Breast engorgement can be physiological or pathological. It is detected during periods of hormonal changes, may indicate the presence of endocrine disorders, accompanies some diseases of the breast. In newborns, it is found during a sexual crisis. It is manifested by swelling, soreness, hardening of the nipples and mammary gland. The cause of engorgement is determined on the basis of survey data, general and gynecological examination, ultrasound results, endoscopic techniques, and laboratory tests. Self-medication until the cause is clarified is not shown.
At the stage of puberty, under the influence of estrogens, the structure of the mammary glands changes: milk tubes grow, alveoli form, and the amount of adipose and connective tissue increases. This process may be accompanied by periodic engorgement. In the absence of clearly localized seals in the chest during adolescence, the symptom is considered a physiological norm.
Subsequently, a slight short-term engorgement is noted before the start of each menstruation, disappears with the appearance of menstruation. The next period of long-term persistence of the symptom is pregnancy. The first episode of engorgement occurs on the 7-8th day from the moment of fertilization. Breast changes persist until 10-12 weeks, then temporarily decrease, and then progress again, starting from 2 weeks.
The onset of lactation is marked by another episode of physiological breast engorgement. After the start of feeding, the symptom disappears. The final normal engorgement associated with the extinction of the reproductive function is sometimes observed in the phase of involutive restructuring of the mammary glands in the premenopausal and menopausal periods.
In women who refuse breastfeeding, unpleasant manifestations persist for several days, until milk production stops. The reasons for engorgement against the background of violation of the rules of feeding are:
Less commonly, lactostasis, against which engorgement occurs, is caused by hyperlactation, spasms, or blockage of the milk ducts. Stagnation of milk contributes to the development of lactational mastitis.
Breast engorgement
Cyclic fluctuations in hormone levels sometimes lead to periodic swelling and soreness of the mammary glands - mastodynia. Pathology is more often detected in women who have not given birth or have one child, 20-4 years old. Predisposing factors are irregular sex life, the presence of diseases of the reproductive system.
In patients with premenstrual syndrome, engorgement is more pronounced than usual. It can be combined with insomnia, irritability, weakness, emotional instability, decreased mood, vegetative-vascular symptoms, swelling of the face and body.
With anomalies of the hymen - non-perforated hymen or hymen atresia - engorgement occurs during menarche, is combined with other signs of menstruation, but due to the lack of a hole is not accompanied by bleeding from the vagina.
Breast engorgement appears not only in normal pregnancy, but also in pathological. In girls, a possible cause of this condition can be teenage pregnancy, which manifests itself with the same signs as normal, but develops in an organism that has not yet fully matured for bearing a child.
Late premenopausal pregnancy requires special attention. In this case, women sometimes regard the cessation of menstruation, breast engorgement and other signs of gestation as the beginning of the menopause. Patients do not turn to the gynecologist in time, are not examined, do not comply with the regimen, which increases the likelihood of complications and increases the risks in childbirth.
There are different types of ectopic pregnancy, which are also accompanied by breast engorgement:
A missed pregnancy in the 1st trimester and anembryony is characterized by an improvement in the general condition and the disappearance of breast engorgement, which is replaced by chills and fever at the onset of spontaneous abortion. At later dates, the absence of fetal movements is noted.
With false gestation, the fetus is absent in the uterus. Cessation of menstruation, morning sickness, breast engorgement and abdominal enlargement are due to the patient's belief that she has a child. During gynecological examination, additional studies of the fetus is absent. Sometimes a similar condition is observed in men during the pregnancy of a partner.
Unlike normal and pathological gestation, in which both mammary glands are simultaneously engorged, unilateral changes are more typical for mammological diseases. The symptom is found in the following pathologies:
Breast engorgement can be found in the following diseases and conditions:
The sexual crisis in newborns develops due to a decrease in the level of maternal estrogens in the blood of the child. Breast engorgement is detected in infants of both sexes, appears on day 4, reaches a maximum by day 7-1. The mammary glands are symmetrically enlarged and compacted. When pressed, a grayish secretion from the nipples is possible.
When soft tissues are infected in children of the first days of life, mastitis can form. Symptoms of the disease, as a rule, are detected 7-1 days after birth. The seal is one-sided, the feeling is painful, on palpation an infiltrate is determined, in the center of which a site of fluctuation is subsequently formed. The general condition is disturbed, the temperature is elevated to febrile numbers.
Unilateral engorgement is found in malignant tumors. Initially, the formation is palpated in the form of a local dense node, later it grows into the surrounding tissues, deforms the mammary gland. Chorionic carcinoma can be located both in the genital organs and outside them. It develops during pregnancy or some time after childbirth. Bloody discharge from the genital tract, breast engorgement, colostrum-like discharge from the nipples are noted.
Ultrasound of the mammary glands
The nature of the pathology that causes engorgement of the mammary glands is determined by the mammologist. The specialist interviews the patient, finds out when and under what circumstances the symptom arose, how the disease developed. During the examination, the doctor examines the condition of the mammary glands, palpates regional lymph nodes, and reveals general changes. Further examination program includes:
Therapeutic tactics is determined by the identified physiological or pathological condition. Pregnant women are registered, pregnancy is managed. With lactostasis, conventional and ultrasonic massage of the mammary gland is performed, straining is performed, oxytocin is injected.
Patients with mastodynia and other conditions that occur against the background of cyclic changes are recommended hormonal drugs, sedatives, diuretics and analgesics. In case of hormonal disorders, taking into account the cause of breast engorgement, oral contraceptives are canceled or the drug is replaced, hormone therapy is prescribed. In malignant neoplasms, radiation therapy, chemotherapy may be indicated.
Depending on the type of pathology, the following operations can be performed: