Introduction
Breast milk production is common in women and individuals born with a female sex (AFAB). After delivery, the discharge of blood-stained maternal milk is an uncommon occurrence, with an estimated prevalence rate of 0.1 percent.
The mother and the medical personnel may get anxious or concerned about this unusual occurrence. Several conditions, including intraductal papilloma (a benign tumor located within a milk duct), mastitis (an infection-related inflammation of the breast tissue), trauma, and damaged nipples, can cause bloody nipple discharge during lactation.
However, pregnant and postpartum women may experience painless bloody nipple discharge due to a rare physiological condition called "rusty-pipe syndrome." Rusty pipe syndrome is the name given to a breastfeeding condition in which the breast milk appears pink, orange, brown, or rust-colored, resembling soiled water emerging from an old rusty pipe.
Usually, colostrum, or initial breast milk, is mixed with a tiny bit of blood to give the rusty color. The first few days of nursing are typically when the rusty-colored milk first shows. The condition usually resolves independently within three to seven days following the start of lactation. In some situations, this illness lasts for the first few weeks of lactation before being left alone.
What Is Rusty-Pipe Syndrome?
If a woman presents with painless, bloody nipple discharge during pregnancy or breastfeeding, the differential diagnosis should include "rusty pipe syndrome," an uncommon, benign, and self-limiting physiological disease. Rusty pipe syndrome is caused by elevated vascularization of rapidly expanding alveoli with a delicate capillary network. Nipple bleeding is caused by the capillaries in the nipples being easily damaged. Primiparous women (which implies a lack of prior delivery experience) are more likely to have this condition if they have bilateral painless nipple discharge during delivery, no indications of breast inflammation, and no history of trauma. The syndrome might start during pregnancy, early nursing, or at the moment of delivery. Unilateral breast involvement may occur at the outset of the condition.
What Causes Rusty-Pipe Syndrome?
Blood that has been left behind in the milk ducts due to vascular breast engorgement is the cause of rusty pipe syndrome. Blood or other fluid fills a vascular engorgement in a particular body area. To get ready for nursing, women's breasts undergo numerous changes during pregnancy. The breast milk-producing glands and milk ducts expand and mature quickly, significantly increasing the blood supply to the breasts. During the initial few days of breastfeeding, some blood remains in the milk ducts and leaks out.
There are several other reasons why women may notice blood in their breast milk (either during the initial days of breastfeeding or later) in addition to rusty pipe syndrome.
Among them are:
1. Bleeding Nipples: The most frequent reason for blood in breast milk is sore, cracked nipples, which are frequently the consequence of an inadequate breastfeeding latch.
2. Breast or Nipple Damage: The breast blood vessels may be damaged by an injury, a breast pump, or the infant, which could result in blood seeping into the milk ducts and breast milk.
3. Mastitis: A bloody discharge from the nipples, soreness, and swelling are all possible symptoms of a mammary infection.
4. Papillomas: Although they are not dangerous, these tiny growths in the milk ducts have the potential to let blood into the breast milk.
5. Breast Cancer: Usually, there is no reason to be concerned if there is blood in the breast milk. However, some types of breast cancer can result in nipple bleeds.
Is Bloody Nipple Discharge During Pregnancy Normal?
The breast undergoes numerous changes during pregnancy, including size growth, the beginning of milk production, preparation for the breastfeeding stage, tenderness and soreness, etc. However, it is not normal to still bleed through the nipple when pregnant. There is no need to worry if they appear during pregnancy and have some blood leaking from them. Bloody discharge during pregnancy is extremely common, though it is rare. Pregnancy causes a rapid increase in blood flow to the breasts, which can alter the dynamics of the breast's epithelial cells and cause a bloody discharge from the nipple. This type of discharge is more likely towards the conclusion of the second or beginning of the third trimester.
Can Bleeding Nipples Affect Baby?
Feeding a baby from a bleeding nipple is generally pretty safe. But, since the unborn child can get sick, this is not advised for mothers with hepatitis B or hepatitis C.
How to Diagnose Rusty-Pipe Syndrome?
The medical history and standard physical examination are the foundation for the first "rusty pipe syndrome diagnosis, " which is confirmed by specialized investigations if needed.
These examinations may include:
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Cytological examination of the bloody discharge to rule out the existence of cancerous cells.
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Mammography of the breast could aid in ruling out additional medical disorders. Early after the postpartum period, diagnostic imaging should be used to assess persistent bloody nipple discharge. When a nursing woman is being examined, ultrasound is advised as the first diagnostic imaging method.
What Are the Treatment Modalities for Rusty-Pipe Syndrome?
It takes a week for rusty pipe syndrome to go away independently, so women do not need to take action.
Treatment is not required. In this period, women can:
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Keep nursing the infant or pumping breast milk for them.
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Keep an eye out for any vomiting or upset stomach in the baby.
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Make sure the situation is improving by keeping a watch on it.
There are a few remedies for nipples that are bleeding or damaged.
That could be managed by:
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After feeding, apply some warm water or breastmilk to the nipples and allow them to dry.
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Try to keep the nipples dry.
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After feeding, carefully massage pure lanolin onto the nipples; replace the breast pads frequently.
Conclusion
Though rare and innocuous, "rusty pipe syndrome" during pregnancy and lactation can cause concern among the mother, carers, and medical professionals; after lactation begins, it normally goes away in three to seven days. It is a self-limiting condition. If there is bleeding for longer than a week, the discharge needs to be checked more closely to rule out papillomas. It is imperative to raise awareness among medical professionals about appropriate counseling and management of this benign illness to prevent mothers' anxiety and needless investigations.
