You should not be in pain while pumping, so let’s troubleshoot the reason you are in pain.

A Deeper Look:

While you may feel discomfort or mild tenderness the first week or so of pumping, if you are experiencing pain in your breasts whether you are actively pumping or not, please contact your healthcare professional.  Even if you only have pain while you pump, it is still a good idea to contact your healthcare professional.  However, if your pain is occurring only while you are pumping, it’s likely an easily fixable issue!

The following is a non-exhaustive list of possible reasons you are feeling pain while pumping:

• You are pumping at too high of a level of suction
• You are not using the correct flange size
• You are feeling discomfort from friction
• You are experiencing sensations associated with your let-down
• You may have thrush
• You may have previous nipple damage that has not yet healed
• You have elastic nipples
• You are experiencing nipple blanching or nipple vasospasms

Suction Level
Stronger is not always better!  Just as everyone’s body is different, every nipple varies in sensitivity.  A strong suction may work well for one mama but it may not for another.  You should use the suction strength that you feel comfortable with.  A high suction can cause swelling and blockage of the milk pathways and may injure the tip of your nipple.  For more information on how to pump, click here.

Flange/Breast Shield Size
What is a flange? It’s the part of the breast pump that comes into contact with your breast and nipple.  It is generally a funnel shape.  Just like a bad latch for those that nurse, using the wrong size flange can cause pain, irritation, inefficient milk removal and other issues.  For more information on finding the correct size flange, click here.

Friction
If you suspect you are experiencing discomfort because of the continual rubbing of your nipple against the flange tunnel, and you have already determined you are using the right size flange, you may benefit from adding lubrication to your pumping routine.  There are lubricants designed for this purpose, but olive oil or coconut oil work just as well and are generally more affordable.  Apply a little bit of oil to your nipples before placing your flange to your breast or rub a small amount (a little goes a long way!) to the flange tunnel.  Please note, that for some individuals who have elastic nipples (see below), the use of lubrication may cause even more of the areola to be pulled into the flange tunnel. 

Let-downs
When you have a let-down, it may feel like an ache, pins and needles, a tingling sensation, or a sudden feeling of fullness in your breasts.  Not all mamas feel their let-down, but for those that do, they may start to feel their let-down in the first few weeks after giving birth as regular pumping establishes the let-down reflex.  Even within a pumping session, a mama may feel her first let-down strongly but each subsequent let-down may be less noticeable.  Accompanying the sensations of a let-down may be feelings of warmth, relaxation, sleepiness, sudden thirst, hunger, or itchiness near your breasts.  If you have recently given birth, a let-down may result in feelings of uterine cramping, which can encourage the movement of vaginal blood flow.  For more information on let-downs, click here.

Thrush/Yeast Infection
Thrush is a yeast infection of the nipples. It may cause you to experience shooting pains in the breast or nipple discomfort while pumping.  Other symptoms of thrush you may experience include: cracked nipples, a shiny bright red rash on the nipples, peeling or flaky nipple skin, and/or a burning or itching sensation.  Check with your healthcare professional for treatment.

Previous Damage to Nipple
Perhaps you were working on getting your baby to latch, you were using the wrong flange size, or you were using too high of a suction strength—whatever the reason, you are in pain while pumping now and pumping is aggravating your nipple while it is trying to heal.  You may try cool packs or ice packs for relief after pumping, gel pads to help heal and protect sensitive nipples when you are not pumping, and olive oil or coconut oil on your nipples when pumping to reduce any friction.

Elastic Nipples
You may have elastic nipples if your nipples stretch to the end of the flange tunnel while pumping.  However, elastic nipples are not cause for concern unless they are causing you pain or problems while pumping.  It is also possible that you may not be in a properly fitting flange, which, just like elastic nipples, may cause too much areola to be pulled into the flange tunnel.  Elastic nipples can cause significant pain and ineffective milk removal.  For more information on elastic nipples, click here. 

