DEAR DOC: I have never given birth, so why am I producing milk?

Dr Flo,

I am a woman aged 21 years, have never been pregnant, but my breasts produce milk every time I press them. If I don’t press them, they are okay. I have experienced this problem for two years now and at some point I thought it was because of using morning-after pills to prevent pregnancy after unprotected sex. However, even after stopping using the pills the problem persists. Please help, I am worried. Joy.

It is good that you have stopped using the morning-after pill and you need to avoid any other hormonal medications until this is resolved. If no underlying problem is found, there are medications to reduce the prolactin levels in the body, which will in turn stop the milk production. In the meantime, avoid breast stimulation and do not wear clothes that have a lot of friction between your nipples and the fabric.

Dear Joy,

What you are experiencing is called galactorrhea — the discharging of a milky substance from the nipples in women who are not breastfeeding, in men, or even in babies. Milk production usually results from having high levels of the hormone prolactin in the body, which is produced in the pituitary gland, part of the brain.

High levels of prolactin can be produced due to use of birth control medications, other medicines like anti-depressants, sedatives, anti-psychotic medications, ulcer medicines, some herbal medicines, and some blood pressure medications. Abuse of cocaine, heroin, morphine and bhang can also cause it.

Other disorders that can cause galactorrhea are tumours of the pituitary gland, chronic kidney disease, hypothyroidism, and disorders of the spinal cord. Another cause could be excessive stimulation during sexual activity, or frequent self examination.

In men, it can occur due to reduced testosterone levels; and in babies, it can happen due to having hormones from the mother still circulating in their blood. In some people, the cause of the galactorrhea may never be found.

You need to visit a doctor for a physical breast exam, examination of the discharge, and tests to find out if you have high prolactin levels, and if you may have any of the other disorders. Treatment will depend on the underlying cause.

It is good that you have stopped using the morning-after pill and you need to avoid any other hormonal medications until this is resolved. If no underlying problem is found, there are medications to reduce the prolactin levels in the body, which will in turn stop the milk production. In the meantime, avoid breast stimulation and do not wear clothes that have a lot of friction between your nipples and the fabric.

Dr Flo,

I keep experiencing some pain in my left lower abdomen, beside the bladder. The pain is more intense when the bladder and the bowels are full but eases when I empty them. It has been on and off for almost four years now and whenever I seek medical advice they only test for sexually transmitted infections, which have been ruled out. Please advice. Reuben Korir.

Dear Korir,

Since the pain is in the lower abdomen, and is present when your bowels and/or bladder are full, then the problem is likely to either be in the urinary tract or in the intestinal tract. You need to have the urine and stool checked, and if they are okay, then you should have an abdominal and pelvic scan done, preferably also including a testicular scan.

You can also have cystoscopy done, where a small tube is passed into the bladder from the urethra, to look at the inside of the bladder, and a colonoscopy to look inside the intestines.

Recurrent pain in the lower abdomen when the bladder is full, that is relieved when you empty the bladder, is likely to be due to interstitial cystitis. This is a condition where, due to unknown reasons, there is persistent inflammation, or sometimes there are ulcers, in the bladder wall. This makes the bladder overly sensitive, and there is pain when the bladder is full, which eases on passing urine.

Similarly, pain in the lower abdomen when the bowels are full, which is eased when you empty the bowels, may be due to an inflammatory condition of the intestines known as irritable bowel syndrome.

Another disorder, pelvic floor dysfunction, which causes abnormal spasms or contractions of the pelvic muscles, may be responsible for both problems. You need to see an urologist and/or a gastroenterologist so that a proper diagnosis is made and you are put on proper management.

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