Nipple Fissure

What are nipple fissures?

Nipple fissures are painful cracks in your nipple that can appear in one or both breasts. Anyone can get them, but fissures most often result from breastfeeding (chestfeeding). Nipple fissures can become so painful that they may prevent you from nursing even if you’d prefer to continue. Luckily, several home remedies and lifestyle changes can ease unpleasant symptoms and heal nipple fissures.

Who do nipple fissures affect?

You’re most likely to have a nipple fissure if you’re nursing, especially if this is your first time. In the beginning, your baby may struggle to latch onto your breast correctly, causing your nipples to become tender, painful and cracked.

Athletes — most commonly joggers, cyclists and surfers — get cracked nipples, too. “Jogger’s nipple” is another term for nipple fissures and affects long-distance runners especially.

How common are nipple fissures?

Eighty to 90% of breastfeeding mothers or gestational parents experience nipple pain and fissures. Symptoms often appear during the second or third week after your baby is born.

Are cracked nipples normal?

No. Nipple fissures are common, but they’re not normal. A cracked nipple is a sign that there’s too much strain on your nipple tissue. Taking steps to prevent further injury while helping the tissue heal can prevent complications associated with nipple fissures.

What are the symptoms of a nipple fissure?

With a nipple fissure, pain or soreness usually accompany a tear in your nipple.

What does a cracked nipple look like?

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

What does a cracked nipple feel like?

• Raw, chafed and dry.
• Irritated, itchy, sore or painful.

Sometimes a nipple fissure is a symptom of another condition called thrush. Thrush is a fungal infection in the mouth and is common among newborns. The fungus can spread to your nipple while you’re nursing, causing a fissure. If you already have a fissure, thrush can worsen it. Your healthcare provider can prescribe antifungal medication to treat thrush.

What causes a nipple fissure?

Nipple fissures mostly appear during pregnancy or afterward once you begin breastfeeding. Less commonly, they result from friction during exercise or a skin condition.

Pregnancy and breastfeeding (chestfeeding)

Changes in your body during pregnancy and, especially, improper nursing techniques usually cause nipple fissures. Causes include:

• Engorged breasts. During pregnancy, your breasts can become overly filled with milk. The excess fluid can cause your nipple tissue to stretch and eventually crack.
• Improper nursing technique. Usually, nipple fissures appear because your baby isn’t latching onto your breast to nurse correctly. Your baby may struggle to get enough milk, putting more strain on sensitive nipple tissue as they try to feed.
• Breast pump misuse. You can develop nipple pain and fissures if the suction settings on your breast pump are too high or if you’re using the wrong size flanges (breast shields).

Other causes of nipple fissures

• Friction during exercise. The friction created when sweaty skin comes into contact with your workout clothes can cause your nipple to crack during intense exercise. Joggers and cyclists experience nipple fissures. Surfers can get them when their exposed nipples repeatedly brush their surfboards. The effects are often worse when it’s cold, and your nipples are erect.
• Skin conditions. Products like soap, lotion, and laundry detergent may contain chemicals that cause an allergic reaction when they make contact with your skin. A skin condition called eczema can also cause your skin to become dry and cracked. These skin changes can cause nipple fissures.

How are nipple fissures diagnosed?

Your healthcare provider can diagnose your nipple fissures during a physical exam.

How are nipple fissures treated?

You can treat fissures at home unless you experience complications like an infection or a fissure that won’t heal.

Treating fissures caused by breastfeeding (chestfeeding)

Healing nipple fissures often involves implementing proper nursing techniques. Getting your baby to latch onto your breast with a full mouth encircling the dark tissue surrounding your nipple (areola) can ease pressure on the nipple itself. An asymmetrical latch protects the nipple. A lactation consultant can show you how.

It’s also important for a trained professional to evaluate your baby’s mouth to determine why they’re having difficulty latching properly. Often a condition called a tongue tie makes it difficult for your baby to latch properly and use their tongue correctly.

Positioning yourself comfortably so that you don’t have to change positions while you’re nursing can allow your fissures to heal, too.

If nursing is too painful, you can:

• Limit the amount of time you nurse and supplement by pumping.
• Alternate breasts so that you’re not putting too much strain on any one nipple.
• Pump and bottle feed for a few days or longer while your nipples heal.

