Ultrasound for mammary glands with lactostasis. Ultrasound therapy - "Ultrasound for lactostasis

24.09.2020

At one time, physiotherapy was treated only as an additional, rather preventive, auxiliary measures that did not deserve special attention.

Fortunately, doctors quickly noticed and re-evaluated their attitude to physiotherapy techniques for breastfeeding problems.

Today, physiotherapy for lactostasis is used as widely as possible.

And the majority of women are immensely grateful for such methods of treatment, which were able to quickly and effectively correct their breastfeeding of newborn babies.

And all because modern medicine began to treat physiotherapy as the most effective, proven procedures for years, allowing adequate treatment for lactostasis.

Various physiotherapy techniques allow you to quickly and most importantly effectively get rid of painful lumps in the chest. And besides, physiotherapeutic treatment helps prevent the development of more complex infectious processes of the breast (mastitis, for example).

The main advantage of a full-fledged physiotherapy treatment for lactostasis can be considered the absolute absence of even minimal pain during the procedure, and in addition, the complete and unconditional safety of such treatment, both for the mother and her child.

In addition to full-fledged physiotherapeutic treatment for lactostasis, correct breastfeeding is of great importance. It is important that the nursing mother understands how to properly attach the baby to the breast, what the feeding schedule should be, and what positions to use. However, let's not get ahead of ourselves, and let's figure it out in order.

The main types of physiotherapeutic treatment of lactostasis

As we have already noted, physiotherapy methods of treatment are the most effective and safe ways to get rid of women from painful stagnant processes that occur in the mammary gland.

All physiotherapy techniques are absolutely safe, effective enough and can give the fastest desired effect.

Most often, with lactostasis, women who have difficulties with the outflow of breast milk are recommended to go through:

Several sessions of ultrasound therapy.
UHF therapy sessions.
Sessions of electrophoresis with certain drugs, herbal infusions, etc.

It is these techniques that allow you to quickly eliminate dangerous congestion, avoiding the degeneration of the process into inflammatory forms. When using such physiotherapeutic techniques, along with congestion, painful cracks in the nipples can pass faster, and other microtraumas of the breast can be eliminated.

The mechanism of action of such procedures, first of all, consists in a noticeable improvement in the outflow of breast milk, in improving blood circulation, in increasing lymphatic outflow, etc.

First of all, such reactions of the body to procedures occur due to a moderate increase in temperature in the treated areas, due to a moderate massage effect.

In addition, all three mentioned procedures have an important anti-inflammatory effect for such a disease, which is excellent as an excellent prevention of the development of mastitis.

Note that in some cases, physiotherapy for congestion in the breast of a nursing mother can use techniques to stimulate the adrenal cortex. We are talking about reconciliation with this ailment of low-intensity high-frequency magnetotherapy.

More than effective in stagnant milk can be lymphatic drainage techniques, such as: alcohol compresses, and as drug electrophoresis with the addition of oxytocin.

But the most important thing that needs to be said about the choice of physiotherapeutic treatment for women suffering from lactostasis is the fact that only a doctor should prescribe such treatment, who can first make sure that the soreness of the mammary gland is associated precisely with milk stagnation, and not with other, more dangerous , diseases.

How to correct stagnant feeding

It is believed that the baby should be applied to the breast as often as possible. It is very important to understand exactly how to attach the baby, so that he has the opportunity to correctly grasp the mother's breast and, as a result, empty it as much as possible.

E. Malysheva: Recently, I have been receiving many letters from my regular spectators about breast problems: MASTITE, LACTOSTASIS, FIBROADENOMA. To get rid of these problems completely, I advise you to familiarize yourself with my new method based on natural ingredients ...

The first rule is the convenience of the mother while feeding the baby. At the same time, it is important to try to provide maximum comfort not only for the baby, but also for yourself. Feeding for both should be similar to rest!
Rule two - choosing the perfect pose. In the very first days of getting to know your baby, try to try several different options for conveniently positioning your baby when feeding him. In this case, you need to choose not one, but two or even three convenient positions, which it is advisable to alternate later.

It is important to remember that there are situations when changing the position of the baby during feeding is not only desirable, but very important and even necessary.

We are talking about injuries to the nipple, when the baby needs to be laid so that he does not injure the affected area, etc. So we would like to dwell on the choice of the correct positions when feeding.

