• how to pump – comfortable
  • how to pump – tips
  • what nipple should look like in flange
  • Flange size
  • Pump settings
  • Cushion
  • cushion - reviews
  • Cream
  • Pads
  • Coconut oil for the flanges
  • Haakaa with warm water

But the good news is these uncomfortable feelings can be avoided.

Pumps and pain

About 15% of women have nipple tissue damage or injury using breast pumps. In our research at Milkdrop, we have found that for every ten women using a breast pump, two have nipple damage or discomfort and eight feel like a cow.

Why pumping might hurt?

Breast pumps – medieval torture device or women’s health product?

When you look at a pump, it’s not hard to see why some women experience this. Your nipple is being pulled into a hard plastic or hard silicone flange, repeatedly.

  • Your nipple and areola is sucked repeatedly against a plastic or hard silicone flange until milk comes out. If you’re pumping every few hours, then you don’t really have time to recover before you do it over again. Nipple pain and discomfort is such a common and big topic that we’ll go through it in more detail in the next section.
  • Your wrists can be sore from holding a cranked position and repeating the same movements frequently, especially if you’re massaging while you pump, holding the pump in position or using a manual pump. In our research at Milkdrop, we found that women using manual pumps had higher rates of wrist pain. Although this makes sense theoretically, (because you are squeezing the handle repeatedly for the pumping session), we can’t say that manual pumps actually caused wrist pain without further study.
  • Your back and neck can ache from supporting an unnatural position, especially if you’re craning to see how your nipple is being drawn into the pump and how much milk you’re collecting.

If you’re pumping soon after birth, then these pumping pains come on top of recovery pains. They can also come on top of emotional stress if things aren’t going as you planned. 

Is nipple pain common?  

If you’re having sore nipples or breasts during or after you pump, you’re not alone.

The most commonly reported adverse events for breast pumps to the United States Food and Drug Administration (FDA) are for pain, soreness or discomfort, need for medical intervention and breast tissue damage[2](Brown et al., 2005)(Brown et al., 2005).

It’s difficult to say for sure, but our best guess is that around 1 in 5 women have nipple pain or damage when they pump. We arrive at that statistic from looking at a few studies (although really there should be more studies funded given that 20% of pumping women represents millions and millions of people in pain):

  • A study of about 900 mothers in Melbourne reported pain (17%), damage to the nipples (11%), bruising and rash[3] as the main adverse effects of pumping.
  • A study of just over 1800 women found that 15% of women had injuries from pumping, with nipple pain being the most common[4].

Most research looking at pain and pumping tends to focus on active pain and damage caused by the breast pump rubbing at the breast. However, if you are not expressing regularly (whether pumping if you’re exclusively pumping or pumping and feeding at the breast) or your pump is not effectively extracting milk, you could  . The only mention of this that we could find was in a study of 69 women with breast pain.  

Whether it’s from rubbing or inefficient milk expression, here are some   that you may recognise.





Cracked, chaffed, bleeding, blisters, bruising






Stretched, elastic






Blebs (milk blisters), blocked







Swollen, bloated, red, hard







Itchy, Tingling, Aching











Shooting pain




What can cause pain?

Few studies look at

There are no studies thoroughly investigating the cause of adverse events; however, a number of studies identify contributing factors.

Brown et al (2015) noted that long, uninterrupted suction disrupted skin and caused breast discomfort or pain.

Jones & Hilton (2009) noted that incorrectly fitting breast shields have been identified by practitioners and patients as sources of pain, damage (severe nipple excoriation), incomplete breast emptying, milk stasis, engorgement and feeling of ‘lumps’ after expressing. They state that if untreated, incomplete breast emptying can lead to blocked ducts, inflammatory and infective mastitis, poor milk production due to build-up of suppressor peptides that down-regulate volume.

Mothers in a study investigating breast pump use reported that they were poorly instructed in how to use pumps (Van Esterik, 1996). This is consistent with personal communication with a number of lactation consultants and general practitioners specialising in lactation medicine, that under-education about flange sizing is one cause of nipple pain and damage.

It can be difficult to diagnose the cause of breast and nipple pain, and even figure out best treatment, especially if you are pumping and feeding at the breast. The important thing to do is to see your doctor or lactation consultant for help. 


Common symptoms

We’ve included some information below that may help you describe your symptoms better or troubleshoot while you’re waiting to see a medical professional. 

Damaged nipple 

If your nipples are bleeding, bruised, chaffed, cracked, blistered, you may have breast or nipple tissue damage from pumping, where the sensitive skin on your nipple and areola has been rubbed against the hard flange.

What nipple damage looks like

Your skin can be rubbed raw or have blisters (not to be confused with milk blisters – see below), have bruising or even bleeding. Often the damage is around the areola, rather than the nipple itself, where you might see rings of raw skin around the nipple. 

Causes of nipple damage

This kind of damage can be caused by a flange size that is not the right size for your nipples, and also by pumping too long or with suction on too high. It can also happen if your nipple isn’t centred when you place it in the pump, and it is pulled or pinched over to one side. 

Even with the right size flange and low level suction, you may still have recurring damage because of rubbing against the hard plastic or hard silicone flanges that come with breast pumps.

How to treat nipple damage
  1. Check your flange size. Learn how to do that here.
  2. Attach a cushion. Consider using cushions or inserts to protect your nipple as you pump. Read about these products here.
  3. Lubricate the flange. Consider using lubricant while you pump, which can reduce friction and rubbing. Read about these products here.
  4. Line up your nipple. If you need to pump while you are waiting for your new flanges and any attachments to arrive then try to line up your nipple into the pump so that before you turn it on, it is right in the centre of the hole. It can be hard to see your nipple in some pumps, so you may have to do this by feel.
  5. Start on low suction. Once you’re positioned as centred as possible, start your session at the lowest suction level. Only increase suction to the point where milk starts flowing for you, and no more. Remember, more suction doesn’t necessarily mean more milk.
  6. Don’t pump for too long. Pump only as long as you have to. Pumping session duration varies so much between women, so see here for how to figure out how long is best for you.


