When Pooping is Difficult For Preemies: 5 Important Reasons

Is your preemie not pooping, or maybe he or she seems to be in pain when pooping?

Let’s take a look at why pooping is often difficult for preemies and find out what you can do about it.

PinMom’s Question:
Is it common or usual for premature babies not to poop, or that it is difficult for them to poop? I have a 3-month-old baby premature at 28 weeks. Technically 2 weeks, she is having problems pushing her poop out; she is not constipated because her stool is very loose. I’ve been helping her with a Q-tip, which seems to help. When she pushes, she gets agitated.

What else can I do so she can start going on her own again? She is on formula lactose intolerance.

Thanks in advance,
Caroline

Pooping Issues In Preemies and Newborns

When Pooping is Difficult for Preemies – Can it be Normal?

I’m actually wondering if your baby really does have problems pushing out her poop – or if what you’re seeing is just normal infant behavior.

Newborn babies (preemie or not) tend to make a lot of noise when they poop, with all sorts of grunts and straining sounds. They may even go quite red in the face. This is normal – and the fact that your baby’s stools are loose when she passes them makes it less likely that she’s experiencing anything unusual. Just make sure that their stools aren’t completely watery or very hard.

Constipation in Premature Babies

That said, it is true that preemies are more prone to constipation than full-term babies. Their intestines are still immature, to the point that movement of digested foodstuff is still uncoordinated – it takes some time before poop comes out, compared to babies who were born term.
Some types of iron supplements that may also be found in preterm formulas could cause constipation in premature babies, although more research is needed to confirm this.

Your daughter’s gastrointestinal system may not be fully mature yet, so she needs to work harder to push the poop out.

Some signs of constipation are hard, pebble-like stools or even a tiny amount of blood on the surface of the stools. You can find more signs of constipation in babies in this article. Since your daughter’s poop is loose, she is unlikely to be constipated.

Medical Reasons to Consider When Premature Babies Are Not Pooping

In addition to constipation itself, other medical reasons can cause pooping difficulties. We’ll briefly discuss some of the most common conditions, but it’s important to remember that this cannot replace your doctor’s advice. If you are uncomfortable or worried at any point, it’s best to have your child seen by a doctor.

Hirschsprung’s disease

Hirschsprung’s disease is a congenital condition wherein nerve cells controlling the movement of the colon walls are missing or insufficient. The colon’s walls cannot move correctly, so stools can get stuck and build up in that area of the intestines.

Most babies with Hirschsprung’s disease cannot pass stools within the first 24 hours of life, but some infants can pass poop at first but then start to develop other symptoms. Some signs and symptoms include difficulty feeding, irregular or infrequent bowel movements that may be explosive, and a bulging tummy.

Small bowel obstruction

It’s possible that other parts of the intestines did not form properly (or did not form at all), causing stools to be blocked and making it difficult to pass them out. However, this is more commonly seen in babies who have not pooped at all yet. Affected babies may have a slowly enlarging abdomen, vomiting episodes, and difficulty feeding.

There are different conditions that cause small bowel obstruction. In duodenal atresia, a segment of the duodenum (a part of the small intestine) does not fully develop. In jejunoileal atresia, a segment of either the jejunum or the ileum (also parts of the small intestine) does not fully develop. In these cases, the poop cannot pass through and will simply build up in that area until it blocks the intestinal passageway.

The gastrointestinal tract undergoes multiple stages of development before a baby is born. In one of these stages, the developing intestinal tract slowly changes its position in the abdomen. In malrotation, this change in position does not happen or happens in the wrong direction. This makes it prone to twist on itself, blocking the passageway of stools throughout the intestinal tract. Babies who have these conditions usually have episodes of vomiting bile and bloody stools.

Anorectal malformations 

Anorectal malformations are another type of congenital condition. The rectum and the anus are two structures at the end of the intestinal tract. Babies may be born with unusual structures or malformations in these areas, making it difficult for stools to pass through properly.

