopathy
• rough scars after surgical interventions (severe forms of mastitis in the past, removal of benign neoplasms, etc.).

Systemic functional factors:

• abnormal course of pregnancy- late toxicosis, threats of abortion, premature birth
• pathology of childbirth - blood loss during childbirth, trauma to the birth canal, manual removal of the placenta, first birth with a large fetus
• postpartum complications- bleeding, postpartum fever, exacerbation of concomitant diseases.

A decrease in tissue resistance to the pathogenic influence of microorganisms against the background of a decrease in the work of local and general immunity after childbirth, hypovitaminosis, concomitant pathologies, pathology of childbirth and pregnancy create favorable conditions for the development of mastitis.

The mechanism of occurrence of mastitis

milk stasis

When milk stagnates, it contains a small amount of bacteria that accumulate in the ducts of the gland. Over time, milk coagulates and undergoes fermentation processes, which provokes the destruction of epithelial cells lining the milk ducts and alveoli.

Curdled milk, together with particles of desquamated epithelium, blocks the milk passages, causing lactostasis. With stagnation, bacteria multiply intensively and cause infectious inflammation. An increase in pressure in the chest disrupts the processes of blood circulation - venous congestion. Edema contributes to a decrease in the overall reactivity of the tissue, which creates excellent conditions for the reproduction of bacteria.

Inflammation leads to significant soreness of the breast, which naturally complicates the expression of milk, creating a vicious circle: lactostasis increases inflammation, inflammation exacerbates lactostasis.

Cracked nipples

The infection, as a rule, penetrates through cracks in the nipples, infection is possible during the expression of milk or breastfeeding, less often the infection spreads through the blood and lymph. In 25 - 31% of cases of all mastitis, nipple cracks are also recorded at the same time, which makes it possible to trace the relationship. And although cracks in the nipples are found in 23 - 65% of all lactating women, when mastitis develops only in 3 - 6%, nevertheless, the prevention of the occurrence of cracks serves as a simultaneous prevention of the development of mastitis.

The main reason for the development of nipple cracks is improper attachment of the child - incomplete grasping of the breast by the child. Improper breast care can also contribute to the aggravation of cracks (see).

Often, it is the occurrence of cracks in the nipples, forced pumping (and not thorough emptying of the breast at the same time) that causes lactostasis and, as a result, mastitis.

Diagnostics

If symptoms of mastitis occur, a nursing woman should contact a gynecologist, mammologist or surgeon. After examining the breast and evaluating the patient's complaints, the doctor may refer to the following tests:

• urinalysis and general analysis blood
• bacteriological (number of bacteria in 1 ml) and cytological (number of leukocytes) examination of milk from both glands
• except clinical symptoms, in the diagnosis of the initial forms of mastitis, laboratory studies of the secret of the female breast will be significant. Normally, it has a slightly acidic reaction (pH - 6.8). Inflammation provokes a change in the acidity of milk towards an increase in pH, which can be explained by an increase in the activity of alkaline phosphatase.

To diagnose erased forms of lactational mastitis, use:

• Ultrasound (with destructive forms of mastitis) to determine the exact localization of the purulent area
• thermal imaging, thermography
• in rare cases, mammography is used for serious indications
• puncture of the infiltrate (with phlegmonous and abscess forms) followed by bacteriological research pus.

Mastitis classification

Depending on the clinical signs, the number of leukocytes and bacteria in the analysis of breast milk, there are:

• lactostasis
• non-infectious mastitis
• infectious mastitis

Using only the clinical signs and symptoms of mastitis, it is impossible to determine the absence or presence of infection. In the absence of effective evacuation of breast milk, non-infectious mastitis will develop into infectious mastitis, and this, in turn, can lead to the formation of an abscess. In clinical practice, the following classification of mastitis is used:

In addition, some breast diseases have similar signs as the symptoms of mastitis in lactating women, so it must be distinguished from:

• boils, carbuncles
• abscesses, phlegmon
• erysipelas, which are combined into one concept - paramastitis
• in chronic mastitis, differential diagnosis with (biopsy of suspicious material and its histological examination).