What are the most preferable breastfeeding positions

Of course, each mother should choose a comfortable and correct position for feeding her baby strictly individually. The choice of poses depends on the activity of the baby, on the shape of the mother's breast, and on the individual preferences of both.

Nevertheless, we want to describe some of the most successful positions to make it easier for moms to make their choice.

Cradle position. With this position, the mother sits comfortably, the baby's head is located on the mother's elbow, the baby lies with its tummy to the mother. The position provides maximum comfort for the newborn because it lies almost like in a cradle, but only on mother's arms.
Hand feeding position. When the baby lies on the pillow directly under the mother's arm (like a bundle under the armpit), facing the chest. The position is comfortable with no pressure on the mother's abdomen and a comfortable grip for the baby.
Position - both on the side. This is a pose when the baby and his mother lie on their side, facing each other. The pose is most convenient for stagnant milk, since it avoids even minimal pressure on the affected breast and, in addition, the second breast will also be in the most favorable physiologically correct position.

Of course, we have not given all the possible positions for proper feeding, but nevertheless, these are exactly the location options that allow you to most effectively deal with the manifestations of lactostasis, resorting to the help of your baby.

Do you still think that it is completely impossible to cure your body?

How can you identify them?

nervousness, disturbed sleep and appetite;
allergies (watery eyes, rashes, runny nose);
frequent headaches, constipation, or diarrhea;
frequent colds, sore throat, nasal congestion;
joint and muscle pain;
chronic fatigue (you get tired quickly, no matter what you do);
dark circles, bags under the eyes.

Lactostasis is a phenomenon of milk stagnation in the milk ducts. When one or more ducts become clogged, stagnation occurs. The chest in this place becomes denser, and over time painful sensations join. The set of signs suggests that the inflammatory process has already begun. Delaying the treatment of stagnation leads to an increase in the area of \u200b\u200binflammation and the spread of the disease to the entire breast. Untreated lactostasis develops into mastitis.

Lactostasis is stagnation of milk in the breast of a nursing mother, which causes inflammation of the ducts (we recommend reading :)

Mastitis in the first stage has such distinctive characteristics: swelling, breast tenderness and high fever. This stage is a reason to immediately consult a specialist, namely, a mammologist. If you fail to do this in time, you risk exacerbating the problem. Various pathogens, such as staphylococci and streptococci, begin their harmful effects: purulent abscesses appear. This severe form of mastitis is called purulent and in most cases is treated only by surgery, when all abscesses are opened.

Treatment of mastitis and lactostasis

Physiotherapeutic procedures are widely used today, which are absolutely harmless to mother and child. Such auxiliary methods are completely painless and help to establish lactation in the shortest possible time.

Among the physiotherapy procedures for lactostasis, we list:

ultrasound;
vitafon;
darsonval;
ultra high frequency (UHF).

Thanks to these methods, milk stagnation is broken. For example, darsonval acts with a current on a painful area in a pulsed mode. Stagnant lumps gradually "break". Ultrasound in lactostasis is an active method of treatment in which mechanical, thermal and physicochemical action is directed to the affected area. The Vitafon device, thanks to the generated sound waves emitted at a variable frequency, helps to solve the problem of stagnation.

Before carrying out physiotherapy procedures, you must definitely do a planned ultrasound

Attention: Vitafon and Darsonval devices can only be used after ultrasound. It must be carried out to exclude tumor processes and mastopathy.

How is the treatment carried out?

The doctor uses an ultrasound sensor to diagnose lactostasis. Seeing the source of the problem and understanding the way to solve it, he chooses the most effective and painless treatment option. In more detail, the diagram looks like this:

The mammologist conducts an examination, an ultrasound scan, and then makes a diagnosis. On this basis, the doctor proposes treatment. It can vary depending on the complexity and neglect of the case: without medication, with medication, physiotherapy, and in severe cases, surgery. The extensive experience of the doctor allows him to operate with a number of knowledge about the indications and contraindications of a particular procedure, which means he will be able to choose an effective treatment specifically for your case.
Numerous breastfeeding services are now widespread. Trained nurses make home visits and provide some assistance, mostly straining. It is important to know that sometimes this is not enough, and in some cases such intervention is contraindicated. For example, the presence of mastitis in a woman requires the statement or refutation of the diagnosis "purulent mastitis". Straining purulent areas will lead to extremely sad consequences. Purulent mastitis is also dangerous because even in the presence of purulent foci, the body temperature can be normal. The woman mistakenly believes that she is on the mend, although in fact the disease is getting worse.
A qualified doctor is able to help every patient by consulting lactation and prescribing the appropriate treatment.

