By Lewis G. Maharam, MD, FACSM
Please stop my nipples from bleeding! After a half marathon or more my nipples bleed, I’m in pain for a week and my favorite t-shirt needs cleaning. Please help me! Will this cause permanent damage? Jonathan s. , Nashville, TN
Oh do we all feel your pain! In fact, the most common spectator comment at finish lines is “wow, that must hurt!” We all know it does and is so easily prevented!
Nipple bleeding is a direct result of chafing from the direct effects of rubbing against clothing, sweat and salt. Nipples first become irritated and tender then open wounds develop with bleeding. The raw skin and salt from sweat in these open wounds with a significant nerve supply are not comfortable in the least and take days and sometimes a week to heal each time! Long term, scar tissue may develop from healing and re-healing that will eventually make your nipples less sensitive, something I’m sure you do not want
Fortunately, prevention is easy:
- Proper Clothing: Wear softer, looser shirts: avoid a new unwashed shirt. Switch from cotton to a synthetic sweat-wicking fabric as the base layer next to the skin.
- Topless: If the weather is warm enough men can go topless. Please remember however that you need a sun block as this method risks sunburn. Use a product that is waterproof so that your sweat doesn’t wash it away. Don’t fear not sweating since your other areas without the sun block are enough to allow your needed sweat mechanism.
- Proper hydration: We do not want you to run out of fluid, you need it to sweat. Without proper fluid, the sweat will dry up leaving salt flakes that are irritative. Do not drink too much or too little; use thirst as a guide. And check your urine. You want your urine to look like lemonade; clear you are drinking too much, iced tea you are drinking too little.
- Use a lube and or protection: Vaseline, Body Glide, Band aids, Nipple Guards are a good prevention against rubbing.
- Remove nipple jewelry before your run. Seems like a no brainer but I have seen participants that hadn’t thought that their fashion statement was the cause behind their nipples’ bleeding! An easy pre-workout removal saves days of discomfort!
A short note to women smiling as they read this: YOU are not immune to nipple bleeding! Improper or poorly fitting sports bras are the cause.
- Cotton keeps moisture in so that the soggy bra shifts back and forth. Switch to a synthetic sweat-wicking fabric to pull the moisture away from the skin.
- Make sure the bra fits snuggly: both the band around your chest and the cup. If it’s loose and moves, chances are that it will cause chafing.
As a physician, I would be remiss if I didn’t mention that if your nipples are bleeding and you are not chafing, that is a time to see your doctor as something more serious may be going on. If you are chafing, following the above advice should alleviate this problem forever.
Enjoy the ride.
Dr. Lewis G. Maharam is the world’s premier running physician. He is medical director of Competitor Group’s Rock ‘n’ Roll Marathon series throughout the country and The Leukemia & Lymphoma Society’s Team in Training program. He also serves as Chairman of the Board of Governors, International Marathon Medical Directors Association. Dr. Maharam “s column can be followed in Competitor Magazine and his Facebook page: Running Doc
Any questions you may want answered by Dr. Maharam in future columns should be e-mailed to Dr. Maharam at firstname.lastname@example.org.