How to Tell the Difference Between Engorgement vs Mastitis

*Disclosure: I only recommend products I would use myself and all opinions expressed here are our own. This post may contain affiliate links that at no additional cost to you, I may earn a small commission. Read full privacy policy here.“

As a breastfeeding momma, there’ve been plenty of nights where I searched the internet with questions about engorgement vs mastitis. Especially as a new mom to my first baby. So if you have stumbled across this post from doing the same, I want to start by saying yes, breastfeeding is hard. Yes, your breasts are made to do this but that does not take away the stress, frustration, or feelings of devastation that can come with it. And if you are struggling in any way with your breastfeeding journey, please know you are not alone. 

With that being said, I hope this post can help inform and empower you through your journey in Motherhood. 

What Is Engorgement?

To put it as simple as I can, engorgement is when your breasts get too full of milk. During the first few days after birth this is completely normal as your body figures out how often baby needs to fed and how much baby will eat. During the first few days / weeks your milk flow may be all over the place until your supply is established. It’s especially easy to see how one could confuse the two. However telling the difference between engorgement vs mastitis comes down to the symptoms, causes and even treatment.

Causes of Engorged Breasts

As I mentioned above, the weeks after birth your body is doing a lot of adjusting, as are you and baby. Babies are not born knowing how to breastfeed properly. Some may catch on pretty quickly while others struggle in the beginning. Even when your newborn has caught on to breastfeeding there may still be some days that go better than others.Especially during the beginning. This fluctuation in production can cause engorged breasts. 

Other reasons you may get engorged would be to baby not emptying the breast during a feed. Additionally if your baby misses a feeding. Like perhaps they slept through the night for the first time. Or baby’s eating habits have changed, maybe eating less or more due to teething or a growth spurt. 

Signs & Symptoms of Engorged Breasts

If you’re wondering, can engorgement cause pain? The answer to that would be an astounding yes. Breasts can get so full that they are hard, swollen and very painful. If they are severely engorged your breast will become hard, shiny, warm and lumpy. As for your nipples, engorged nipples feel like a lumpy painful mess as well. Often becoming flat and tight. Which, for anyone wondering, feels completely different from if baby bites your nipple while nursing.

What Is Mastitis? 

Mastitis is an inflammation/infection within the breast tissue. Most common in breastfeeding women, but mastitis can also affect non – breastfeeding women and men. Mastitis can be very painful and if left untreated will create large amounts of puss around the breast tissue. This may result in a surgical procedure being needed to remove the abscess. 

Causes of Mastitis

Depending on what you read, you can find quite a few different causes of mastitis. But ultimately mastitis is a result of bacteria found on the skin and saliva making its way to the breast tissue through a milk duct or crack in the skin. This typically happens from a blocked milk duct in a lactating woman. Being under a lot of stress (which new mom isn’t?) places moms at an increased risk of mastitis. As does having a low iron count. 

Signs & Symptoms of Mastitis

The signs and symptoms of mastitis are often very similar to a blocked milk duct. Only affecting one breast, sometimes a red wedge-shaped mark will develop. I’ve personally experienced red streaking radiating from the affected breast. I also experienced flu-like symptoms such as body aches, a fever and was extremely fatigued. Other symptoms of mastitis can include: 

• Overall feeling of unwellness.
• Nipple discharge, nausea, headaches and chills
• Nausea
• Headaches 
• And chills. 

Breast Engorgement vs Mastitis: How to Tell the Difference 

I’ve been in the same painful position you are, so I know there’s probably one BIG question on your mind: how do I know if I have engorgement or mastitis? As a mom who was once new to breastfeeding I can understand the confusion when it comes to knowing the difference between mastitis and engorgement. Confused as to whether you need antibiotics or a hot towel to soothe the soreness in your breast, because as we all know the quicker we can get the right treatment the better.  

But knowing what to look for can help alleviate a lot of unnecessary stress and potentially stop mastitis from developing. Since prolonged engorgement can lead to a clogged milk duct which ultimately causes mastitis, getting treatment quickly is critual. 

First know the signs of mastitis vs engorgement. While engorgement is painful and can cause a lot of discomfort, it typically does not come on overnight nor does it have flu like symptoms similar to the ones I listed above.

Additionally a hot towel, increased feedings and a breast massage will soon soothe  engorged breasts vs mastitis most likely will require a doctor’s visit. 

Does Engorgement Lead to Mastitis?

While one or two occurrences of engorgement is no cause for worry, such as what is typically within the first few days after birth. If your baby is not emptying your breast well for a prolonged period, getting some assistance from a location consultant may be necessary. I say this because prolonged engorged breast can lead to a blocked milk duct and then potentially mastitis. So the quicker we can get baby draining the breast the better for everyone. 

What’s the Difference Between Engorgement and a Clogged Duct?