Other things that may help: You may find relief after pumping by placing a cool or heat pack on your breast, applying gel pads or soothing creams and ointments.

[insert video/giff about drinking straw]

Caption: Think about it this way. If you took a drinking straw, close one end with your finger and sucked really hard on the other end, the straw will collapse. That straw is your milk duct. It’s fragile, be gentle.


Stretched nipples  

Most nipples stretch when they’re sucked into a pump. You might find that your nipple stretches much further than you expect. [definition of elastic nipple].

What is a stretched or elastic nipple?

An elastic nipple is a nipple that stretches more than you expect when you pump.  

You might have elastic nipples if you find that your nipple stretches right down the shaft. 

What causes elastic nipples?

Nipples actually stretch quite a bit when nursing directly at the breast. They can extend 2-3 times their normal length, as the baby sucks the nipple right to the back of the palate.

How do I treat stretched or elastic nipples?

If you’re not having pain, damage, swelling or milk flow constriction, you don’t need to ‘treat’ elastic nipples as such. But you will need to find a pumping set up that fits   

It’s more about finding a pumping set up that doesn’t hurt or damage you, because your nipple will stretch to any size you place it in.

Bleb or blocked nipples

Bleb definition (milk blister)

Blocked nipples
  • sore nipples – blocked
Blebby nipples
  • nipple bumps / blebs - what are they
Blocked ducts & mastitis
  • mastitis
  • Mastitis
  • Can breast pump cause mastitis
  • Causes –
What blebs and blocked nipples look like 
Causes of blebs and blocked nipples
How to treat blebs and blocked nipples

Swollen, bloated, darker nipples

Swollen nipples
  • Pumping problems – swelling
Bloated nipples
  • Pumping problems - swelling
Red or purple nipples
  • pumping problems - purple nipples
Hard nipples
  • Pumping problems - breast hard


Itchy, tingling or aching nipples

Itchy nipples
  • Sore nipples – itchy
Tingling nipples
  • Sore nipples – tingling
  • nipples tingle
  • nipples tingling
  • nipples tingling
Aching nipples
  • sore nipples - ache


Blanched (white-spot) nipples


Treatment : heated flange

Blanched nipples (or white spots)
  • pumping problems - nipple blanching
  • sore nipples - white spot

Shooting pain

Shooting pain in nipples
  • sore nipples - shooting pain
  • words to include: sharp pain in nipple, shooting pain, stabbing pain, sharp nipple pain
  • letdown pain / milk ejection



  • sore nipples – thrush
  • how to get rid of thrush on nipples
  • how to treat nipple thrush
  • nipple thrush
  • nipple thrush home remedy
  • nipple thrush symptoms
  • nipple thrush treatment
  • signs of thrush on nipples
  • nipple thrush breastfeeding
  • thrush breastfeeding nipple
  • thrush nipples breastfeeding
  • thrush on nipple breastfeeding
  • thrush in nipple
  • thrush nipple
  • thrush nipples
  • thrush on nipple
  • thrush on nipples
  • what does nipple thrush look like
  • what does thrush look like on nipple
  • what does thrush on nipples look like

What helps nipple pain

  • Pumping problems - breast pain – treatment
  • Pumping problems - nipple pain – treatment
  • Pumping problems - sore nipples – treatment
    • what can i use for sore nipples while breastfeeding
    • what can i use for sore nipples while breastfeeding
    • what can i use on my nipples while breastfeeding
    • what can i use on my nipples while breastfeeding
    • what to do with sore nipples from breastfeeding
    • what helps sore nipples during pregnancy
  • Pumping problems - pain – treatment
  • sore nipples – shield
    • best nipple guards for breastfeeding, nipple covers, guards, shield, pros & cons, silicone nipples
  • sore nipples – cream
  • balm – reviews

In 2014, a Cochrane review[6] of four trials involving 656 women, looked at various treatments such as lanolin, glycerine gel, breast shells or covers and other ointments for women suffering sore nipples from feeding, but unfortunately they couldn’t find sufficient evidence that these worked better than no treatment or simply applying some expressed milk to the area. The study excluded women who exclusively pumped though, because pain from breast pumps and treatment is different.  

  • sore nipples – pads
  • sore nipples – treatment
  • Pumping problems – back pain
  • How to size your nipples for the correct flange size (refer to flange size section)
  • Mastitis & other breast feeding related infections - how to overcome and what to do?

**comment that you need to see doc

Often you can have sore nipples from feeding and pumping, and it’s difficult to figure out the cause. Here are some common nipple soreness problems, how to recognise them and what to do about it.

  • sore nipples - bad latch
  • bad fitting pump

How to prevent pain

The good news is that with the right information, you can make sure your breast pump helps rather than hinders your feeding journey.

Here are five steps you can take, before you start pumping, to reduce the risk of pain, damage or discomfort pumping:

  1. Have your flange size as close to correct for your nipple as you can. Learn how to do this here
  2. Start at the lowest suction level on your pump, and only increase to the highest comfortable level. More suction does not equal more milk if you’re in pain.
  3. Pump for as long as it takes to feel like you’ve expressed most of your milk, up to 20 minutes. As you get used to pumping you may vary the time, but this is a good starting point. 
  4. Try some coconut oil or lanolin inside your pump funnel to allow your nipple to slide.
  5. Use a soft insert or pump attachment to soften the interface to your pump. See Milkdrop, Pumpin Pals, Beaugen or Lacteck for examples.