If lactostasis has not turned into mastitis, a breastfeeding consultant will be able to help establish feeding and breastfeeding

Diagnosis with ultrasound

The main purpose of ultrasound in mammology is the diagnosis of fluid and acoustic dense formations in the breast, as well as the visible control of therapeutic and invasive procedures. Ultrasound diagnostics is an effective way to determine lactostasis. Scanograms reflect stagnation in the form of overly dilated breast ducts. Expansion of distant ducts and sinuses can be seen especially clearly. With lactostasis, in contrast to mastitis, the structure of the mammary gland is preserved in the absence of blood and lymph impurities in the tissues.

There is compensated and decompensated lactostasis (we recommend reading :). The presence of one of them can be determined using a pharmaco-sonographic test using pituitrin. To begin with, a woman is asked to express her breasts as much as possible, and then an ultrasound is performed. After determining the diameter of the milk ducts, 1 ml of pituitrin is injected into the body (intramuscularly). After 15-20 minutes, the ultrasound examination is repeated.

If the milk ducts have decreased in comparison with the first examination, a compensated form of the disease is diagnosed. In the absence of effect, the diagnosis is "decompensated lactostasis". Such a conclusion requires the selection of an appropriate treatment with drugs.

On ultrasound, the specialist will see the dilated ducts and will be able to make an accurate diagnosis

Physiotherapy with ultrasound

Today, doctors successfully treat problems that arise in nursing mothers during lactation. Diseases of the mammary glands are perfectly eliminated by ultrasound. In just 2-3 sessions, a young woman gets rid of the problem. An effective and painless method allows you to improve the work of the thoracic ducts, increase milk production and minimize the risk of inflammation in the chest. This method should be combined with pumping, which should be done by an experienced specialist.

Ultrasound works in a complex manner. Blood vessels dilate, milk ducts become easily passable, and pain sensations subside. In fact, ultrasound imitates massage movements that actively nourish the breast tissue by increasing the diameter of the blood vessels. An experienced functionalist performs this procedure using an ultrasound sensor. It treats the entire breast surface, except for the areola and nipple. The therapy time is 15 to 20 minutes.

To achieve a positive effect, 4 to 8 physiotherapy procedures should be carried out. The amount will depend on the severity of the disease.

As an alternative, the doctor may suggest the Vitafon apparatus. Physiotherapy ends with compulsory expression. It does not hurt to carry it out, because the mammary gland has received good softening. For full expression, you can seek help from an experienced specialist in this area.

When is ultrasound contraindicated?

Although ultrasound is very simple and harmless, there are still a number of contraindications to its use.

The main prohibition will be diseases of the nervous system that a woman has. Active exposure to ultrasonic waves, especially in the chest and heart, can lead to various kinds of disorders in the activity of the central nervous system.
When a woman has breast tumors, the above method cannot be used. When exposed to heat, an increase in the number of cancer cells occurs, as well as the transformation of benign neoplasms into malignant ones.
Cystosis of the mammary gland, mastopathy can be the place of origin of the cancer process. It is also impossible to treat such areas using ultrasound.
In the presence of purulent mastitis, an ultrasound procedure is excluded. The presence of inflammation based on milk stagnation implies an immediate visit to a doctor who will suggest a course of therapy and help avoid surgery.

Before starting to treat the problem with ultrasound, you should consult a specialist. Anything that interferes with physiology can have both positive and negative results. A young woman should be aware that self-medication in this case is unacceptable.

If the examination revealed a tumor of any kind, ultrasound is contraindicated for a woman.

Prevention and treatment of lactostasis at home

By regularly applying the baby to the breast, observing the "on demand" mode, you will help the milk ducts to completely get rid of milk. Over time, the body will adapt to the needs of the baby and will produce the required amount of milk.
The change will have a positive effect on the release of the various lobes of the mammary glands. This method will prevent stagnation of milk in some parts, otherwise, one part will always be emptied.
Do not pump too often. In this case, the body will perceive this as a signal to produce an even larger volume of milk, which means that lactostasis may reappear.
Feeling a seal in some place of the chest, all the more painful, it is important to begin independent straining under a warm shower, focusing on the place where there is stagnation. If the crumb is not able to dissolve the stagnation, use a breast pump (we recommend reading :).
The futility of trying to clear out on your own requires an urgent appeal to a mammologist.