Symptoms

What is the difference between breast engorgement and full breasts? When the breast swells, both lymphatic and venous drainage is difficult, pressure in the milk ducts increases, both breasts swell and swell. A similar picture is with a breast filled with milk, but there are differences:

• breast full of milk- hard to the touch, heavy, warm, but no swelling or redness, and no visible shiny surface, the milk leaks spontaneously from the nipple, the baby sucks easily and the milk flows easily.
• engorged chest- sore, enlarged, swollen, looks swollen and may be shiny, with blurry areas of reddened skin, the nipple sometimes stretches to a flat state, it is difficult for the child to attach to the breast and also to suck, because milk does not flow easily from the breast.

Serous form of mastitis, unlike milk stagnation

Acute inflammation must be distinguished from simple milk stasis, which can be caused by: abnormal structure nipple, short frenulum in a child, improper attachment, underdevelopment of the milk ducts in primiparas, untimely pumping, intensive milk production.

For non-infectious mastitis early stage spontaneous recovery is possible - the seal resolves, the pain subsides, the temperature returns to normal. With an infectious, as a rule, without treatment, the process passes into an infiltrative phase. Doctors advise any severe engorgement of the mammary glands with an increase in body temperature to be considered the initial stage of mastitis in order to start diagnosis and adequate treatment in a timely manner.

There are cases when banal lactostasis occurs with severe soreness of the breast and a violation of the general condition of the woman, then after careful decantation of milk after 3-4 hours, the infiltrate is re-palpated and examined:

• With lactostasis, the temperature decreases, the pain subsides and the condition returns to normal.
• With a combination of mastitis and lactostasis after 3-4 hours, the painful infiltrate is palpable, the condition does not improve, the temperature remains high.

Infiltrative stage

In the absence of adequate treatment, after 2-6 days, the process can move into an infiltrative phase, which is characterized by a greater severity of clinical symptoms, and a worsening of the woman's condition.

• An infiltrate without clear contours forms in the affected breast.
• The affected breast increases, the skin over the infiltrate does not turn red yet and there is no edema yet, an extremely painful affected gland.
• In 80% of patients, body temperature rises to 38.0 - 41.0, with treatment it can be reduced to 37-37.5C.
• Signs of intoxication: weakness, headache, lack of appetite.

In the absence of therapy, the infiltrative form of the disease after 4-5 days passes into a destructive stage, serous inflammation becomes purulent and breast tissue resembles a honeycomb with pus or a sponge soaked in pus.

Destructive - purulent and gangrenous mastitis

An increase in general and local symptoms of inflammation will indicate the transition of the initial forms of mastitis to a purulent stage, while signs of purulent intoxication are well expressed, since toxins come from the focus of inflammation into the blood:

• Body temperature is constantly kept at high numbers, temperature drops of several degrees during the day are characteristic. The temperature of the mammary gland itself also rises.
• Intoxication: appetite decreases, headache, weakness appear, sleep worsens.
• The chest is tense, enlarged, the infiltrate itself increases in size, has clear contours, the skin of the chest turns red, and every day this is more and more pronounced.
• In one of the areas of the gland, symptoms of fluctuation appear (movement of fluid / pus).
• In some cases, there is an attachment of regional lymphadenitis (an increase in the nearest lymph nodes).
• Abscesses can form on the surface or in the deep sections of the gland with subsequent spread.

There are the following forms of destructive mastitis:

• Abscessing - with the formation of cavities of abscesses (cavities filled with pus), while softening and a symptom of fluctuations are felt in the infiltrate zone (overflowing liquid when palpated).
• Phlegmonous - significant swelling of the breast and its massive increase, sharply painful, the skin is bright red, perhaps even bluish-red, there is often a retraction of the nipple. The woman's hemoglobin is reduced and the urinalysis worsens.
• Infiltrative-abscessing- the presence of a dense infiltrate, which includes small abscesses of various sizes. It flows harder than abscessing. The symptom of fluctuation is rare due to the fact that the abscesses are not large and the compaction may seem uniform.
• Gangrenous - an extremely serious condition of a woman, characterized by a fever of 40 - 41º, an increase in heart rate to 120 - 130 beats / min, the breast increases sharply in volume, skin edema is noted, blisters with hemorrhagic contents are determined on its surface, areas of necrosis are determined. Gradually, the edema spreads to the surrounding tissues.

