Bleeding Nipples is in most cases a benign condition with a variety of different causes. However it is a source of extreme anxiety for many females due to fear of it as being a sign of breast cancer. It is usually caused due to certain benign medical conditions like intraductal papilloma or duct ectasia. In very rare cases, Bleeding Nipples point towards breast cancer. There are several diagnostic tools available to identify a cause for Bleeding Nipples which include ultrasound, exfoliative cytology, and galactography to name a few but these tests do not provide conclusive diagnosis and even may give false negative results in some cases.[1]
Some studies have opined that ductal lavage along with cytology are quite effective in giving a conclusive diagnosis for Bleeding Nipples, although these studies are quite limited. The frontline treatment option for Bleeding Nipples depends on the cause and in some cases involves surgery to remove the area from where the discharge emanates. This form of treatment has proven to be extremely effective in controlling the discharge.[1]
Bleeding Nipples is quite common in females but males also may get it at times. The causes for Bleeding Nipples can be associated with breastfeeding but certain infections and medical conditions also tend to cause Bleeding Nipples. This article explains in detail the various causes of bleeding nipples.[1]
The etiology for bleeding nipples can be divided into breastfeeding and non-breastfeeding causes.
Breastfeeding Causes for Bleeding Nipples
Breastfeeding: The process of breastfeeding itself is a primary cause for Bleeding Nipples. This is because of severe irritation of the skin that occurs during breastfeeding. This causes severe pain while breastfeeding and can result in Bleeding Nipples. Studies suggest that nipple pain can also occur as a result of poor positioning of the baby while breastfeeding. This causes the baby to latch out to the nipples causing pain and bleeding.[2]
If a female has an inverted nipple then it also causes nipple pain and resultant Bleeding Nipples. Some of the other causes of nipple pain include infections, psoriasis around the nipple area, and dermatitis. Scientists suggest that lying down when breastfeeding may alleviate nipple pain and manage Bleeding Nipples.[2]
Nipple Thrush: Oral thrush is a common fungal infection seen in newborn or breastfeeding infants. This infection may get transferred to the mother from the child while breastfeeding causing Nipple Thrush. This results in severe irritation in the nipple area causing Bleeding Nipples. A baby with oral thrush will have patches of skin that are red in color that will be very painful and make the infant cry incessantly.[2]
The presenting features of a nipple thrush include severe pain in the nipple, flasking of the skin around the nipple and alveolar region. The female will also experience pain in the breasts. A female with nipple thrush will have to make certain dietary and lifestyle modifications to clear the infection away. Sugars and refined carbohydrates will have to be completely eliminated from the diet until the time the infection clears. A consultation with a physician will also be helpful to hasten the process of healing with medications.[2]
Mastitis: This is a common condition seen in breastfeeding females where the milk ducts become wide. This at times may result in Bleeding Nipples. Some of the risk factors for mastitis include being overweight, having a known diagnosis of diabetes, and having a history of smoking prior to being pregnant.[2]
The best way to treat mastitis is to drain the excess milk present in the milk ducts so that they can get back to their normal size. It is also helpful to apply warm compresses before and after every feeding to help with the pain that is caused due to mastitis. Some females will need antibiotics to treat mastitis.[2]
Non-Breastfeeding Causes For Bleeding Nipples
Duct Ectasia: This is one of the most common causes for Bleeding Nipples in females who are in their 40s. In this condition, the milk ducts become blocked resulting in infection. Apart from Bleeding Nipples, a female with duct ectasia will have pain along the breast with tenderness. There may also be inversion of the nipples.[2]
Some females notice a lump behind the nipple due to duct ectasia. If the milk ducts get infected then the female will require antibiotics for treatment. Otherwise, applying warm compresses to the affected region can effectively treat the condition and control the symptoms.[2]
Dermatitis: This is yet another cause for Bleeding Nipples. Dermatitis occurs as a result of skin inflammation. It results in the development of scaly itchy rashes along the nipples or the surrounding alveolar region. Skin irritation is the primary cause of dermatitis, although certain infections or an allergic reaction may also cause this condition.[2] Dermatitis can also occur as a result of fabric that irritate the skin or to which the patient is allergic. It can also be triggered due to use of certain soaps and detergents. Avoiding these products and having a knowledge about which fabric can irritate the skin can help a great deal in preventing nipple dermatitis.[2]
Intraductal Papilloma: These are benign tumors that form in the milk ducts and are also quite a common cause for Bleeding Nipples. There may be a solitary lump around the breast in most cases of intraductal papilloma but in some cases there may be numerous small lumps which are spread all over the breast.[2]
There is no age prevalence in the development of this condition but are mostly observed in people between the ages of 30 and 50. Very rarely, it is seen in males. There are certain risk factors which increase the likelihood of an individual developing intraductal papilloma. These risk factors include use of contraceptive pills, hormone therapy, or a family history of this condition suggesting a genetic link.[2]
Cancer: This is a rare but definitely a cause for Bleeding Nipples. However, if this is the only symptoms then it may signify breast cancer. Additional features that may present along with Bleeding Nipples in cases of breast cancer include presence of a noticeable lump that may continue to grow in size. There may also be swelling and pain along the breasts. If these are the symptoms observed by a female then an urgent consultation with a physician is required to look for the presence of breast cancer.[2]
Paget Disease: This is another rare cause of Bleeding Nipples. This disease presents itself with development red scaly rash which are quite similar to psoriasis in their characteristics. This rash will be present on the nipples and cause bleeding. The individual will also feel soreness around the nipples.[2]
In most cases, Paget disease is associated with breast cancer and hence of a physician suspects that the patient has this condition then a biopsy will be ordered to look for the presence of any malignancy.[2]
In conclusion, Bleeding Nipples is commonly caused due to breastfeeding but there are certain other medical conditions that can also cause it to occur. Infection, tumors, allergic reactions, and skin irritation are the most common causes of Bleeding Nipples. In extremely rare cases, Bleeding Nipples may signify breast cancer. Bleeding Nipples can make a female extremely anxious due to fears of having breast cancer. However, there are many tests available now which can rule in or rule out conditions which can cause Bleeding Nipples.[1,2]
The treatment of Bleeding Nipples depends on the underlying cause. Benign conditions like breastfeeding, irritation of the nipples, or nipple thrush can be treated with over the counter medications or changing the positioning of the baby while feeding. However, if more serious pathology is suspected by the physician then further tests may have to be done to find out the cause and formulate a treatment plan for the patient to manage Bleeding Nipples.[1,2]
For cases where infections or allergies cause Bleeding Nipples then antibiotics may be prescribed to clear the infection and steroid creams will be given for treatment of allergy symptoms.[1,2]
In some instances surgery may have to be done to control Bleeding Nipples and associated symptoms. This is usually done in people where normal conservative treatments are found to be ineffective. The surgery will involve excision of the damaged part of the nipple or the surrounding structures which are believed to be responsible for causing Bleeding Nipples.[1,2]