Attention! All manipulations with the mammary glands require utmost care. Handling errors can cause bruising, swelling and an increase in the area of \u200b\u200binflammation. If it is impossible to cure lactostasis on your own, you should refuse to use the forceful method of straining, because this approach will only aggravate the problem. Incorrect tactics can lead to the appearance of diseases that require long-term and serious treatment.

The introduction will be short, but for anyone interested you can read the review: Breastfeeding. Hyperlactation. When there is a LOT of milk. When a breast pump is needed. Link:

When my daughter was only 10 days old, I invited a consultant. It cost me 3 thousand rubles. She invited me to think it would help, she showed how to apply, it turned out to be a whole science. Probably, psychologically, I needed to communicate with someone, because there was not really anyone. And, behold, she found out that I was straining and strictly forbade me to do it. In general, her advice was not much different from all the advice on the Internet. As a result, after a couple of days I had a terrible lactostasis in all its manifestations.

With fever, pain and stony chest. The consultant herself only repeated the positions in the attachment, they did not help me in any way, not from this, not from that. There was stagnation in one lobe, but milk came from others, and this was enough to feed the baby. Therefore, after sucking a little, my daughter was full, and I was left alone with my problem.

It should be noted that the daughter did not make much effort in sucking. I think she should have started, as the milk itself poured into her mouth, she just opened her mouth and swallowed. What kind of help is there in straining? Then she never hung on her chest, feedings were always short, only to eat.

Therefore, the breast pump was my great helper. I used it to strain with milk stagnation, and with it I pumped my breasts to relief, no more.

BUT, and the breast pump did not help to strain so that everything would work out again. I even called the government seating service. They didn't help me at all! They said that I have the flu))

On the Internet, I read about ULTRASOUND. It was after this procedure that the milk began to flow and was further distilled with a breast pump. I had AVENT automatic.

LACTOSTASIS what helped me:

Traumeel C cream
Cabbage leaves beaten off (I never liked my grandmother's recipes, but here it seems they helped
Expressions with a breast pump (I had an automatic AVENT, in my case only an automatic one was suitable, I can't imagine how to sort out stagnation manually)
You can still massage chest in soul, having previously lubricated with vazilin, well, this is an addition, not the main one.
Further, if this does not help you, feel free to go to the gynecologist and ask for a referral to ultrasound... 2-3 sessions were enough for me. They say that milk starts to flow right in the office, this did not happen to me, I tried to quickly get home and shove my breast to my daughter, then I strained it with a breast pump.

I also read a lot about Magnesia and Aloe, I even bought ingredients, the reviews are only good, but after 2 lactostasis it was not useful to me and I did not have time to try it.

In both cases, it was the ULTRASOUND that became the decisive factor in helping with milk stagnation.

You must bring to the procedure:

Petrolatum

Diaper

You can use breast pads if milk is already on the way home

Dear Mom, do not torture yourself with painful hand-straining. Do not spend money on aunts who, for 5000 rubles, will torment your breasts to help you disengage.

The ultrasound procedure is free, safe and painless... Talk to your gynecologist or mammologist. It is these doctors who give directions for ultrasound.

Lactostasis worries many women who are breastfeeding, both immediately after childbirth and in the following months. Milk stagnation is provoked by increased lactation, inadequate nutritional activity of the child, the wrong approach to feeding and other reasons, but this condition should be treated immediately after the first signs are detected. Ultrasound for lactostasis is one of the procedures that allow for a short time to adjust the outflow of milk, release clogged ducts, eliminate pain and lumps in the chest.