Should you continue or stop breastfeeding if you have mastitis?

As for the preservation of breastfeeding with mastitis, a few decades ago, the recommendations of pediatricians and gynecologists were categorical: interrupt breastfeeding for the period of treatment of mastitis.

Today, the situation has turned 180 degrees and without exception, all breastfeeding specialists demand to breastfeed babies, no matter what. It seems that the truth, as usual, is still closer to the middle, or at least should be based on a set of arguments for and against. It is worth making a distinction between feeding the baby with this milk and maintaining lactation as such:

Preservation of lactation

Lactation should be maintained whenever possible, since a regular outflow of milk is very important, according to some reports, only in 4% of cases, acute mastitis progresses to an abscess or purulent mastitis while maintaining lactation and feeding the child.

Breastfeeding a baby with mastitis

As for breastfeeding the baby, it is worth weighing the risks and benefits for the baby of not breastfeeding against the impact of the mother's treatment. In each clinical case, the issue is resolved individually:

• For non-infectious mastitis, which is not so different from lactostasis, breastfeeding cannot be stopped. Of course, in conjunction with rational pumping (not to the last drop, but if necessary to avoid hyperlactation), soft therapeutic massage and anti-inflammatory therapy (Ibuprofen, Traumeel, ultrasound).
• If we are talking about an infectious process. Here it is necessary to proceed from how pronounced the general condition of the mother suffers (it is difficult to feed with a temperature of 40, wild pains and axillary lymphadenitis).

The second moment becomes purulent discharge from the nipples. Breastfeeding instructors stubbornly prove that pus is just dead bacteria and white blood cells and it is not contraindicated to feed a child with it. But let us object, why is purulent discharge still sown in bacteriological laboratories, getting a good bacterial growth and determining the sensitivity of pathogens to antibiotics? Purulent discharge from the nipples should:

• or pump very thoroughly before feeding
• or become an obstacle to the continuation of breastfeeding for the period of treatment of purulent mastitis.

It is also possible to maintain lactation during the treatment period with the help of regular pumping until the problem is resolved, but during this period to feed the child and then treat for intestinal disorders against the background of staphylococci obtained during feeding, as well as from the effect of antibiotic therapy, is an extremely unfavorable matter for the baby, for a long time. and costly.

Almost all antibacterial drugs, administered to a nursing woman, enter breast milk and into the child's body, having an adverse effect - toxic and allergic reactions, the normal microflora of the gastrointestinal tract suffers.

Depending on the different pharmaceutical groups, some antibiotics easily pass into milk and create high concentrations. active substances, others pass in small quantities, which does not pose a real threat to the baby and therefore are approved for use during breastfeeding.

Conservative treatment

Depending on the condition of the patient, treatment can be carried out both in a hospital and on an outpatient basis. On the initial stages a comprehensive conservative therapy, when:

• the disease lasts no more than 3 days
• the general condition of the woman is relatively satisfactory
• no obvious symptoms of purulent inflammation
• temperature less than 37.5 C
• moderate breast tenderness
• general blood test is normal.

Since the main cause and aggravating factor is lactostasis, it is important to effectively empty the mammary glands, so milk should be expressed every 3 hours, first from a healthy breast, then from an affected one. Mastitis treatment:

• Regular feeding or pumping to resolve lactostasis in combination with massage.
• Broad-spectrum antibiotics for infectious mastitis
• Symptomatic therapy - non-steroidal anti-inflammatory drugs (), antispasmodics ()
• Traumeel gel for non-infectious mastitis.

A day later, with positive dynamics, physiotherapy is prescribed - UHF therapy, ultrasound, they promote the resorption of the inflammatory infiltrate and normalize the functions of the mammary gland. Home treatment involves examining a woman every 24 to 48 hours, in the absence of positive dynamics and response to antibiotic therapy, the woman should be hospitalized.

