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.
These episodes, exhausting for the infant and anxiety provoking for the parents, occur several times daily. They may prompt parents to visit their child’s clinician during the infant’s first 2 to 3 months of life with concerns that their child is constipated. The parents describe a healthy infant who cries for 20 to 30 minutes, turns red in the face, and screams, seemingly in pain, before defecation takes place.
Defecation requires two coordinated events:
- Pelvic floor relaxation
- An increase in intra-abdominal pressure (bearing down to have a bowel movement)
Children with infant dyschezia have not yet developed this coordination so they are unable to enjoy easy defecation.
Infant dyschezia is a problem in learning to defecate. Crying is the infant’s attempt to create intra-abdominal pressure, before they learn to bear down more effectively for a bowel movement. The infant is not crying from pain.
The clinician will perform an examination, and review the infant’s growth and history including diet. In a child with infant dyschezia all will appear normal.
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.
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.