What is the treatment for breast engorgement?

Treatment of Breast Engorgement

For lactating mothers with breast engorgement, cold cabbage leaves applied to the breasts are likely the most effective first-line treatment, reducing pain, breast hardness, and potentially extending breastfeeding duration, though the evidence quality is limited. 1

Primary Treatment Approaches

Cold Cabbage Leaf Application

• Cold cabbage leaves reduce breast pain more effectively than routine care (reduction of 1.03 points on 0-10 VAS scale) and may be more effective than cold gel packs (reduction of 0.63 VAS points) 1
• Cold cabbage leaves reduce breast hardness compared to routine care (reduction of 0.58 VAS points) 1
• Room temperature cabbage leaves are more effective than hot water bags for reducing engorgement (reduction of 1.16 points on 1-6 scale) 1
• Women report significantly higher satisfaction with cold cabbage leaves compared to routine care (42% more satisfied) or cold gel packs (23% more satisfied) 1
• Application technique: Place chilled cabbage leaves directly on engorged breasts, replacing when wilted; continue until symptoms improve 2
• Duration of breastfeeding may be extended by 6 days (36 vs 30 days) with cabbage leaf treatment 2

Cold Gel Pack Application

• Cold gel packs reduce breast hardness compared to routine care (reduction of 0.34 points on 1-6 scale) 1
• Evidence for pain reduction with cold gel packs alone is uncertain 1
• Women's satisfaction with cold gel packs is similar to routine care 1

Alternating Hot and Cold Compress Therapy

• Alternating hot and cold compresses significantly reduce engorgement, pain levels, and improve infant latch compared to no intervention 3
• Hot compresses applied before feeding help milk flow, while cold compresses after feeding reduce swelling 3
• This approach shows statistically significant improvement in LATCH scores and overall breastfeeding assessment 3

Alternative Treatment Options

Herbal Compress Treatments

• Herbal compresses reduce breast pain more effectively than hot compresses alone (reduction of 1.80 VAS points) 1
• Massage therapy combined with cactus and aloe compress reduces pain more than massage alone (reduction of 1.27 VAS points) 1
• Cactus and aloe cold compress reduces breast hardness by 34% compared to massage alone 1
• Caution: 2 out of 250 women (0.8%) experienced skin irritation with herbal compress treatment 1

Scraping (Gua-Sha) Therapy

• Gua-Sha therapy targeting acupoints ST16, ST18, SP17, and CV17 significantly reduces breast temperature, engorgement, pain, and discomfort levels 4
• Technique: Lightly scrape each acupoint position seven times in two cycles 4
• Effects are measurable at 5 and 30 minutes post-intervention 4
• More effective than traditional hot packs and massage for all measured variables except body temperature 4

Medical Treatments (When Non-Pharmacologic Measures Fail)

• Protease enzymes may reduce breast pain (83% reduction in risk) and breast swelling (66% reduction in risk) 1
• Serrapeptase may reduce engorgement risk by 64% compared to placebo 1
• No adverse events reported with protease or serrapeptase use 1

Treatment Algorithm

1. First-line approach: Apply cold cabbage leaves to engorged breasts, replacing when wilted 1
2. If cabbage leaves unavailable or ineffective: Use alternating hot (before feeding) and cold (after feeding) compresses 3
3. If symptoms persist: Consider cold gel packs for breast hardness 1
4. For refractory cases: Trial herbal compresses or Gua-Sha therapy if available and patient is willing 1, 4
5. If non-pharmacologic measures fail: Consider medical treatment with protease or serrapeptase 1

Important Clinical Considerations

What to Monitor

• Breast pain levels using VAS scale (0-10) 1
• Breast hardness and engorgement severity 1
• Infant latch quality using LATCH scoring 3
• Signs of mastitis development (fever, localized redness, systemic symptoms) 2
• Skin irritation if using herbal treatments 1

Common Pitfalls to Avoid

• Do not apply heat alone without cold therapy, as this may worsen engorgement 3
• Avoid recommending treatments without clear evidence - many traditional remedies lack robust support 5
• Do not delay treatment - early intervention prevents premature breastfeeding cessation 2, 1
• Do not use room temperature cabbage leaves when cold leaves are available - cold application is more effective 1

Contraindications and Cautions

• Monitor for skin irritation with herbal compress treatments (occurs in <1% of cases) 1
• Ensure proper hygiene when applying cabbage leaves to prevent infection 2
• Oxytocin treatment shows uncertain benefit and should not be routinely recommended 1

Evidence Quality Note

The overall certainty of evidence for breast engorgement treatments is low due to small sample sizes, heterogeneous methodologies, and inconsistent outcome measures across studies 1, 5. Despite this limitation, cold cabbage leaves represent the intervention with the most consistent positive findings across multiple outcomes 2, 1.