Antibiotics to treat mastitis

Once lactational mastitis is diagnosed:

• the woman has a high temperature, severe general condition
• there are cracked nipples and signs of mastitis
• the condition does not improve a day after the normalization of the outflow of milk.

antibiotic treatment should be started to ensure optimal results. Even the slightest delay in prescribing therapy will increase the likelihood of abscess formation. The duration of the course of treatment is determined on an individual basis, the average course is 7 days. Groups of antibiotics:

• Penicillins

Penetrate into the milk of a woman in limited quantities. The concentration of benzylpenicillins in milk, compared with the concentration in serum, is ten times less. The same rule is typical for semi-synthetic penicillins. In inflammatory processes, the transition of these components into milk is reduced. A relatively low degree of diffusion into milk is characteristic of broad-spectrum penicillins. The index for penicillins is significantly less than 1.

• Cephalosporins

Data suggest limited passage into milk. The maximum concentration in healthy women, an hour after administration, is 2.6% of the maximum concentration in the blood serum. With inflammation, there is an increase in the passage of the antibiotic into breast milk. There is evidence of poor excretion of second and third generation cephalosporins in breast milk. Despite the fact that the index is also less than one, but its value exceeds that of penicillins.

• Macrolides

Penetrate in relatively high concentrations, reaching an average of 50% of the level in the blood serum. But at the same time, there is no negative effect on the penetration of macrolides into the child's body.

• Aminoglycosides

Most of the representatives do not penetrate well into breast milk, and in low concentrations. But still, official studies have not been conducted, since the drugs are prohibited during pregnancy and lactation due to nephrotoxicity. The concentration in breast milk is 30% of the concentration in the blood, but there may be an effect on the intestinal microflora of newborns.

• Fluoroquinolones

All representatives of this pharmaceutical group pass into breast milk, but strictly controlled studies have not been conducted. The use of drugs of this group during pregnancy and breastfeeding is not recommended, due to high risk toxicity.

Drugs of choice without stopping breastfeeding: amoxicillin, augmentin (amoxiclav with caution if the benefit to the mother predominates over the harm to the baby), from cephalosporins - cephalexin. Inadmissible when feeding a child: sulfonamides, lincosamines, tetracyclines, fluoroquinolones.

Is it possible to make compresses for mastitis, use ointments?

When the first signs of lactostasis or mastitis appear, you should consult a doctor, establish a diagnosis, determine the stage of the disease and discuss treatment options.

Noninfectious mastitis- warming compresses can only be used for lactostasis and non-infectious mastitis in complex treatment. It is possible to use semi-alcohol dressings on the affected area at night, cabbage leaf with honey, burdock leaves, etc. After the compress, the chest is rinsed with warm water. You can also use homeopathic Traumeel gel.

At purulent mastitis warm compresses and the use of ointments may aggravate the course of the disease and are therefore not recommended.

Surgery

Often, despite the active implementation of conservative treatment with antimicrobial drugs, there may be a transition to purulent or destructive stages of about 4-10% of developing mastitis. Such complications require immediate and active surgical treatment, which will be carried out only during hospitalization.

The abscess zone is opened to remove pus from the tissues and the wound is actively washed with antiseptics, followed by drainage. The procedure is carried out under general anesthesia. Also, as an additional study, in order to conduct differential diagnosis, a small fragment of the walls in the abscess area is sent for histological examination, because process can be combined with a malignant neoplasm.

Prevention

Seeing a doctor earlier at the slightest suspicion minimizes the risk of developing purulent mastitis. In the postpartum period, a nursing woman should be carefully monitored for the purpose of early diagnosis of lactostasis and mastitis. Basic prevention:

• Use only comfortable nursing underwear
• Better to breastfeed on demand
• If hyperlactation occurs, express a little milk before feeding
• Attach the baby correctly, monitor the correct grip of the breast by the baby
• Don't shorten your feeding time
• Better to sleep on your side or back
• Feed at night, avoid big night breaks
• Do not overcool the chest and protect it from injury
• Prevent the occurrence of cracked nipples and treat them in a timely manner.

It is mandatory to observe the sanitary and hygienic regime. Timely identify and sanitize foci of infection in the mother's body (carious teeth, tonsils, sinuses).

Non-lactational mastitis is a disease in which an inflammatory process occurs in the mammary gland. Unlike lactational mastitis, it has nothing to do with breastfeeding. That is why this pathology can develop in patients of absolutely any age.

Important! Most often, non-lactational mastitis is encountered by women in whose body hormonal changes occur.

