BellaOnline Forums Health and Fitness Breastfeeding Breast Thrush for months - please help!

I have been having breast thrush for months and still not able to cure it, please help!

I was given antibiotic (both oral and inject) when Alex was born. After about 2 weeks of pain free breastfeeding (except for engorgement!) my breast start hurting like hell and I noticed there's white spots in Alex mouth. So we were treated with:
Alex - Nystatin suspension
Me - Clotrimazole cream
Since I was breastfeeding, I asked if I needed to wipe it off before feeding and was it sufficient just to apply it twice per day for such a short period. The doctor said it'd be sufficient if the cream has been on for more that half and hour and I should wipe the cream off. So I followed the instructions and the situation improved slightly. After 2 weeks, the doctor stopped Alex's medication as the spots in his month had cleared.
I was still in pain so I seeked help from breastfeeding councilor. She gave me leaflet to show to the doctor. I did and the doctor gave me:
Alex - Nystatin suspension
Me - Miconazole and Fluconazole 100mlx2 for the 1st day and 50mlx2 for the remaining 9 days.
I had the Fluconazole for 14 days ( I had the Miconazole for 3 days and it get extremely itchy as soon as I applied it, so I changed to use the Clotrimazole instead) and when I went back to request for more, my doctor was on leave so I was refer to another doctor. He looked at my record and decided that my thrush was cured (dispite I was still in pain!) and believed that I had Mastitis instead (although I didn't have any red spots on my breast or flu like symptoms). Anyway, he's the doctor and he asked me to stop the Fluconazole and gave me antibiotic.
A few days after I stop the thrush medicine, the pain intensified and I went back to the doctor but he refused to gave me thrush medicine as he didn't believe that it's thrush (as I didn't have cracked nipple!) and asked me to take pain killer only.
I think the doctors are incompetence so I changed to another medical centre last week. I told her my concern of wipping the cream off for feeding and not able to have it on for long enough. So she gave me:
Alex - Nystatin suspension
Me - Miconazole oral gel (so I don't need to wipe it off!)
I have had it for 4-5days (I myself decided to used Miconazole cream during night as they are designed to penetrate the skin!) but again after using it for a few days, my nipple become very itchy and hurt more than before! (I think I'm allergic to the cream!)
I'm using the oral gel only at this moment but I don't believe that it'll help as I read that it's not designed to penetrate the skin. I'm slowly reducing breastfeeding and hope that once I don't need to breastfeed, I can concentrate on treating the thrush and much easier to keep my breast dry. And don't need to worry about transferring the thrush back to Alex.

I don't know what I should do now. My breast hurt and the doctor doesn't seem to know how to deal with it. Please could anybody help?! Any successful cases of treating thrush, please give me some tips please!

Danna

My daughter went through this for an extended period about a year ago. It is torture, but it eventually goes away. Our ob-gyn prescribed the fluconazole. My daughter kept fluconazole on hand and used it when she felt a flare-up. (She could always tell when it was flaring up.) It took somewhere around 10 treatments of fluconazole. In addition, she AND the baby were given Nystatin. Also, we treated the baby with widely spaced applications of gentian violet.

Gentian violet is an old remedy but very effective. It is rarely used any more because, if over-used, it has potential bad side effects. Also, people don't like that it stains the baby's mouth (and anything else it touches) deep purple. It sure does work, though; and the baby's mouth is only purple a couple of days. It was available over-the-counter when we needed it--hope it still is. You dip a cotton-tip applicator (one with a long stick so it can't accidentally be swallowed) into the bottle and swab the inside of the baby's mouth. One application should be all it takes for at least two weeks. It can also be used as a topical treatment for yourself. You should however read about it before using it.

Another topical treatment to try is soaking your breasts in a solution of vinegar water--no more than 1/2 vinegar. My daughter found that treating thrush both topically and orally was the best solution.

After my daughter was over this problem, we discovered that we could have gotten a special solution from our local breastfeeding clinic. This solution is supposed to be great, but I don't know what's in it. Check your area for such a clinic! It would certainly be worth the drive.

In our experience, most doctors are not as familiar with this malady as one would wish. It's such a rare problem, I think they do not see it enough to have treatment down pat. We have only met one other person who had this problem, if that tells you anything.

I really hope you won't let this keep you from continuing the breast feeding. Now that my daughter has gotten beyond those first awful months, she is very glad she continued. Although, she too went through times of considering quiting.