The essence of the problem

Ultrasound is prescribed for women who are faced with swelling and soreness of the mammary glands caused by lactostasis. The reasons for this condition can be many, from the anatomical properties of the body to improper breastfeeding. Here are the main ones:

poor-quality emptying of the glands due to improper attachment of the child - when it captures only the nipple, and not almost the entire area of \u200b\u200bthe areola (this is fraught not only with lactostasis, but also with damage to the skin on the nipples);
a monotonous posture when feeding - while not all breast lobes are released, and in the rest, blockage of the ducts begins;
sleeping on your stomach, on your side without changing position, wearing a tight bra, holding your breast while feeding with two fingers - all this contributes to the development of stagnation;
chest trauma, general or local hypothermia;
the transition from natural feeding to artificial mixtures - with the previous lactation, the baby sucks out less milk, provoking the onset of lactostasis;
stress and lack of proper rest;
expressing unnecessarily with increased milk production - it becomes even more, the crumb cannot cope with the volume of fluid, stagnation occurs.

Another reason for stagnant milk, doctors consider feeding on a schedule, with an interval of 3-4 hours. Mothers who apply the baby to the breast on demand are less likely to complain of signs of lactostasis, since their glands are emptied efficiently and regularly.

Important! The first signs of stagnation are soreness in the chest, the appearance of puffiness and lumps, which can be felt through the skin. The temperature may remain within normal limits, but in the area of \u200b\u200bthe mammary glands, the skin feels hot. It is impossible to delay the start of therapy, because after 2-3 days lactostasis can turn into purulent-infectious mastitis.

Straining of lactostasis with ultrasound is an effective and safe procedure, thanks to which you can quickly stop the development of the inflammatory process in the breast, soften the seals, adjust the outflow of milk and make the nursing mother feel better. In the absence of contraindications, UST or ultrasound therapy for lactostasis has the following advantages:

improving the blood supply to tissues in the area of \u200b\u200bstagnation;
elimination of pain;
removal of edema;
arresting the inflammatory process and preventing its further development;
getting rid of spasms.

Need to know! The action of ultrasonic waves with a frequency of 20-3000 kHz on the mammary glands is also considered bactericidal, restorative and relaxing, it does not damage the chest, at the same time it massages and warms the tissues by 1 o C. The ultrasonic wave breaks the seal, and the body reacts to an increase in temperature by improving metabolism.

As a result, the patient quickly and painlessly receives three types of treatment at once - mechanical, thermal and physicochemical. In this case, the recovery function is triggered at the cellular level, providing removal of puffiness, resorption of seals, elimination of pain and stagnation in the ducts of the mammary glands.

Features of the ultrasound procedure

Treatment of lactostasis with ultrasound is carried out on a special apparatus. It creates waves that pass from the sensor deep into the glandular tissues by means of a gel - the breast is warmed up, receiving the effect of a micromassage. The specialist makes light movements in a circle on the breast surface, without affecting the nipple and areola, the session time is 10-15 minutes. The intensity of the apparatus is chosen by the physiotherapist, it can be continuous or pulsed, the power is 0.2-0.4 W per square centimeter.

The peculiarities of ultrasound therapy of lactostasis is that the effect of waves on the gland is not limited only by the time of the procedure. The body's responses proceed in several phases:

Direct effect on glandular tissue, accompanied by the release of heat and the onset of chemical reactions in cells.
The phase of the next four hours after ultrasound exposure - hormones and beneficial substances are released into the blood, causing the activation of immunity, an increase in the protective properties of leukocytes and the destruction of bacteria.
Phase twelve hours - after the procedure, the metabolism in the cells is accelerated.
The final phase is blood flow to the glands, increased oxygen supply to tissues, active carbohydrate and lymphatic metabolism.

On a note! After ultrasound treatment, the breast immediately becomes soft and painless, milk should be expressed from it, since it is impossible to feed the baby to it. It is proposed to do this directly in the physiotherapy room. After 2-3 sessions, the patients notice a significant improvement in the condition of the mammary glands, but the full course of therapy is 7-8 ultrasound procedures.

Contraindications

There are a number of contraindications in which the doctor may consider ultrasound to be harmful.

Despite the fact that the treatment of lactostasis with ultrasound is considered an effective and absolutely not harmful procedure, there are situations when such therapy cannot be carried out. The following health problems are contraindications:

diseases of the central nervous system - under the influence of ultrasonic waves in the region of the heart and chest, disturbances in the functioning of the central nervous system may appear;
hormonal disruptions that provoked the development of mastopathy, fibroadenoma, breast cysts - all these diseases can be exacerbated as a result of ultrasound treatment, causing the process of degeneration of benign cells into malignant ones;
pulmonary tuberculosis;
high blood pressure;
acute purulent infectious mastitis, as well as other viral and bacterial inflammatory processes occurring in the body;
endocrine system pathologies, for example, diabetes mellitus;
breast cancer;
pregnancy.

