One of the most common complaints pediatricians hear during an infants first few months of life is “constipation.” In these cases, the parents are concerned because their baby seems uncomfortable passing a bowel movement (BMs), often paired with inconsistent timing and sometimes long gaps. What they are shocked to discover from their pediatrician is that this is, in fact, a normal thing called infantile dyschezia (latin for baby has discomfort with pooping).
Why This Happens
It is extremely normal for some infants to have some discomfort with BMs, and this is quite simply because we are not actually born knowing how to do it. Passing stool requires two coordinated events:
- pelvic floor relaxation and,
- an increase in intra-abdominal pressure.
In other words, you need to both take the cap off the toothpaste tube and squeeze the tube for the toothpaste to come out. Babies do not know how to coordinate these movements yet. It is normal for infants (especially breastfed infants) to have 5-10 BMs a day, or one BM up to every 5 days. As long as the consistency is soft, we would not term that constipation.
Clinical presentation
Infantile dyschezia typically occurs during the infant’s first 2 to 3 months of life. Parents often describe their baby as “turning red” or “fussing or crying” when trying to have a BM which is relieved by getting it out. The BM itself is soft and typical for infants.
Diagnosis
While there are some issues that do cause constipation in healthy infants such as challenges with the anatomy or nerves of the colon or anus itself, these are very rare. If your infant
- has soft bowel movements,
- is feeding well, and
- is growing normally,
Then no additional testing is needed to diagnose infantile dyschezia.
Treatment
You might wonder why this tends to present so early in life. Like many developmental milestones such as sitting, crawling, walking and talking, muscle coordination develops with time. As infants grow, muscle coordination naturally develops without any need for treatment. Ironically, the thing which typically slows this development the most is when parents try to “help” the baby, usually consisting of using a finger in the anus, a parenting tool designed to relieve gas, or a suppository. These interventions prevent your baby from effectively learning how to coordinate the muscles and can actually increase the risk of developing true constipation. In almost all cases, symptoms are resolved by around 3-4 months of age, and no further issues arise. If you’re ever unsure or concerned, checking in with a healthcare provider is always appropriate, but remember that for many infants, this phase is simply part of learning how their bodies work.