What is infant dyschezia?
Infant dyschezia is a functional condition characterized by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stools in an otherwise healthy infant less than six months of age.
Parents visit the clinician during their infant’s first six months of life concerned that their child is constipated. The parents describe a healthy infant, who cries for 20–30 minutes, screaming, and turning red in the face with effort, until a bowel movement finally takes place. The stools are soft and free of blood. These crying episodes, exhausting for the infant and anxiety provoking for the parents, occur several times daily.
Assessment includes charting the infant’s growth, history (including diet), and a complete physical examination (including rectal examination) as the parents watch. All are normal, and the parents are reassured by the clinician’s careful examination.
For infants, a successful bowel movement requires two coordinated events:
- relaxation of the pelvic floor muscles (a thick sheath of muscles that span the underlying surface of the bony pelvis),
- and an increase in abdominal pressure to squeeze out stool.
Infants with dyschezia have not yet learned to coordinate those two required actions. Crying is how they increase their abdominal pressure. They cry until, by chance, they relax their pelvic floor muscles at the same time and a BM occurs.
For the fist few weeks of life many activities such as sucking, swallowing, urinating and stooling are accomplished by instinct alone. As development proceeds, instinct goes away and the child learns how to eat based on smell, taste and texture, how to urinate based on the physical urge, and how to have a BM.
No treatment is necessary
No tests or treatments are necessary. The infant will soon learn to have bowel movements more easily. Use of suppositories or rectal stimulation is inappropriate as these will interfere with the infant’s learning to coordinate the act. Laxatives are unnecessary.
Infant dyschezia rarely lasts more than a week or two. It will resolve spontaneously as the child develops.
Learn more about childhood defecation disorders
Adapted from IFFGD Publication: Childhood Defecation Disorders: Constipation and Stool Incontinence #810 by Paul E. Hyman, MD, Professor of Pediatrics, Louisiana State University; Chief Pediatric Gastroenterology, Children’s Hospital, New Orleans, LA.