A specialist who knows the medical history of a particular patient can tell in more detail about contraindications to ultrasound treatment. Before signing up for a course of sessions to eliminate signs of lactostasis, a woman must definitely come to an appointment with a physiotherapist.

The lactation period in lactating women is often accompanied by a disease such as breast lactostasis. The development of the disease can be associated with various factors: spasms of the ducts, hypothermia, improper attachment of the child or refusal to feed. Ultrasound for lactostasis is an effective physiotherapy procedure that improves blood circulation and the process of milk outflow from the breast. Treatment of the disease should be carried out in a timely manner so as not to provoke the appearance of inflammatory processes.

Lactostasis

Lactostasis disease occurs in nursing mothers due to blockage of the excretory canals by the arriving milk. In most cases, the disease manifests itself as a compaction in the mammary glands, accompanied by unpleasant and painful sensations. Insufficient emptying of the mammary glands provokes increased pressure in the lumen of the ducts, as well as inside the lobes, which causes tissue edema in this area of \u200b\u200bthe breast, and subsequently leads to inflammation. If milk is not excreted from the mammary gland for a long time, it begins to be absorbed back and acquires some pyrogenic qualities that increase the body temperature. This syndrome is called "milk fever". Lactostasis appears due to a number of reasons, including:

increased production of breast milk;
disturbed outflow from the mammary gland;
wrong feeding regimen;
chest injuries and bruises;
flat nipple or cracked nipple;
tight clothing that squeezes the chest;
physical exercise.

Increased milk production usually occurs at the beginning of lactation, as many primiparous women have narrower and undeveloped excretory ducts. Painful sensations do not disappear after expressing.

At the first manifestations of the disease, it is necessary to start treating it, otherwise there is a risk of transition to breast mastitis.

Treatment methods

To combat lactostasis, women are first of all recommended to reduce fluid intake to ensure a smoother flow of breast milk, more often to apply the baby to a sore breast. If milk stagnation is significant, then oxytocin is injected intramuscularly, which contributes to the reduction of ducts.

If these methods do not help or are ineffective, then ultrasound treatment is prescribed. This method allows you to penetrate into the focus of the seal without harming the soft tissues and to act on stagnant milk by breaking it and micromassage. In this case, in the tissues under the influence of ultrasound, an increase in metabolism occurs due to the release of temperature.

Ultrasound treatment usually involves vibrations up to 3000 kHz in frequency with a certain dosage of exposure. With the help of ultrasonic waves, thermal, mechanical and physicochemical effects are achieved. This method is a kind of irritant that can trigger the body's natural defense mechanisms, resulting in rapid tissue regeneration and the disappearance of edema.

Description of therapy

Physicians often prescribe physiotherapeutic procedures for women with complaints of lactostasis, among which electrophoresis with medicinal herbs and ultrasound therapy are widely practiced. Ultrasound is usually used to treat stagnant lumps, which break into small particles under the influence of ultrasonic waves. Due to the fact that lactostasis is a blockage of the excretory canals and stagnation of milk in the mammary glands, its treatment requires the use of ultrasound therapy. Ultrasound at a microscopic level affects the thickened areas of the mammary gland, liquefies and transforms the stagnant milk mass into an emulsion.

Ultrasound treatment is the best prevention of other breast diseases, including mastitis, due to its anti-inflammatory properties. The procedure increases the temperature in the chest and has a massage effect. The therapy is carried out with the help of a special apparatus, with which the doctor gently treats the breast in circular movements without affecting the nipple area. The positive qualities of this therapy include the absence of discomfort or pain in a woman during the procedure. The duration of the procedure takes 15 minutes, and the full treatment lasts up to 8 daily procedures or 3 days, 3 sessions a day.

Ultrasound treatment is a safe procedure, approved by leading specialists and widely used around the world. After ultrasound therapy, such signs accompanying the disease of lactostasis as varicose veins, painful sensations disappear quite quickly, ultrasound fights cracks and other nipple injuries, while simultaneously preventing mastitis and other breast diseases. Therefore, this therapy is the best solution in the treatment of lactostasis.