Nipple discharge

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 5, 2015
StartSymptomsNipple discharge

Nipple discharge is a problem which may occur in both men and women. For men, this is frequently an indication of an underlying problem. In women, the condition is often a normal or unremarkable occurrence, particularly while pregnant or breastfeeding. For both sexes, seeing a doctor may be the right choice.

Contents

Definition & Facts

Any fluid leaking or draining from one or both breasts is considered nipple discharge. This liquid may be any of a wide range of colors, from clear to brown, green to bloody. Consistency is also variable. The fluid secretes, drips or runs from the milk ducts of the nipple, just as milk is secreted by lactating women.

Women more frequently experience nipple discharge due to hormonal and other physical changes associated with pregnancy, breastfeeding and menstruation.

Nipple discharge can be disturbing when first discovered. In most cases it will subside or there is a reasonable cause for the fluid. It is sometimes an indication of a health issue, however.

Causes

Women who are pregnant or breastfeeding typically become accustomed to changes in their breasts, including secretion of fluid from the nipples. For pregnant women, the discharge may even appear bloody at times. This can actually be normal, due to physiological changes.

Of course, the menstrual cycle is also a time of significant hormonal changes. Some women may experience clear nipple discharge during those time periods or when the breast is stimulated through physical or sexual activity. Even women who have stopped breastfeeding and feel their body has returned to a more normal, non-lactating state, may still experience some fluid release from the nipples for as many as two years.

As part of conditions when nipple discharge is normal, both breasts usually exhibit the same changes and discharge. This type of nipple discharge usually increases when the nipple or breast are squeezed. Although women often squeeze the nipple to check for nipple discharge, this is actually a bad practice which can lengthen the time before the discharge naturally diminishes.

Women often experience one or more of the common causes of normal nipple discharge in their lifetime. Those normal causes include:

  • Excessive stimulation of the breast
  • Injury or trauma to breast tissue
  • Hormonal changes or imbalance, including during the menstrual cycle
  • Use of particular medications
  • Pregnancy
  • Breastfeeding

Among abnormal occurrences of nipple discharge is the possible presence of a benign tumor which commonly causes bloody discharge. This noncancerous tumor is usually indicated through discharge by only one nipple duct. To determine whether a tumor is the root cause of bloody discharge, an ultrasound is required. When a lesion is discovered, a biopsy can provide clarification of whether the growth is a papilloma.

Common causes of abnormal breast discharge include:

Overall, most abnormal nipple discharge is indicative of a benign problem. Indications of a more serious concern like breast cancer include:

  • A lump or mass in the breast
  • Changes and discharge in only one breast
  • Bloody discharge
  • Spontaneous occurrence
  • Only a single duct is affected

When to see a doctor

For men, seeing a doctor is recommended in all occurrences of nipple discharge. For women, prolonged, painful or bloody nipple discharge is usually cause for seeing their healthcare practitioner. Rarely is breast cancer the cause of fluid seepage from the nipple. But other treatable conditions may require attention.

In instances of clear or lightly colored, odorless and painless nipple discharge, women can wait to see their doctor if they are still having menstrual periods. If the condition remains through the next menstrual cycle, a doctor should be seen.

The same is true of women who are pregnant, breastfeeding or stopped breastfeeding within the past few years. Refraining from squeezing the breast or nipple and allowing some time for the nipple discharge to subside without stimulating it should solve the problem.

For menopausal women, seeing a doctor right away is justified if the discharge is spontaneous and only in one breast or a single duct. An evaluation can determine the cause.

Treatment & Therapy

Nipple discharge is treated according to the cause of the problem. Normal nipple discharge as part of a menstrual cycle, pregnancy, breastfeeding or after breastfeeding has been stopped will generally subside without medical treatment.

When normal causes are behind fluid leakage or accumulation at the nipple, it is always best to avoid stimulating or squeezing the nipple. Such actions can prolong the discharge, regardless of its cause.

There are some conditions of which nipple secretions are a symptom or side effect. For those health issues, there is often a specific treatment. Medications may be in oral form or topically applied to the breast and nipple. Treatable conditions include:

Infection

Treatment for a breast infection will vary according to the type of infection. Antibiotics are administered for bacterial infections, whereas fungal infections require an antifungal medication.

Benign tumor

Tumors found to be noncancerous do not always need to be removed. Their growth does need to be monitored, however, This is done through regular doctor's visits.


Hypothyroidism

When the body has stopped producing enough thyroid hormones, the body's own chemical reactions are disrupted. A prescription medication can be prescribed for daily use, to bring thyroid hormones and the body back into balance. Doing so will stop associated nipple discharge.


Ectasia Ectasia is a condition of swollen milk ducts, which usually goes away without treatment. However, milk ducts can be removed if the swelling becomes a problem and does not resolve on its own. An antibiotic can be taken when these ducts cause a bacterial infection.


Pituitary tumor Pituitary tumors can cause a wide variety of problems in the body. They are not usually surgically removed, as they are located in the brain. When these tumors press on nerves or become too large, surgery or radiation treatments may become a requirement. There are two medications which treat pituitary tumors and each usually resolves associated nipple discharge.


Paget's disease of the breast

Paget's disease is a cancer which can occur in bones or the breast. Tumors may exist within the nipple or throughout the breast. Surgical removal of the nipple and areola may be warranted, as well as radiation treatments to ensure an end to the disease. In some cases, mastectomy is necessary.

Prevention & Prophylaxis

Nipple secretions can be prevented by not taking medicines which commonly cause this type of discharge. For people diagnosed with hypothyroidism, thyroid medication must always be taken, even when the nipple returns to normal. Such nipple discharge is only a side effect of that condition, not the overall problem.

When exercising or pursuing activities such as horseback riding, women should wear a well-fitted sports bra and appropriate clothing. Running can cause nipple discharge, so it is particularly important to wear the right attire and constrain the breasts when engaging in this type of exercise. Women who are trying to encourage an end to lactation or those ceasing breastfeeding should pay particular attention to their clothing and keep their breasts comfortably secure until lactation and discharge have ended.

Even men should wear fitted clothing such as an undershirt when running or riding horses.