What are nipple fissures?

Nipple fissures are irritated, cracked, or sore nipples. They are a common occurrence among women who are breastfeeding. Many women cite nipple fissures as their reason for discontinuing breastfeeding. Nipple fissures are sometimes called jogger’s nipple because it’s also common in runners and other types of athletes who are prone to nipple chaffing, such as surfers or cyclists.

Unless infection occurs, nipple fissures can usually be treated easily at home.

Symptoms

Nipple fissure symptoms can occur in one or both nipples. Symptoms vary in severity and duration. The main symptoms of nipple fissure typically include:

  • redness
  • soreness
  • chafed, dry appearance
  • crustiness or scabbing
  • oozing
  • bleeding
  • open cracks or sores
  • pain or discomfort

Learn more: Why do my nipples hurt? »

Causes

In breastfeeding women, nipple fissures are usually caused by incorrect positioning while nursing, or difficulties with suction or latching on. They can also be caused by engorgement of the breasts.

In athletes, nipple fissures are caused by chaffing of the nipples. In runners and cyclists, this may happen if their shirt isn’t snug and moves freely, causing irritation to their nipples. It may be made worse by coarse or damp fabric, or during cold weather when the nipples are more likely to be erect. Irritation can become more pronounced on longer runs, leading to open sores, oozing, or bleeding.

One study found that nipple fissures are also more common among athletes who run for longer distances. The study found a large increase in incidence of nipple fissures among athletes who ran more than 40 miles (65 kilometers) per week. Jogger’s nipple is less likely to occur in athletes who wear snug, sweat-wicking shirts, or well-fitting bras for women.

In surfers, nipple fissures can occur from the friction of their nipples rubbing against the surfboard.

Home treatment

In most cases, you can treat nipple fissures at home.

Home treatment for athletes

You may need to take a break from certain activities while your nipple fissures heal. Consider cross-training as you heal, which will help you stay active without further irritating your nipples.

  • Use an antiseptic cream on your nipples. That can help prevent infection while your nipples heal.
  • Consider applying an over-the-counter (OTC) balm to your nipples, like lanolin.
  • Avoid activities that can cause additional irritation.
  • Cover your nipples with a soft gauze pad while wearing shirts to avoid further irritation.
  • Avoid wearing rough or scratchy shirts. If you’re a woman, avoid bras with seams over the nipples.

Home treatment for breastfeeding women

There are many safe things breastfeeding women can do to treat this condition.

  • Apply an OTC ointment to your nipples after breastfeeding. La Leche League International, a breastfeeding organization, recommends Lansinoh lanolin. You only need to apply a small amount each time, so a tiny tube can last you a long time. The product is safe to use while breastfeeding.
  • Bathe the nipples with warm water after each feeding. Applying moist, warm compresses to the area will also help it heal. You can purchase pads specifically designed for the breast and nipples, or you can make your own compress by soaking a soft towel in warm water, and then applying the towel to your nipple. Avoid dry heat.
  • If your breasts are engorged or your nipples are very irritated, express some milk before breastfeeding and gently rub the expressed milk into your nipple. Breastmilk can help soften your nipple and may provide some antibacterial protection to the area. Expressing can also help to reduce engorgement and relieve irritation
  • Apply peppermint oil to your nipple. One small study indicated that peppermint oil, also known as menthol essence, was more effective than breastmilk in aiding the healing process when applied to nipple fissures.
  • Use a nipple shield to help protect the area while healing takes place.
  • Eliminate products that might further irritate your nipples, and opt for fragrance- and chemical-free or organic soaps and lotions.

Complications

If left untreated, nipple fissures can lead to lactational mastitis, or inflammation of the breast. Mastitis can cause a breast abscess to form, which might require incision and drainage to treat.

Breast infections can also be aggravated by the yeast Candida, especially in breastfeeding women. Yeast thrives in breastmilk. So if you or your baby has thrush, a common type of yeast infection that’s often seen in infants, rinse your nipples in warm water after breastfeeding to remove excess milk. Thrush can cause cracking, pain, and itching to occur, which can make nipple fissures worse.

Read more: How to treat thrush while breastfeeding »

Seeking help

If nipple fissures don’t go away with treatment, are very painful, or look infected, make sure to get checked by your doctor. If you have a yeast infection, you may need an antifungal medication, in either topical or oral form.

If you’re breastfeeding, remember that it’s normal for breasts to feel sore during the early days of breastfeeding. Talk to your doctor or your child’s pediatrician if you’re having trouble breastfeeding and need support. They can offer tips to help make it more comfortable and, if needed, recommend a lactation coach. Many hospitals also have lactation coaches on staff who can work with you right after you give birth.

Prevention

If your nipple fissure is caused by chafing fabric, altering the type of garment you wear while exercising will eliminate the problem. Here are a few other things you can do while exercising:

  • Apply waterproof tape or bandages over your nipples before exercising, especially if you’re going for a long run. That will help reduce friction and irritation.
  • Apply petroleum jelly or an anti-chafing balm to your nipples before you begin your exercise routine. That will help soften your nipples and keep them from drying out, which can increase your risk for irritation.
  • Wear close-fitting, sweat-wicking shirts while exercising.
  • If you’re a surfer, wear a tight-fitting rash guard or wetsuit to reduce friction on your nipples from your surfboard.
  • For women, avoid wearing bras with seams over the nipples, and avoid loose-fitting sports bras.

If the issue is caused by breastfeeding, proper positioning and latching should help. There are several positions you and your baby can try. No matter what position works best for you, always make sure to bring your baby up to your nipple height to avoid slouching. This will help your baby latch on correctly and may alleviate nipple soreness. Here are some other positioning techniques to try:

  • Make yourself comfortable. Be sure to have enough back and arm support so your body remains relaxed. Foot support can also help eliminate fidgeting, which can disturb and move your baby during feeding.
  • Position your baby with their hips flexed so they don’t have to turn their head in order to reach your breast.
  • Make sure your breast isn’t pressing down on your baby’s chin. Their chin should jut into your breast.
  • Help your baby latch onto your breast by gently opening their mouth wide and supporting their back instead of the back of their head. Their nose should be touching, or almost touching, your breast.
  • Support your breast with your free hand. This will help reduce its weight on your baby’s chin.
  • Make sure your baby has latched onto your whole nipple, with part of the areola included.
  • If your baby isn’t latched on comfortably, or you feel discomfort or pain, gently place your finger in their mouth to help them reposition.<

Outlook

Nipple fissures can cause a lot of discomfort, but they aren’t usually a serious medical condition. If your nipple fissures don’t improve with home treatment or they begin to get worse, see your doctor. It’s possible to develop an infection.

You should also talk to your doctor if you want to breastfeed, but nipple fissures are making it difficult to continue nursing your baby. In many cases, nipple fissures from breastfeeding can be prevented by adjusting the way you position your baby while breastfeeding.