Nipple pain – symptom, causes & risk factors

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nipple pain causes

This is a type of pain, which happens in the breast tissue around the area of nipple. The nipple pain can be associated with other signs and symptoms, such as skin changes, itching, breast lump or mass, nipple discharge and breast pain. The nipple pain can be sensation of burning, throbbing, tingling, tenderness or aching. It can happen also in males, but it is more common in females [1]. The nipple pain can include the nipple and the areola, which is the ring of pigmented skin around the nipple. There could be different causes for nipple pain, but most of them are not serious. In most cases, nipple pain comes from some sort of trauma to the nipple and sometimes this trauma can be subtle and tricky to recognize. You should remember what you have been doing before the nipple pain started, so you will help to identify the real cause for it.

Symptoms of nipple pain

The nipple pain may accompany other symptoms and they depend on the underlying cause. Also, some symptoms that affect the nipple can involve other body systems.

Nipple or breast symptoms that may happen along with nipple pain:

The nipple pain can be accompanied by other symptoms affecting the nipple, such as

  • Skin discoloration, such as bruising
  • Bleeding from the nipple
  • Retracted nipple
  • Breast lump
  • Redness, warmth or swelling
  • Breast tenderness rash or sore on the breast or nipple; itching or cracking
  • Breast tenderness
  • Nipple discharge
  • Hardened area within the breast
  • Change in the look and feel of the skin of the breast, such as puckering or dimpling
  • A change in the size, shape or appearance of the breast

Other symptoms that may happen along with nipple pain:

Nipple pain can be accompanied by other symptoms related to other body systems, such as

  • Nausea with or without vomiting
  • Fever

Symptoms that may indicate a serious condition:

There are some cases when the nipple pain can happen with other symptoms that may indicate a serious condition. The breast abscess can be a complication of mastitis and if it is left untreated, then it can spread into the bloodstream and cause sepsis and potentially leading to organ failure. If you have some of the below mentioned symptoms, then seek immediate medical care:

  • Significant decrease in urine output
  • The confusion or loss of consciousness for even a brief moment
  • Shortness of breath
  • Fainting or change in level of consciousness or lethargy

nipple pain causesCauses of nipple pain

The nipple can happen as a normal symptom of the menstrual cycle as breasts and in some cases nipples in particular, become more sensitive with changes in hormone levels of estrogen and progesterone [2]. The irritation or surface abrasion caused from friction with fabric if you do not wear a bra or if you wear an ill – fitting bra can lead to nipple pain [3]. The breastfeeding is also another common cause for nipple pain [4]. Your nipples can easily become cracked and dry. If the nipple surface becomes cracked, then bacteria can enter and it can lead to an inflammatory disorder, which is causing breast pain and additional nipple pain.

Friction causes of nipple pain:

In some cases, nipple pain can be caused by abrasions due to the friction, including:

  • Wearing an ill – fitting bra [5]
  • Not wearing a bra, particularly during exercise or physical activity
  • Rough handling

Physical causes of nipple pain:

Physical changes can lead to nipple pain, such as

  • Onset of puberty [1]
  • Breast – alteration surgery [6]
  • Inverted or prominent nipple (normal constriction that can cause positional friction in some cases)
  • Breastfeeding [3,4]
  • Hormonal changes during the menstrual cycle [1]
  • The drying or cracking of the nipple or areola

Disorder – related causes of nipple pain:

There are some cases when the nipple pain can be a symptom of specific disorder, such as

  • Eczema [7]
  • Candidiasis [8]
  • Breast abscess or Zuska’s disease (this is a rare condition of abscesses around the nipple)
  • Galactocele (this is a benign tumor in the breast)
  • Breast and nipple inflammation (known as mastitis)
  • Galactorrhea (this is a spontaneous discharge of milk in a non-breastfeeding woman) [9]
  • Contact dermatitis [10]

References:

[1] Harvard Men’s Health Watch. Breast disorders in men. Harvard Health Publishing. 2007. Retrieved from www.health.harvard.edu/mens-health/breast_disorders_in_men

[2] Goyal A. Breast pain. BMJ Clinical Evidence. 2014;2014:0812.

[3] Giugliani ERJ. Common problems during lactation and their management. Jornal de Pediatria. 2004;80(5).

[4] Cadwell K, Turner-Maffei C, Blair A, et al. Pain reduction and treatment of sore nipples in nursing mothers. Journal of Perinatal Education. 2004;13(1):29–35. doi:10.1624/105812404X109375

[5] Wood K, Cameron M, Fitzgerald K. Breast size, bra fit and thoracic pain in young women: a correlational study. Chiropractic & Osteopathy. 2008;16:1. doi:10.1186/1746-1340-16-1

[6] Urits I, Lavin C, Patel M, et al. Chronic pain following cosmetic breast surgery: A comprehensive review. Pain and Therapy. 2020;9:71-82.

[7] Amir L. Eczema of the nipple and breast: A case report. Journal of Human Lactation. 1993;9(3).

[8] Jimenez E, Arroyo R, Cardenas N, et al. Mammary candidiasis: A medical condition without scientific evidence? PLoS One. 2017;12(7):e0181071. doi:10.1371/journal.pone.0181071

[9] Huang W, Molitch ME. Evaluation and management of galactorrhea. American Family Physician. 2012;85(11):1073-80.

[10] Feroze K, Manoj J, Venkitakrishnan S. Allergic contact dermatitis mimicking mammary paget’s disease. Indian Journal of Dermatology. 2008;53(3):154–5. doi:10.4103/0019-5154.43210

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