Causes

The most common causes of non-lactational mastitis include:

• excess estrogen and progesterone;
• decreased immunity;
• surgery on the mammary gland;
• the presence of foci of infection in the body;
• severe single chest injuries or minor but permanent;
• hypothermia of the body;
• wearing the wrong bra;
• bathing in ponds with dirty water;
• deficiency of vitamins and minerals.

Important! Non-lactational mastitis never affects both mammary glands at once.

signs

Symptoms of non-lactational mastitis in non-lactating women can vary greatly depending on the form of the disease: acute or chronic.

In the first case, the patient develops severe pain in the mammary gland, which does not have a clear localization. The breast itself may turn red and become swollen. As the disease progresses, the pain moves to the armpit area. In this case, an increase in the size of the lymph nodes is often observed. Body temperature in acute mastitis often increases to 39 degrees, the patient complains of chills, weakness, dizziness, nausea and general malaise. Acute non-lactational mastitis requires an urgent referral to a mammologist and surgeon.

Symptoms of mastitis in a non-lactating woman, if the disease occurs in chronic form are much less pronounced. The general condition in this case will be satisfactory. In the area of ​​inflammation, there may be retraction of the skin, under which there is a dense infiltrate.

If the disease begins to worsen, the fistulous passages may open in a woman, from which pus will subsequently come out (non-lactational purulent mastitis). In some cases, fistulous passages open in the area of ​​the nipple and areola.

Important! Chronic non-lactational mastitis and breast cancer are very similar. That is why, at the first symptoms of pathology, one should not self-medicate, but immediately go to a qualified specialist.

Diagnostics

Diagnosis of non-lactational mastitis can be carried out exclusively within the walls of a medical institution. Before visiting a doctor, the patient must refuse to take any medications (except for vital ones).

Diagnosis of pathology always begins with an examination of the patient, a survey and a thorough collection of her anamnesis. Before treating non-lactating mastitis, your doctor may prescribe:

• clinical blood test;
• gland puncture.

To confirm the diagnosis of "non-lactational mastitis" a woman must undergo a series of studies. During the diagnosis, the doctor must not only confirm the very fact of the presence of the disease, but also identify the reasons for which it arose. This allows you to select the maximum effective method treatment and prevent relapse.

Treatment Methods

The choice of treatment for non-lactational mastitis depends on the causes of the disease, as well as on the severity of the pathological process. In any case, therapy for nulliparous mastitis should be started as early as possible. In this case, it is impossible to use expectant tactics, as in the lactation form of the disease. Otherwise, the woman may face dire consequences.

If the pathology is mild, then the doctor may recommend the patient the use of prescription drugs. traditional medicine and homeopathic medicines.

Without fail, a woman is prescribed antibacterial drugs. The choice of the most suitable of them is carried out by the doctor based on the results of bacterial culture. After taking antibiotics, already on the 2-3rd day, signs of mastitis in a non-nursing woman may partially or completely disappear. However, this does not mean that the course of treatment should be interrupted. It is necessary to use medicines within 7-10 days, otherwise the woman will face a relapse.

Important! Unfortunately, antibiotics negatively affect not only pathogenic bacteria, but also the healthy human microflora. That is why, in order to avoid the development of dysbacteriosis, the patient must use probiotic preparations throughout the course of treatment and for some time after it.

For elimination pain for mastitis in a non-nursing woman, analgesics can be used. To eliminate the inflammatory process, a specialist may prescribe drugs from the NSAID group.

Advice! To accelerate the elimination of toxins from the body and eliminate the unpleasant symptoms of non-lactational mastitis, the patient should drink at least 2 liters of water per day.

In severe cases, surgery may be required. In this case, the surgeon opens the lesion, cleanses it of pus and drains it.

Surgery for non-lactational mastitis is performed under general anesthesia or using local anesthesia(depending on the extent of the proposed surgical intervention). At the end of the procedure, a suture is applied to the chest. In this case, special cosmetic threads are used, so a woman may not worry that scars or scars form on her chest.

Important! In smoking patients, body tissues are much worse saturated with oxygen than in those who lead a healthy lifestyle. This can adversely affect the wound healing process. Therefore, during treatment and during the rehabilitation period, it is better for a woman to give up addiction.