One of the more common complaints for breastfeeding mommas is a blocked milk duct. Often the cause of prolonged engorgement, a blocked milk duct feels like a hard lump or wedge within the breast. It can move locations as baby feeds, and the pain can be mild to moderate. Decreasing after feeding. Unlike mastitis, a blocked milk duct is not warm to the touch or show any signs of redness in the affected area. Additionally symptoms of a blocked duct gradually appear and may include: 

• Breast discomfort centralized to one spot. 
• Decreased milk being produced during pumping.
• Stringy or fatty looking lumps in expressed milk.

Does Mastitis Make Your Breast Hard?

Mastitis while breastfeeding can be super frustrating and cause some extreme pain. Accompanied by tenderness of the breast, mastitis causes a lump in the breast tissue. This lump or wedge will be hard and painful. And in some cases it can even be hot and swollen. While engorgement does not cause your breast to get hard this is yet another difference of engorgement vs mastitis.

How I Recovered from Mastitis  

I’ve breastfed five children over the course of 11 years at the writing of this post. In this time I have dealt with mastitis three times. Once with my second child and twice with my last. As I’ve mentioned above the symptoms literally happened over night. I went to sleep with a hard lump in my breast, thinking it was a clogged milk duct. I massaged it with a warm towel before bed. Not getting any relief I decided I would try to pump in between feedings in the morning. 

However, by the time morning came that lump had turned into so much more. It hit me like a ton of bricks each time. I was extremely tired, had a really bad headache and couldn’t breastfeed my child without being in a lot of pain. The first time I ever dealt with mastitis I had no idea what to do. But by the third time I was prepared and got over it without a trip to the doctor. 

What worked for me when treating my mastitis

The name of the game is to try and keep your breast as empty as you can. The fuller your breast gets, the more pain you are in. At least that is what  happened to me. So outside of feeding my son more often than I typically would, I also tried to pump in between nursing. Nothing major, I just tried to make sure I pumped for at least 5 -8 minutes on each breast each time. 

Massaging my breast really seemed to help. What worked best was taking a hot shower before the massage. Pointing the shower head directly on my breast I would massage the lump in a downward motion while the hot water ran down my breast. Once I finished in the shower, using a warm towel I continued to massage my breast for as long as I could tolerate it. Massage can be done manually or with a wide toothed comb. Using oil, HPA Lanolin or soap can help the comb glide smoothly.

Staying hydrated, getting lots of rest and eating well also helped a ton. Each time I experienced mastitis, how long it lasted varied. The first time being a little over a week with me having to get antibiotics from my doctor. While this last time was maybe two days with no appointments or medications needed. 

Tips to Prevent Both Engorgement and Mastitis

Outside of the engorgement most new moms face directly after birth, other reasons you could be experiencing it are baby starting to sleep longer stretches, baby transitioning to solids and not feeding as often or reintroducing breastfeeding after bottle. Which can undoubtedly come with its own sets of challenges. 

And while most of these situations are out of your control, there are ways to prevent engorgement and mastitis during these times. In the beginning when you and baby are just learning how to latch, feed, and empty the breast properly, your body is also learning how much milk it needs to produce. One way to prevent engorgement directly after birth is to make sure to  initiate feeding in a timely manner. So at the first sign of hunger cues, if possible. I personally like to have a timer/alarm. Feeding my newborns every 2-3 hours during the day and every 3-4 at night. 

Seeking help with positioning and latch during feeding is another way to prevent engorgement. Lactations consultants typically work in hospitals and are available 24/7 if assistance is needed. If you’re having a home birth your midwife can offer advice and assistance in the days following your birth as well. Most make home visits! 

Finally, having a well fitted, loose bra does wonders. I can’t tell you how uncomfortable I was with my first trying to figure out breastfeeding and dealing with a wired nursing bra. I hated it! Later on I also learned that tighter fitting bras (or bras that put pressure on the breast) can cause engorged breasts or a clogged milk duct. Yet another reason to grab some super soft and super comfy nursing bras that allow for easy unrestricted nursing. 

Conclusion

Most of the preventative measures I listed above can work just as well for mastitis, engorgement or a clogged duct.  However, wherever you find yourself on your breastfeeding journey, dealing with mastitis vs engorgement or even a clogged milk duct, remember to: 

• Rest when baby rest 
• Nurse from the affected breast first 
• Moist heat, such as a warm washcloth, and massage before and after feeding will help decrease pain 
• Same as above (moist heat and massage) during a nursing session to help drain any blockage in the ducts
• Pumping in between feeds if possible 
• Cold compresses after nursing to help with swelling 
• And pain medications / anti-inflammatory meds can help too (consult your doctor first) 

Breastfeeding is a beautiful thing, but that does not mean there aren’t pros and cons to it. There are days where your patience will be tested, you’ll long for control of your body back and you’ll definitely wish you could sleep like your S.O. sleeps for just once. All in all though, once this journey has come to an end you’ll hopefully look back fondly and be proud of the sacrifices you made. And enjoy the amazing bond you’ve created with your little one.