Nipple Fissure: Symptoms, Types, Causes and Treatment

Nipple fissure is a common yet distressing condition, particularly affecting breastfeeding women. Characterized by painful cracks or sores on the nipple, this issue can disrupt breastfeeding, cause significant discomfort, and even lead to early cessation of nursing. Understanding the symptoms, types, causes, and treatments is crucial for mothers, healthcare providers, and anyone seeking to support breastfeeding success. This comprehensive guide explores the latest research and evidence-based recommendations for managing nipple fissures.

Symptoms of Nipple Fissure

Recognizing the symptoms of a nipple fissure is the first step toward effective management. Early identification can prevent complications, reduce discomfort, and support uninterrupted breastfeeding.

Symptom	Description	Impact	Source(s)
Pain	Sharp, burning, or stinging sensation	Can lead to breastfeeding avoidance	1 5
Redness	Inflamed, reddened skin around the nipple	Indicates irritation or trauma	1 5
Cracking	Visible splits or cracks on the nipple	May bleed and worsen over time	1 5
Bleeding	Minor to moderate bleeding from cracks	Can increase infection risk	5

Table 1: Key Symptoms

Understanding the Symptoms

Nipple fissures present with distinct and often uncomfortable symptoms. The most prevalent is pain—ranging from a mild sting to severe burning—which can make breastfeeding an agonizing experience for new mothers. This pain typically intensifies during feeding sessions, sometimes persisting even between feeds 1 5.

Other observable symptoms include:

• Redness: The nipple and areola may appear inflamed or irritated, a telltale sign of ongoing trauma.
• Cracking: Small splits or fissures form on the nipple surface. These may start as superficial but can deepen if not addressed.
• Bleeding: In more severe presentations, these cracks may bleed, increasing the risk of secondary infection and adding to the mother's distress 5.

These symptoms often lead to a vicious cycle: pain causes poor latch or reduced feeding frequency, which, in turn, exacerbates the underlying problem.

Why Early Recognition Matters

Prompt recognition helps mothers seek help early, before symptoms escalate. When left unaddressed, nipple fissures can interfere with milk transfer, reduce milk supply, and even cause infections such as mastitis or thrush.

Types of Nipple Fissure

Nipple fissures can vary in appearance, depth, and underlying cause. Identifying the type helps guide tailored interventions and optimal treatment strategies.

Type	Features	Prevalence/Context	Source(s)
Superficial	Shallow cracks affecting surface layer	Most common in early breastfeeding	1 2
Deep	Deeper cracks, possibly with bleeding	Longer duration or severe trauma	1 5
Infected	Signs of infection (pus, swelling)	Occurs if left untreated	2

Table 2: Types of Nipple Fissure

Superficial Fissures

These are the most frequently encountered type, especially in the early days of breastfeeding. Superficial fissures involve only the top layers of the skin and usually result from minor trauma, often associated with incorrect latching or positioning 1 2.

Deep Fissures

Deep fissures are more concerning, as they extend into the deeper layers of the nipple and may bleed. These often develop when superficial fissures are not managed promptly or when repetitive trauma continues. Deep fissures are not just more painful; they also take longer to heal and are more prone to complications 1 5.

Infected Fissures

If a fissure is not properly cared for, it can become infected. Signs include increased redness, swelling, pus formation, or systemic symptoms such as fever. Infected fissures require prompt medical attention and may necessitate specific antimicrobial therapy 2.

Causes of Nipple Fissure

Understanding what leads to nipple fissures is crucial for both prevention and effective management. While breastfeeding is the most common context, other factors can also contribute.

Cause	Mechanism/Trigger	Risk Context	Source(s)
Poor Latch/Positioning	Improper attachment causes repeated trauma	Common in new mothers	1 2
Improper Suckling	Baby's tongue/lips not correctly placed	Associated with feeding difficulties	2
Dryness/Irritation	Environmental or care practices	Can worsen existing cracks	5
Infection	Bacterial or fungal colonization	Complicates healing	2

Table 3: Causes of Nipple Fissure

Poor Latch and Positioning

The overwhelming majority of nipple fissures are caused by poor breastfeeding technique. When a baby does not latch deeply enough, the nipple is compressed against the hard palate, resulting in friction and trauma 1 2.

• Common mistakes: Baby's mouth not wide open, shallow latch, or misalignment between baby's mouth and the nipple.
• Prevalence: These issues are especially common among first-time mothers or those who have not received proper lactation support 1.

Improper Suckling

Even with correct positioning, some infants may not suckle effectively due to anatomical reasons (such as tongue-tie), leading to uneven pressure on the nipple and subsequent fissuring 2.