After the main therapeutic measures are taken, the patient is prescribed hormonal drugs. Their choice is based on the age, height, weight and phenotype of the woman. You need to take these medicines for several months.

To prevent relapse, a specialist may prescribe immunostimulating drugs, as well as vitamin and mineral complexes.

Forecast and prevention

With timely treatment of non-lactational mastitis, the prognosis is quite favorable. However, if therapy is not started on time, then a woman may face complications such as:

• abscesses of internal organs;
• inflammation of the lymph nodes;
• transition to a chronic form (with acute mastitis in a non-nursing woman);
• sepsis.

Prevention of the disease includes timely treatment various diseases, the implementation of measures aimed at strengthening immunity, normalizing hormonal levels and preventing injuries to the mammary gland.

In addition, you need to go for preventive examinations to the mammologist. He will be able to detect the pathological process at the earliest stages, because he knows the symptoms and treatment of non-lactational mastitis in non-lactators better than other specialists.

> Mastitis

This information cannot be used for self-treatment!
Be sure to consult with a specialist!

What is mastitis?

Mastitis is inflammation of the breast tissue. This pathology occurs most often in women during lactation. The lactation form is especially often diagnosed in the first 90 days after birth. But mastitis can also develop in pregnant women, nulliparous girls (non-lactational form) and extremely rarely in men.

The main causes of the development of the disease

The main causative agent of mastitis is Staphylococcus aureus, which penetrates the mammary gland through skin lesions, as well as cracks and abrasions on the nipples. Participation in inflammatory processes and other microorganisms is possible.

Immunodeficiency states, traumatization of the nipples due to inept or incorrect attachment of the child to the breast, acute or chronic lactostasis (milk stasis), damage to the skin predispose to the development of such a pathology.

The clinical picture of mastitis depends on the form in which it occurs, acute or chronic. In the development of acute mastitis, three stages are clearly defined: serous, infiltrative and destructive.

Stages of development of acute mastitis

In the serous stage, a woman begins to be disturbed by pain in mammary gland, an increase in its size, the appearance of a feeling of fullness and a violation of the outflow of milk from the ducts. Gradually, the patient's condition worsens: the body temperature rises (up to 39 degrees or more), there is a sharp weakness, body aches. A day after the onset of the disease, local signs of acute mastitis are determined: sharply painful foci of compaction begin to be felt in the mammary gland. The skin above them is hyperemic.

If left untreated, serous mastitis passes into an infiltrative stage, in which seals in the chest progressively increase, thicken, acquire clear contours, and become sharply painful. The woman's condition is getting worse. The temperature often reaches 40 degrees, while antipyretic drugs are ineffective. Sleep, appetite are disturbed, regional lymph nodes are enlarged.

After another 24-48 hours without treatment, the infiltrative stage passes into one of the destructive forms: abscess (purulent fusion of breast tissues occurs), phlegmonous (limited purulent foci form at the site of seals), gangrenous (total suppuration of breast tissues with transition to neighboring areas) . At the destructive stage of mastitis, the woman's condition is extremely difficult, often there is a violation of consciousness.

Features of the chronic process

Chronic mastitis develops as a result of inadequate treatment acute form when the patient's condition improves during therapy, general symptoms. At the same time, foci of compaction and inflammation remain in the mammary gland, touching which can cause pain. Often marked purulent discharge when pressing on the nipple.

Diagnosis, treatment methods and prevention

The diagnosis of acute mastitis is not in doubt. For its setting, it is enough to examine the patient. In the chronic form of the disease, it may be necessary to conduct an ultrasound of the mammary glands, mammography and a general clinical blood test.

Treatment of mastitis in the serous and infiltrative stages is carried out by conservative methods, which include the use of antibiotics, anti-inflammatory, antipyretic drugs. During the treatment period, it is necessary to provide the mammary gland with an elevated position, it is desirable to minimize milk production as much as possible. But you should not refuse feeding, as it helps to reduce congestion in the chest. In destructive forms of acute mastitis, urgent surgical intervention is indicated.

The chronic variant of the disease begins to be treated with anti-inflammatory drugs, physiotherapy, restorative drugs. If they fail, surgery is performed.

Prevention of mastitis is to prevent injury to the mammary gland and the appearance of cracks, as well as to ensure a normal outflow of milk.