Cracked Nipples (Nipple Fissures)

Nipple fissures are painful cracks in your nipple that can appear in one or both breasts. Most people with this issue say they have “cracked nipples.” You’re most likely to have cracked nipples if you’re breastfeeding, especially if this is your first time.

Cracked nipples can become so painful that they may keep you from nursing even if you’d prefer to continue. You might feel worried, frustrated or ready to give up. But cracked nipples are common and treatable with home remedies. And they don’t have to stop you from breastfeeding. Lactation consultants can teach you ways to adjust your nursing technique to protect your nipples.

In this article, we focus on cracked nipples related to breastfeeding. But it’s important to know there are other causes, too. For example, friction from clothes can irritate and crack your nipples. This happens to runners and cyclists, and it’s known as jogger’s nipple. Cracked nipples can also occur from skin conditions like eczema.

Symptoms of cracked nipples

The main symptoms of cracked nipples are pain or soreness along with a split in your nipple’s surface. Symptoms often appear during the second or third week after your baby is born.

A cracked nipple can look:

• Crusty, with flaky skin or scabs on or around your nipple
• Red and dry, sometimes with more pronounced redness at the tip
• Darkened or changed in color

A cracked nipple can feel:

• Raw, chafed and dry
• Irritated or itchy
• Sore or painful
• Like it’s splitting

Cracked nipple causes

Too much strain on your nipple tissue can cause cracks to develop. Common causes of such strain include:

• Engorged breasts: This is when your breasts swell up from extra fluid volume. It’s common in the first week after giving birth. The swelling can cause your nipple tissue to stretch and eventually crack.
• Improper latch: If your baby isn’t latching on well, they may struggle to get more milk. This puts more strain on sensitive nipple tissue. Many things affect your baby’s latch — from their position at your breast to medical conditions like tongue-tie.
• Breast pump issues: You can develop nipple pain and fissures if the suction setting on your breast pump is too high. Using the wrong size flanges is another possible cause.
• Frequent non-nutritive suckling: This is when your infant latches on and suckles for comfort, rather than for milk.

Complications of this condition

Without treatment, cracked nipples can open up and bleed. It’s also possible for germs to enter the cracks in your skin, causing bacterial mastitis or an abscess.

How doctors diagnose this condition

Your healthcare provider can diagnose cracked nipples during a physical exam. They may suggest you see a lactation consultant or breastfeeding medicine specialist.

It’s not too difficult for your provider to identify nipple fissures. But the cause isn’t always so obvious. Providers will talk with you and may observe a breastfeeding session. They may also examine your baby’s mouth to check for issues like tongue-tie.

Knowing what’s causing your cracked nipples can help you and your provider treat them. This is because soothing the damaged skin will only help temporarily. You may need to make some changes to your breastfeeding technique to keep the fissures from coming back.

How are nipple fissures treated?

You can treat cracked nipples at home by:

• Applying nipple balm that doesn’t contain lanolin: You can buy this at your local store. Apply it liberally. Be sure to look for lanolin-free formulas. Lanolin is derived from sheep’s wool and may cause an allergic reaction, further irritating your nipples.
• Applying MediHoney®: This is a gel that can help heal your nipples. But don’t be misled by the name. This is a special medical formula with sterilized honey. Never apply honey from a jar to your nipples while breastfeeding as it can cause botulism in infants.
• Using warm compresses and/or hydrogel nipple pads: These can soothe nipple pain and promote healing.
• Using unscented soaps, shampoos and conditioners: This won’t directly treat cracked nipples from nursing. But scented products could cause contact dermatitis on your already irritated nipples. So, opt for fragrance-free whenever possible.

While your nipples heal, you might find nursing painful. It may help to alternate breasts so that you’re not putting too much strain on either nipple. You may also choose to pump and bottle feed as your skin heals. A lactation expert can advise you on how long to pump and how to use the pump correctly to prevent nipple soreness.

Your lactation expert may also suggest changes to your breastfeeding technique. For example, they can help you with:

• Position: You shouldn’t have to reposition yourself or shift your body while your baby’s nursing. Your baby shouldn’t have to turn their head to find your nipple. Small position changes can help reduce strain on your nipple.
• Latch: Your baby shouldn’t just suckle on your nipple. Their mouth should cover your entire nipple and most of your areola. This way, the suckling doesn’t place too much pressure on your nipple.
• Pumping: Setting the suction too high can hurt your nipples. Finding a comfortable yet effective level of suction eases strain on your nipples. It’s also important to use the correct flange size.

A proper position and latch can help your nipples heal and protect them from future damage.

How long do cracked nipples last?

It can take anywhere from a few days to a few weeks for cracked nipples to heal. But the soreness may improve much sooner.

When should I see my healthcare provider?

Contact your healthcare provider if:

• The cracks in your nipple aren’t healing
• Your nipple feels swollen or warm to the touch
• You have flu-like symptoms
• Your symptoms are making it hard to nurse or pump