Is my newborn constipated?

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Many young infants cry and strain when they’re pooping, especially in the first 3 months of life.

Which sounds like constipation.

…But is it?

Read on to learn about infantile dyschezia, which often looks the same (and is a more likely explanation if your baby’s bowel movements still look normal).

I’ve been there…

When my first was a baby, she went through a period of several weeks where she cried hysterically every time she tried to poop. She had reflux, too, and was generally not a happy baby, which made things confusing. She would turn red, squirm, and scream multiple times per day as she tried to pass stool.

I can’t honestly remember how often she pooped, but I do remember that her bowel movements were still soft/normal consistency.

So she wasn’t constipated.

But she acted constipated.

And worse - she seemed like she was in pain.

Those months were a blur, but I do know that I spent a great deal of time crying in sympathy and frantically trying everything in my arsenal to soothe her.  Eventually she outgrew it, but man, those were some tough days.

Pooping is a …skill?

Think about the act of pooping.

You are seated (or squatting), and you bear down. This increases your intra-abdominal pressure. You also relax your pelvic floor… and stool comes out.

Now imagine trying to poop laying down. The whole process is harder because you don’t have gravity to help. Generating intra-abdominal pressure, and even passing the bowel movement is harder - in part because you don’t have gravity to help.

Infantile Dyschezia

Newborns with infantile dyschezia struggle with the act of passing stool.

They are having trouble coordinating the two elements of pooping: increasing abdominal pressure AND relaxing the pelvic floor. They cry for 10-15 minutes during stool or gas passage, not because they are in pain, but because it is an easy and obvious way to increase the abdominal pressure.

How is this different from constipation (and how can I tell?)

Infants with infantile dyschezia have soft, normal consistency stool. (If you want a primer about what is considered “normal” in terms of consistency and frequency of pooping in newborns, head over to the guides section of this website).

Typically, babies with constipation present with harder, more pebble-like poop, or sometimes even blood in the stool. Contrary to popular belief, frequency of stooling is not how we define constipation. Newborn babies can poop as frequently as 8-10 times per day…. or as infrequently as once every 8-14 days. Both can be normal - as long as poop consistency is normal.

A caveat

There are rare, more serious conditions that can look similar to infantile dyschezia (straining and discomfort with stooling). This article is written for educational purposes, but in the end if your baby is exhibiting these symptoms, it is still wise to touch base with your pediatrician. In most cases, the pediatrician will want to examine the ano-rectal area to make sure there are no abnormalities (placement, musculature, etc), and will get a stooling history to make sure there are no additional red flags.

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How can I help my baby?

Many parents turn to the windi or rectal stimulation to help their babies stool. Although those are useful tools to use occasionally, they typically do not really give your baby the chance to practice co-ordinating the muscles in order to learn the important skill of pooping.

I wish I had a better answer than “wait it out” but unfortunately, at least for infantile dyschezia, this is a skill your baby needs to figure out. And they will, I promise. Most infants outgrow infantile dsychezia within the first 2-3 months of life.

The best thing you can do is remember - the crying in this case is designed to increase intra-abdominal pressure, and not because they are in pain.

Take a deep breath, and ask another caregiver to help if you are feeling super distressed. Do not resort to changing mom’s diet, offering medications, switching formula, or anything else without first discussing with your pediatrician.

What about gas?

Babies are challenging, because they are often gassy and fussy. I have a separate post on gassy babies here, and a guide on fussy infants in the guides section as well.

In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!

We are evolutionarily designed to be distressed when our baby cries. My hope is that this article helps, but even knowing about infantile dyschezia did not stop me from feeling awful that I couldn’t fix it.

I get it.

So, please, give yourself some grace, but have faith in your baby too. They all figure out how to poop, I promise!