How to Fight Thrush and Win

How to Fight Thrush and Win

Thrush is a yeast infection (a fungus) of the infant mouth, which can also affect the nursing mother's nipples and/or breasts. I, like many women, got it after a massive course of Penicillin after my first daughter was born by C-section. Antibiotics kill off lots of bad microorganisms and of course they kill lots of good ones too, so your body chemistry gets out of whack and the yeast gains the upper hand.

It's possible for you to have it in your breast without it appearing in your baby's mouth (this is called being 'asymptomatic') - or your baby can have it in his mouth, and never show up in your breasts. If your baby does show symptoms, it will appear up as white curd-like patches, and may make your baby's mouth so sore that he won't want to nurse.

Symptoms of Thrush include, but are not limited to:

A red 'rash' on the nipple/red nipples and aureola or unusual pinkness/redness of the nipple
A taut, shiny appearance to the skin of the aureola (which is normally slightly creased and dullish, like any other skin)
Increased and eventually hyper-sensitivity of the nipple to any and all touch, and
Excrutiating pain during nursing and
Pain/burning of the nipples between feedings
Stabbing pains deep within the breast (if yeast gets up into the milk ductules), not to be confused with ordinary pain associated with let-down.

The nurses at the Lactation Department of Overlake Hospital Medical Center in Bellevue, Washington recommend that mother and baby both be treated for Thrush whenever either one has it, because even an asymptomatic nursing baby can give it back to mom, and vice versa.

If you think you may have Thrush, see your doctor, midwife, or a International Board-Certified Lactation Consultant (ICBLC) at your friendly neighborhood hospital or out of the phone book. If Thrush is diagnosed, you're in for a long haul, but you can get rid of it. This will require: medication, diet, hygiene, and time.

Medication:

Your doctor will probably prescribe Nystatin, a yellow, sweet, sticky medicine - that's for the baby - and an OTC 1% or 2% cream (miconazole or clotrimazole) for you. He or she may also prescribe Diflucan (fluconazole). Note: the recommendations on fluconazole changed recently and it may be prescribed more freely, including being prescribed for infants. The current recommendation for Diflucan (per the lactation consultant at OHMC; also Dr. Tom Hale) is 200 mg the first day, and 100 mg/day thereafter, for a total of either 10 or 14 days (or, some say, for a full two weeks after cessation of symptoms). This is for the mother; the baby gets treated independently, generally with Nystatin.
Some doctors will refuse to prescribe more than a single day's worth of Diflucan, saying one pill is good for a week (true for vaginal yeast infections, but not true for breast yeast), and/or advise you to "pump and dump" your milk for the duration of the treatment. If your doctor tells you this, find another doctor who is more up on the current research, or refer him or her to the book Medications and Mother's Milk by Tom Hale, PhD., or to the Lactational Pharmacology and Therapeutics web site.
Ed. note: I do not personally advise trying fluconazole first because it can impair liver function. I know, because it happened to me. I am not a doctor, and I don't pretend to be one, but I always prefer the most effective AND least harmful treatments be tried first.

I used Diflucan for 10 days. My thrush came back. I have not yet tried a course of 14 days. Some strains of yeast seem to be developing a resistance to Diflucan, miconazole, and other pharmaceuticals. Other options include: Terazol, a topical cream which targets many varieties of yeast. (I had an allergic reaction to it, and had to discontinue use), oral nystatin for the mother, nystatin cream and ointment for the mother, to be applied 3x/day or as prescribed by your physician.
Buy an industrial-sized box (or two, or three) of nursing pads, any brand which does not have a 'moisture barrier' (I usually used the EvenFlo brand, even though they're not as soft as some others, because they don't have the plastic barrier). Yeast thrive in warm, moist environments, which plastic helps to create. Use them religiously, and change them if they get any milk leakage.
Go 'amazon' as often as possible, so your nipples get a chance to be perfectly dry. But this means no clothing against your nipples! Clothing contaminated by yeast can re-infect you later. Using nursing pads inside your bra as soon as you put clothes back on.
The miconazole (or other) cream will start to take the burning sensation away within a day or two or four, but don't mistake cessation of symptoms for being cured. Keep it up for 2 weeks after cessation of symptoms. Apply enough to make a thin white haze over the entire aureola and nipple, every time (or as directed by physician).
Your doctor may tell you a few days of treatment will do it (mine did), but the ladies at the La Leche League, the nurses at the OHMC Lactation Department, and my own experience say otherwise. It won't harm your baby for you to use it for 2 weeks, and if you don't get rid of it and it comes back, you have to start all over again, including the 4X/day Nystatin for the baby.
But be certain to wipe any excess cream off your nipples before baby nurses. Usually, it is absorbed (or rubbed off on your bra) but if there's any visible, wipe it off (or wash, as directed by physician).

