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Why does pumping hurt?

Pumping breast milk is a common practice for many new mothers, allowing them to provide breastmilk for their baby while having the flexibility of bottle feeding. However, it’s also common for pumping to cause some degree of discomfort or pain. Here’s an overview of some of the common causes of pumping pain and tips to help make pumping more comfortable.

Letdown Discomfort

One of the most common sources of pumping discomfort is the letdown reflex. This is when breastmilk starts flowing in response to pumping. Some women experience the letdown as a pins and needles sensation or even cramping. This is caused by the release of oxytocin, the hormone that triggers letdown. The discomfort is usually brief, lasting for the first 30-60 seconds of pumping. If it persists longer, you may need to adjust your pump settings.

Tips for managing letdown discomfort:

  • Start pumping on the lower end of the suction range and gradually increase
  • Try massaging your breast gently as you start to pump
  • Lean forward and dangle your breast while pumping if the discomfort is severe

Nipple Friction

Friction on the nipple from the pump flange is another major cause of pumping pain. The suction required for pumping pulls the nipple and areola into the tunnel of the flange. If the fit isn’t right, this can cause rubbing and irritation.

Signs of nipple friction:

  • Nipples appear rubbed or blanched after pumping
  • Nipples are tender, sensitive, or show signs of trauma like cracks or blisters
  • Pumping sessions become increasingly painful

Tips for reducing nipple friction:

  • Make sure flange size fits correctly – measure nipple diameter and follow guidelines
  • Try using lubricant on the flange tunnel
  • Check flanges for rough spots and replace if needed
  • Adjust suction if needed and pump for shorter intervals

Breast and Nipple Vasospasm

Some women experience pain from vasospasms during or after pumping. Vasospasms occur when blood vessels in the breast and nipples constrict, temporarily cutting off circulation. Women describe the pain as burning, stabbing, or stinging.

Signs of vasospasms:

  • Intense burning/stinging pain during or after pumping sessions
  • Nipples may look blanched or dusky in color
  • Pain persists even with adjustments to pump settings and technique

Tips for managing vasospasms:

  • Apply warm compresses to the breast before and after pumping
  • Massage the breasts and nipples during pumping breaks
  • Try hand expression if pump suction seems to make it worse
  • Discuss medication options with your doctor if pain is persistent

Breast Engorgement

Engorgement, when the breasts become overly full and swollen with milk, can also make pumping more difficult and painful. The increased pressure in the milk ducts can make the breasts tender to the touch. Pumping when engorged may cause discomfort as milk is extracted forcefully.

Signs of engorgement:

  • Breasts feel hard, swollen, and tender
  • Skin may appear shiny and tight
  • Pumping output is reduced due to compression of milk ducts

Tips for managing engorged breasts:

  • Pump more frequently to reduce engorgement
  • Massage or gently compress the breast while pumping
  • Try heat pads, warm showers, or gentle massage before pumping
  • Use reverse pressure softening to help loosen milk ducts

Improper Flange Fit

One of the most common pumping problems that leads to pain is using the wrong flange size. The flange, also called the breast shield, needs to fit the breast properly for comfortable and efficient pumping. An ill-fitting flange can cause significant nipple friction and pain.

Signs of improper flange fit:

  • Nipple rubs on side of flange tunnel
  • Breast tissue gets pulled into flange causing friction
  • Discomfort improves significantly when flange size is changed

Determining proper flange size:

The internal diameter of the flange tunnel needs to match the diameter of the nipple for the best fit. Here are some tips:

  • Measure nipple diameter across the base
  • Standard flange sizes range from 24mm to 36mm
  • Diameter should allow nipple to move freely with gentle friction
  • Consider larger size if nipple rubs tunnel or is pinched

Improper Pump Settings

Discomfort when pumping can also result from suction that is too high. This causes nipple friction and irritation. Cycling too quickly between suction and release phases can also lead to pinching.

Signs of improper pump settings:

  • Suction feels too strong based on comfort
  • Nipples appear compressed or blanched after pumping
  • Milk ejects too quickly, overflow occurs

Adjusting pump settings for comfort:

  • Start on lower end of suction range and adjust gradually
  • Lengthen suction/release phase cycles to improve latch
  • Reduce suction if nipple friction, blanching, or pain occurs
  • Check with lactation consultant if issues persist

Physical Causes of Pain

Some physical conditions of the breasts or nipples can also contribute to pumping discomfort. These issues may require medical evaluation and treatment.

Conditions linked to pumping pain:

  • Breast infection (mastitis)
  • Plugged milk ducts
  • Skin conditions like eczema or dermatitis
  • Damage or scarring of nipple tissue (from trauma, nursing, etc)
  • Anatomical causes like inverted or flat nipples

Seeking medical help for pumping pain:

Consult your doctor or lactation consultant if pain persists despite adjusting pumping technique, sports bras, flange size, and settings. Some causes of pain like infections, dermatitis, vasospasm, or anatomical variations may require medical intervention beyond basic troubleshooting.

Preventing and Managing Pumping Discomfort

While some pumping discomfort is normal at the beginning, ongoing pain can often be minimized with proper flange fit, technique, and pump settings. Try these tips for making pumping more comfortable:

  • Invest in properly fitted flanges and replace every 3-6 months
  • Apply moisturizer after pumping to soothe skin
  • Ensure breast is centered in flange tunnel with nipple
  • Rotate suction levels and massage breasts between pumping
  • Adjust cycles to allow nipple to fully retract between suction
  • Limit pumping duration if needed and gradually increase
  • Warm compresses before pumping can improve milk flow

When to Call the Doctor About Pumping Pain

Contact your doctor or lactation consultant if pain during pumping doesn’t improve after adjusting technique, flange size, pump settings, and lubricating nipples. Severe or persistent pain may indicate:

  • Breast infection (mastitis)
  • Blocked milk ducts
  • Skin infection or nipple damage
  • Vasospasm of blood vessels
  • Possible anatomical variations causing pain

Unresolved pumping pain and discomfort can lead to early weaning. But with the right assistance, most women can find ways to make pumping more tolerable and continue providing breast milk for their baby.

Cause of Pain Signs Self-Help Strategies When to Seek Medical Help
Letdown Discomfort Pins and needles sensation, cramping in first 1-2 minutes Start pump on low suction, massage breast, lean forward If pain persists >2 minutes
Nipple Friction Rubbed, blanched or damaged nipples Check flange size, lubricate, adjust suction If nipple trauma develops
Vasospasm Burning/stinging, dusky nipples Warm compresses, massage, hand expression If pain persists despite remedies
Engorgement Hard, swollen, tender breasts Pump frequently, massage, warm compresses If no improvement within 12-24 hrs
Poor Flange Fit Nipple slips, breast tissue pulled in Size flanges correctly, replace if needed If optimal size doesn’t help
Improper Settings Nipple blanching, overflow Adjust suction, cycle speed gradually If optimal settings don’t help


Pumping breast milk enables nursing mothers to provide breastmilk even when baby is bottle fed. But pumping can cause discomfort due to letdown, nipple friction, vasospasm, engorgement, and improper equipment fit and use. Troubleshooting common issues and optimizing flange fit, pump settings, lubrication, and technique can alleviate most pumping discomfort. But persistent or worsening pain should be evaluated by a lactation consultant or doctor to identify any underlying medical causes and protect breastfeeding duration.