The Rusty Pipe Syndrome During Lactation
by Anne Eglash MD, IBCLC, FABM
The term ‘Rusty Pipe Syndrome’ (RPS) has been used for many years to describe brown or reddish-appearing colostrum and breastmilk during the last weeks of pregnancy and the first several days postpartum. However, the analogy of rusty pipes is silly- brown water from mineral deposits built up in old water pipes has nothing to do with red blood cells that appear in colostrum and early milk. Lactiferous ducts are not old and crusty!
From my experience, RPS does not occur very often, and I have not found published evidence on the frequency of bloody appearing colostrum and breastmilk during pregnancy or early postpartum. The literature has a handful of case reports with a few authors theorizing that RPS is due to the growth and development of blood vessels around the glandular tissue, some of which may be fragile and either break or leak small amounts of blood.
There are other reasons why women may have blood from their nipples during pregnancy and lactation, and women need an evaluation to make sure there is not another cause of bleeding, such as a rash, nipple sore/lesion, or breast mass causing the bleeding, before assuming it is RPS.
- RPS should resolve by 7-10 days of lactation postpartum.
- Bleeding from 1 pore is less likely to be RPS.
- Women with RPS typically report significant nipple pain.
- RPS has been reported to be more common postpartum than during pregnancy.
- Bleeding from 1 breast would increase suspicion for another cause of bleeding than if bleeding occurs from both breasts.
- RPS only occurs with the first pregnancy.
- RPS is the most common cause of nipple bleeding in the first trimester.
See the Answer
Abstract
Presence of blood in colostrum may change the color of breast milk and it is known as ‘‘rusty pipe syndrome.’’ It may resolve within days, but it may be a barrier for exclusive breastfeeding. Knowledge of ‘‘rusty pipe syndrome’’ among health professionals is very helpful in the management of breastfeeding initiation.
RPS does not cause nipple pain, and mothers with RPS can breastfeed. Women who experience RPS in their first pregnancy may have it occur again with next pregnancies. RPS has not been described in the first trimester, so a full workup for bleeding in the first trimester is necessary.
It is amazing how little we know about RPS. The big message here is to make sure women with bloody colostrum or breastmilk see a physician or other provider to have a breast exam, to rule out lesions or masses causing the bleeding. Because there is no tool to identify RPS, ruling out other pathology by history and exam is the only way to diagnose this, and would also reassure families.
Out of respect for lactating individuals, let’s put our collective minds together for a more appropriate term. How about something like Lactiferous Tissue Spotting – LTS?
Alyssa Schnell
Rusty pipe syndrome — or Lactiferous Tissue Spotting;) — is not uncommon among parents inducing lactation. It happened to me when I induced lactation and quite a few of my clients have reported it as well. It is often just on one breast. I wonder if it may occur just as frequently among birthing parents, but they just don’t know it because they are direct breastfeeding? Or maybe because there is more colostrum than first milk of inducing lactation, it is more evident?
Lois Wattis
I have seen this and other discolourations of colostrum both antenatally and postnatally and all have been temporary and have not adversely affected breastmilk production or breastfeeding. A few times analysis of the colostrum has been requested by doctors (Obs and Paeds) and the results have always come back as normal colostrum components and safe to ingest as normal. Certainly if there was significant or ongoing blood visible in breastmilk the whole story needs to be explored and further investigations if pathology is identified or suspected. However, in most cases the discoloured colostrum/milk is BENIGN and not a reason to worry mothers unnecessarily during a period of transition which may already be challenging.
Dixie Whetsell
I have also seen larger amounts of blood in breast milk during the first week postpartum in some mothers who are taking anticoagulants. The presentation seems to be different from RPS in that the milk appears dark red. This typically resolves within the first week postpartum.
Melanie Myers
Prior to working in Private Practice I worked as a Hospital IBCLC and rounded in the NICU. Typically I would receive push back to use RPS milk and I would advocate. One day a breastfeeding NICU family was rooming-in and the baby spit up blood, they instructed the mom to pump. I arrived for the consult, believed it was RPS due to nipple damage/tie. At the Nurses station (not the NICU’s) the NICU RN came to check on the family. The NICU RN suggested an Apt test. The Nurses at the station had never heard of it and the NICU RN (very seasoned) said they used to use it years ago to determine if its maternal or fetal blood. It was tested and the Neo allowed the pumped milk to be given and assisted with a referral for tie. I have not seen this test suggested in any protocols, listserv or professional groups. This came up again recently and neither party was familiar with the Apt test. I love the questions of the week! Thanks for all you do to advance lactation education.
Tammy
My daughter is dealing with this right now. It started 2-3 weeks before birth and she is now two days postpartum and it’s still quite dark.
Karina Rodriguez
hi I’m only 37 weeks pregnant doctor said will be giving birth early taught of pumping to see how it works and how it looks has like a dirty water color to it just wanted to know if it’s normal or if it isn’t if there’s a treatment for it first time mom just want my baby to breastfeed well
IABLE
Hi, I suggest you talk to your physician about this.