Consult with your provider or a lactation expert about how long you should pump and how to use a breast pump correctly to prevent nipple soreness.

In addition to ensuring that you’re breastfeeding correctly, you can:

• Apply gentle over-the-counter creams and ointments. Applying small amounts of Lanolin, Purslane cream, diluted peppermint oil or Menthol essence on your nipples can soothe nipple pain from fissures and encourage healing. Wipe off any antiseptic creams or lotions before you nurse.
• Rub a small amount of your milk onto your fissures. The milk from your body has antibacterial properties that can moisturize nipple fissures and help cracks heal.
• Allow your nipples to air dry. Using creams and ointments while allowing your nipples to air dry can promote healing while keeping your nipples from getting overly moist. Overly moist nipples are prone to tear. Wear bras with pads made out of breathable fabric. Consider going topless when possible.
• Wear breast shells in between feedings. Breast shells can prevent any painful friction between your nipples and your bra while your fissures are healing.
• Massage engorged breasts to relieve pain. If your breasts are so full of milk that it’s hard for your baby to latch, consider pumping first to ease pressure and encourage lactation. You can also perform reverse pressure to soften the nipples and make it easier for your baby to latch.
• Apply warm compresses or gel pads to relieve pain. Gel pads for your nipples can soothe your pain and promote healing. A homemade warm towel compress can promote healing while easing sore nipples, too.

Treating other fissures

Treating nipple fissures related to exercise involves:

• Using antiseptic cream to prevent infection.
• Changing up your exercise routine while your nipples heal.
• Covering your nipples with soft gauzes or waterproof bandages to protect them from frequent contact with your workout clothes.

If a skin condition causes your fissures, you should avoid products containing harsh chemicals that may be causing a reaction. Topical creams and antiseptics can help your nipples heal.

What are the complications of a nipple fissure?

Untreated nipple fissures can lead to:

• Bleeding. A cracked nipple can become so irritated that it begins bleeding.
• Infection. Bacteria can enter your body through a nipple fissure. In some instances, bacteria that enter through a nipple fissure can form an abscess and lead to lactational mastitis. In addition to prescribing antibiotics, your healthcare provider may have to lacerate and drain any abscesses.

How can I prevent nipple fissures?

Prevent nipple fissures by using proper nursing techniques and preventing too much friction between your nipple tissue and your workout shirts or bras.

Preventing fissures from breastfeeding (chestfeeding)

Consult your healthcare provider or a lactation coach before attempting to nurse for the first time. They can teach you:

• Correct positioning. You shouldn’t have to reposition yourself or shift your body while your baby is nursing. Your baby should not have to turn its head to find your nipple.
• Correct latching. Your baby should nurse with a full mouth over your nipple and most of your areola. This way, the sucking doesn’t place too much pressure on your nipple.

Preventing friction during exercise

To prevent nipple fissures caused by friction during exercise, you can:

• Wear fabrics made of soft material, specially designed to prevent skin injury.
• Wear well-fitted exercise clothing, including a sports bra that’s snug but not too tight.
• Avoid wearing bras with seams covering your nipples when you’re exercising.
• Moisturize your nipples with petroleum jelly or balm before exercising in extremely cold weather or running long distances.
• Apply waterproof tape or gauze over your nipples before putting on a shirt or bra.

What can I expect if I have this condition?

Nipple fissures are sore and painful, but they’re treatable. Addressing what’s causing the problem and pampering your nipples while they heal can help.

How long does a nipple fissure last?

Nipple fissures may take anywhere from a few days to a few weeks to heal, although the soreness may improve much sooner.

When should I see my healthcare provider?

Contact your healthcare provider if:

• Your fissures are not healing with home remedies alone.
• You notice signs of an infection, like a warm nipple, swelling in or around your nipple, oozing, inflammation, tenderness or redness.
• Nipple pain or nipple fissures are interfering with your ability to nurse or pump.

A note from Cleveland Clinic

Nipple fissures are unpleasant, but you can usually heal them without visiting your provider’s office. Learn about proper breastfeeding techniques before you leave the hospital with your newborn to prevent fissures. If you’re having trouble nursing your baby, don’t hesitate to reach out to your provider or a lactation consultant for help.