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.
- Women with RPS should not breastfeed because the blood will cause the baby to vomit.
- 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
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?