Diet (and non-pharmacological treatments):

Yeast doesn't survive well in an acidic environment, so you want to acidify your body, and eat things that are natural antifungals, as well as starve the yeasties into submission:

Eat unsweetened (plain), no sugar or aspartame/Nutrasweet) yogurt every day (make sure it says 'active live cultures' on the container) and/or drink Acidophilus milk.
Take acidophilus/bifidus capsules. Some of these require refrigeration and lose potency if they warm to room temperature, so be sure to read the label.
Eat garlic. Take garlic tablets.
Add flax seed oil to your diet (liquid or capsules). Keep it refrigerated so it doesn't go rancid.
Eat rutabagas. No kidding.
Add olive oil to your diet. Or apply it directly to your nipples. It has antifungal qualities.
Try the commercially-available "Yeast Guard" type capsules, with multiple ingredients, but check with the health-store employees, your midwife, lactation consultant, LLL and/or physician for their safety.
Go to your health food store and get Caprylic acid capsules. I was told to take 4 per day, 2 in the morning and 2 at night, but not to take them within an hour of taking acidophilus capsules.
Alternatively, try a homeopathic 'Candida Away' type sublingual pellet, but don't use mint toothpaste while you use it or any other homeopathic remedy (mint is an antidote to homeopathic remedies).
Smear a tiny amount of acidophilus powder mixed with water, on your nipples. Let dry.
The Womanly Art of Breastfeeding (La Leche League) recommends at least trying a weak vinegar bath for your nipples - 1 tablespoon of vinegar to a cup of water, changed daily. I found that it helped ease the discomfort at least. It also made my baby reject the breast sometimes, I suspect because of the taste.
Gentian Violet will work against Thrush (in the baby's mouth), in many cases. It seems to have worked for me. For information by Dr. Jack Newman on how to use it, see http://www.erols.com/cindryn/6.htm. It's a very very messy stuff, but a bottle costs about $2 or $3 and will last for many treatments, and for a handy antiseptic treatment, similar to mercurachrome, for scratches and scrapes later on. You'll have to call around to find a pharmacy that actually carries it.
The Womanly Art of Breastfeeding also suggests a mild baking soda solution for the baby's mouth, but again, I can't verify this.
Try to cut all processed sugars, and as many natural sugars from your diet as possible - this means glucose, sucrose, honey, maple syrup, corn syrup, and everything else. Unless you're diabetic, of course.
Try to cut out as much white flour as you can. You can eat all the millet, beans, lentils, barley, amaranth, quinoa, teff, and so on, as you can tolerate, but avoid white rice, white pastas, and other simple carbohydrates.
Avoid foods with molds or yeasts in them, such as cheese, brewer's yeast, beer, yeast-raised bread, wine, etc.

Hygiene:

Boiling water will kill yeast, but you have to do it right. Get the water going at a rolling boil before you put anything into it. Keep it boiling for a minimum of 20 minutes. Make sure bottles and bras don't bob out of the water. They need to be immersed.

Boil your bras. Boil them once initially, and then again if they get milk leak-through. This does bad things to the elastic, so be very conscientious about keeping your bras from getting milk on them until you're better. You might boil them once and then after your 2 weeks of treatment are up, if you can keep a nursing pad between you and the fabric all the time.
Boil breast-pump breast shields, bottles, and anything else (plastic, glass or metal) that comes in contact with yeast-contaminated milk, every day. Use disposable bottle-bags if you freeze milk.
If you use bottles to store or feed expressed breastmilk or even formula, boil them too - both bottles and nipples. Boiling makes latex nipples hard, and ruins them. Silicone or PVC nipples (clear or jewel-toned clear) seem to handle this boiling adequately.
If you pump milk, try to use it the same day. If you must freeze it, date and mark it with a 'Y' or something, and feed within a few days. If you feed your baby yeast-contaminated milk after your course of treatment is over, you'll just re-infect her, and start the cycle over again. Make sure you discard any remaining when your treatment is over. Freezing does not kill yeast.

Time:

Two weeks is the minimum for most treatments before you can consider the yeast completely gone.

Good luck, and keep at it. You can beat Thrush.

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