Nipple Blanching or Nipple Vasospasms
Nipple blanching—the name for when a nipple turns white—occurs when blood flow to the nipple is cut off, such as through compression.  A vasospasm is a more severe, sudden constriction of the blood vessels in the nipple that causes an intense stinging, burning, or shooting pain and a color change in the nipple.  Cold can make the vasospasm worse.  Pumping may induce a vasospasm.  Sometimes, the vasospasm is due to nipple trauma but it can also occur as a result of a syndrome known as Raynaud’s Phenomenon.  Addressing the source of the trauma to your nipple may resolve the vasospasm.  However, until you have addressed the source of the problem, warm heat is should help, as it should relax the constricted blood vessels (think: blow dryer, warm washcloth, rice heating pad).  

The EP&Me Take:

I pumped in pain every day, all day, for the about the first four months of my Little’s life.  Every time I pumped I would grit my teeth to help with the pain.  I thought the pain was normal.  I believed the pain was just what happened when you had to pump instead of nursing.  As it turns out, I was using the wrong size flange.

I planned to nurse my Little during my maternity leave, and practice pumping only once it was almost time to return to work.  So when my Little did not latch well at the hospital, and the lactation counselor suggested I rent a breast pump, I was woefully uninformed about anything to do with pumping.  I trusted that when the counselor informed me I should use a size 24mm that I was, in fact, a size 24mm!  It never occurred to me that there might be more flange sizes than the two included in the Medela kit provided by the hospital and that perhaps the lactation counselor only picked the size 24mm flanges because the only other size included in the kit was size 27mm.

I pumped using those size 24mm flanges for three and a half months until one day, while perusing a forum for new mothers, I learned that pumping should not hurt and that improper flange sizes were a common culprit for pain.  I was shocked, sad, frustrated, bewildered, and angry.  I wondered how it was that I was unaware pumping was not supposed to cause pain.  I then wondered how I was supposed to know that pumping shouldn’t be painful—these weren’t the kinds of conversations that were randomly discussed by my friends and I hadn’t even thought to ask anyone because I thought it was NORMAL.  After this revelation, I started to look at the nipple rulers and then into the companies you could pay to size your nipple for the proper fitting flange.  Although I felt sure that I was using the wrong size flange, I didn’t feel confident in picking the right size even after using the nipple rulers, so I paid one of the companies to size me (at that time I also planned to transition to the Willow pump and wanted to order the correct pieces, so I was very motivated to get the proper size).

After I was sized, it was recommended that I try a size 17mm flange on both sides.  I ordered the flanges and was disappointed to find I was still in pain.  The pain was not any worse than I was used to, so I continued to pump with the new flanges and nearly two weeks later, the pain started to improve.  I realized then, that I had still been in pain because my nipples were damaged and needed to heal.  Looking at my nipples, I realized how swollen they had been.  I even decided to try size 15mm flanges, and as it turns out, the right size for me is 15mm AND 17mm—Yes! Two different sizes!—a far cry from 24mm.  I am a 15mm on my left and a 17mm on my right.  While I think I probably needed a 15mm on both sides one the swelling reduced, for some reason (perhaps only a psychological one), I liked the 17mm on the right side.  I was finally pumping without pain.

In addition to fixing my flange size, I decided I was not going to deal with the intense suctioning anymore and reduced the suction level I used for the majority of a pump session from a 9/10 while in expression mode to a 4/5.  When I first made the switch I had to work a bit harder to empty my breasts, but after a few weeks, my body responded well to the lower suction.  Between having properly fitting flanges and training my breasts to empty to a lower suction, I was on cloud nine.  I will never call pumping pleasant, but it certainly was much easier, and I dreaded it a whole lot less.

A side note on nipple damage:
Even though I went home from the hospital with a pump, my Little and I worked on nursing for a number of weeks.  Although we were ultimately unsuccessful in our endeavor—which of course was why I became an EPer—we successfully managed to tear up my nipples in the process.  I used the Ameda Comfort Gels to help heal my nipples and protect them when I wasn’t pumping or trying to nurse, and I thought they helped a lot. I hope you are able to troubleshoot the source of your pain and find a pain-free path forward. Good luck mama!