Dryness and Irritation

Frequent washing with soap, use of harsh creams, or exposure to dry air can strip the nipple of its protective oils, making it more vulnerable to cracking 5. These factors tend to exacerbate existing fissures rather than cause them outright.

Infection

Once a fissure forms, it becomes a potential entry point for bacteria or fungi, leading to secondary infection. This can further delay healing and increase discomfort 2.

Treatment of Nipple Fissure

Treating nipple fissures effectively requires a multipronged approach, combining symptom relief, healing promotion, and addressing underlying causes. Recent research highlights a range of conventional, alternative, and emerging strategies.

Therapy/Intervention	Approach/Method	Key Benefits	Source(s)
Correct Breastfeeding Technique	Education, hands-on support	Prevention & faster healing	1 2 3 4 5
Warm Compresses	Applied before or after feeding	Pain relief, healing	1 5
Topical Lanolin	Natural ointment applied to nipples	Moisturizes, speeds recovery	5
Herbal Remedies	Aloe vera, menthol essence, others	Soothes, promotes healing	1 5
Silicone Nipple Shields	Barrier to reduce trauma during feeding	Allows continued feeding	2 5
Silver Cap Device	Silver-impregnated nipple cover	Rapid pain relief, healing	3 4
Phototherapy (LED)	Light-based anti-inflammatory treatment	Enhances healing, reduces pain	2
Medical Therapy	Antifungals, antibiotics if infected	Treats secondary infections	2

Table 4: Treatment Approaches

Correct Breastfeeding Technique

The foundation of both prevention and treatment is ensuring proper breastfeeding technique. Education and support from lactation consultants are critical. Techniques taught include:

• Ensuring a deep, wide latch
• Proper positioning of both mother and baby
• Breaking suction gently before unlatching

Evidence consistently shows that education alone can significantly reduce pain and promote healing 1 2 3 4 5.

Warm Compresses and Simple Home Care

Applying a warm (not hot) compress to the nipple before or after feeding can provide substantial pain relief and promote healing 1 5. Breast milk itself, expressed and left to air-dry on the nipple, may also have protective properties 2.

Topical Treatments

• Lanolin: A natural, hypoallergenic ointment frequently recommended to keep the nipple moist and facilitate healing. When used with a nipple shield, lanolin has shown strong efficacy in reducing pain and speeding recovery 5.
• Herbal Remedies: Aloe vera gel and menthol essence are among the most studied alternative treatments. These provide soothing relief and may accelerate healing, though more robust studies are needed 1 5.

Nipple Shields

Silicone nipple shields act as a barrier, allowing mothers to continue breastfeeding while reducing direct trauma to the damaged nipple. When paired with other treatments, they can improve comfort and aid recovery 2 5.

Silver Cap Device

A promising innovation is the use of silver-impregnated nipple covers (e.g., Silver Cap®). Clinical trials indicate that these devices not only accelerate healing and reduce pain more rapidly than standard care but are also well tolerated and preferred by users 3 4. No significant side effects have been reported.

Phototherapy (LED)

Emerging evidence suggests that LED-based phototherapy offers anti-inflammatory effects, supports tissue repair, and can significantly reduce pain. As a non-invasive and relatively affordable option, it is gaining attention as a supplementary therapy 2.

Medical Therapy

If infection is suspected—signaled by pus, increased redness, or systemic symptoms—medical therapy with appropriate antifungals or antibiotics is indicated 2. This ensures that healing can proceed without the complication of underlying infection.

Integrating Treatments

Often, a combination of these approaches yields the best results. For example, correcting technique, applying a soothing ointment, and using a nipple shield together may be more effective than any single intervention.

Conclusion

Nipple fissures are a common yet highly manageable challenge, particularly among breastfeeding mothers. By recognizing symptoms early, understanding the diverse types and causes, and applying evidence-based treatments, mothers can continue nursing comfortably and safely.

Key Takeaways:

• Symptoms: Pain, redness, cracking, and occasional bleeding are hallmark signs of nipple fissure 1 5.
• Types: Nipple fissures can be superficial, deep, or infected, each requiring tailored care 1 2 5.
• Causes: The main culprits are poor latch/positioning, improper suckling, dryness, and secondary infection 1 2 5.
• Treatments: A multifaceted approach—including technique correction, warm compresses, topical therapies (lanolin, herbal gels), nipple shields, silver cap devices, and phototherapy—offers the best outcomes 1 2 3 4 5.

By staying informed and seeking early support, mothers can overcome nipple fissures, preserve breastfeeding, and ensure the well-being of both themselves and their babies.