Thanks Cela. I'd like to ask a few more questions if I may.
- You've mentioned that your daughter took fluconazole when she felt a flare-up. Does it mean that she didn't take the fluconazole continuously? I thought one course of treatment should be at least 10 days?
- The pain seems to come and go. Everytime when the pain came back, I thought it meant the medicine was not working. But it sounds like it's quite normal in your daughter's case. So does it mean that I should continue the medication despite the pain coming back?
- Did your daughter try Miconazole cream? In my case the breast become increasely itchy and painful after applying the cream (the 3rd day!). I wonder if I'm allergic to it or if it's normal?
- I wash my clothes with the 90oC setting in my washing machine. Is it sufficient to kill the thrush?
- How important it is to throw away all the bottles and teats which has come in contact with thrush contaminated expressed milk?
- Since I live in the UK but not the US, I don't know whether I can get the 'solution' you've mentioned.
Thanks again for your help!

Danna--I'm putting my daughter on to talk to you here:
Hi, I'm so sorry you're going through this. I know how difficult it is. I would encourage you to stay strong and continue despite the difficulty. Thrush is stubborn, but you can beat it. My baby is now 13 months old, and he is still breastfeeding. Despite the horrific pain I went through during the thrush months, I'm so glad that I continued. It's worth it.
On to your questions.
--I took the full course of fluconazole treatment multiple times. I would take a course of the medication and then I would wait a few days and start another course. At the end of my thrush experience, I think I had gotten 9 or 10 refills on my prescription. Thrush is known for being a difficult infection to treat, so you have to continuously treat it. You also need to keep treating it for at least two weeks after you think it's gone.
--It is very normal for the pain to come and go for a few months. Just continue treatment. If you continue treatment, the flareups will become less and less severe.
--I am allergic to Miconazole (at least for vaginal use). I would not be surprised if it created a problem of increased pain in breasts as well. I would stop using it in favor of Niastatin and vinegar/water treatments. Also an occasional round of gentian violet on the nipples is helpful.
--That 90 degree C is certainly hotter than I washed my clothes, so, your clothes are probably fine.
--I didn't express milk for my son, so I can't answer that from personal experience. However, I have a friend who has had thrush, and she expressed milk for her babies. I believe she just made sure to sterilize the bottles by washing them in very hot water. She also has to pasteurize any milk that she expresses and freezes while she has the infection.
--Have you searched for a lactation specialist or a breastfeeding clinic in your area? They often know a lot more than other clinics about treating thrush. Even a midwife might have some good advice if you have access to one.
Another thing that I found was that disposable nursing pads irritated my skin further. I ended up using washable pads once I figured that out.
I so hope this helps you. The pain of thrush is HORRIBLE. The worst part is that it seems like it will never end, but it will. Good luck to you, and feel free to ask any questions.

Danna,

This sounds a lot like what I experienced with my first baby. Interestingly, what I had did NOT end up being thrush.

First of all.. there is an outstanding online handout that I link to in the "challenges and problems" section of this website on Nipple Pain and Yeast -BellaOnline ALERT: Raw URLs are not allowed in these forums for security reasons. Please use UBB code. If you don't know how to do UBB code just post here for help - we will help out!

Danna,

I also meant to explain a little more that the APNO includes all three of anti-yeast med, antibiotic and a steroid cream. That way, it doesn't really matter if it is yeast, antibiotic, irritation/dermatitis or some combination of all three (sometimes one can prevent the others from being effectively treated), it will knock it out.

I healed VERY quickly once I started using the APNO. I used it again early on with my second baby when I was incredibly sore just from the start of nursing, and it helped right away and I never went down that road. I really do think it would help you if you can find someone to prescibe and compound it. Incidentally, if you can find a pharmacy to fill the ingredients in the proper amounts, you can just compound it yourself by buying a sterile container (a urine specimen container your doc probably has would work really well) and mixing it up yourself will work according to a pharmacist in my family!

Nicki :-)

Danna,

I also just found what you wrote about the sterilizing. You absolutely can "reinfect" yourself easily by not sterilizing bottles/nipples, etc. Also, your nursing bra would have it if you are not using disposable pads. However, your mention of nipples and teats makes me think you are pumping and feeding expressed milk, and brings me back to wondering if you are having skin irritation as I did and not thrush at all? Pumping can definitely lead to contact dermatitis.

Nicki

I'll have to second the recommendation for Gentian Violet. My nurse-midwife prescribed it for three days and said to use it once, every 24 hours for 3 days and then stop. It knocked it out! The thrush responded SO quickly it was amazing.

I hope you discover what is wrong and are able to resolve the issue. Hang in there, Momma!

Angela <><

I'm entering the conversation a little late, but hopefully not too late to help.

Thrush is an overgrowth of candida (yeast) and can become systemic, and with some work, it is curable. Antibiotics are the best little helpers in the world for creating systemic candida.

Here is my article on Systemic Candida - I hope it helps!

Shay