Anal Stenosis 

In anal stenosis, the anal opening is too narrow. In this condition, a baby’s poop will usually look like soft, thin ribbons.

Anal Atresia

In anal atresia, the anus does not form at all. A baby might not be able to poop at all, but in some cases, the poop comes out instead through another anatomical malformation called a fistula. This usually forms between the intestinal wall and a genital organ (the urethra for boys and the vagina for girls). 

In general, these conditions definitely make it more difficult for babies to poop. Depending on which condition is involved and how severe it is, there are different possible treatments, including surgery.

Necrotizing enterocolitis, or NEC

Another severe possible reason a preemie has difficulties pooping is a disease called Necrotizing enterocolitis, or NEC. It is the most common in babies born before week 32 and occurs when tissue in the small or large intestine is inflamed or injured. The intestines will not hold the waste, which can pass into the baby’s abdomen and make the child very sick.

Some symptoms can be constipation or diarrhea, a swollen, red, or tender belly, green vomit, and a lethargic baby.

However, your baby is NOT likely to have NEC because it seems like your preemie has already been on infant formula for some time and is already at home. NEC usually happens when a preemie transitions to oral feeding in the NICU. It’s very rare for a preemie to be sent home if there are still with feeding. It takes a few weeks of good feeding outcomes and constant weight gain before a premature baby is usually sent home.

I mention NEC because this article is found by many parents searching for information on why their premature baby is not pooping, and in some cases, NEC could be a reason.

Learn more about NEC in this video:

What to do When Preemies Have Difficulties Pooping

For Normal Newborn Straining, It is Best Not to Intervene

If your preemie can poop but strains and have difficulties, I would personally not intervene with a Q-tip, at least not on a regular basis. If she cries or seems overly distressed, then, of course, you can help her once in a while.

It takes a while for babies’ intestines to mature and for their bodies to figure out how to poop; for some babies, it takes longer than for others. A preemie obviously may take longer than a full-term baby. “Helping them”, which seems very natural to do as a parent, may very well delay the learning process.

Give Your Baby a Massage

Instead of intervening, you can try a clockwise tummy massage, starting from your baby’s right side towards the left side of the tummy. 

Try Different Movements

An efficient “exercise” for your baby to help her poop is to lay her down on her back, then bend her knees towards her tummy in a cycling motion. This really helps for releasing gas and poop.

You can also try placing your baby in a squatting position during warm baths.

Take the opportunity to make eye contact and talk or sing to your daughter! 

Carry in an Upright Position

Being carried either belly down on your arm or in an upright position in a baby carrier or baby sling can also help.

For Formulafed, Constipated Preemies, Assess the Formula

For formula-fed babies, it is a good idea to talk to your baby’s healthcare provider to see if the formula should be changed in any way to improve the situation.

As I have written above, premature babies often drink special high-calorie, iron-rich formulas, which some studies say can contribute to constipation. In such a case, there may be alternatives available.

For those who breastfeed and supplement with formula, increasing the share of breastmilk may help.

Babies that Appear to be Ill or Weak Need Immediate Assessment

Finally, if your baby appears to be ill – he or she is weak-looking, appears to be in pain, has a swollen belly, is feeding poorly, or has other symptoms you are uncomfortable with, no home remedies should be tried. You should contact a doctor immediately.

Takeaway

To conclude, while it is certainly possible that your baby is experiencing typical newborn straining, I do believe you should bring up the matter with your baby’s healthcare provider. You do not write anything about your baby appearing to be ill, but it is much better to bring up one “unnecessary” issue than to miss something that may need treatment.

I hope this helps,
Paula

More Babies With Pooping Difficulties

• Baby Won’t Poop By Herself
• 1 Month Baby Not Pooping Since Days
• Baby Not Pooping? Important Reasons, Remedies, When to Worry
• Baby Cries In Pain When Pooping Even When Loose Stools

References

• Volvulus and intestinal malrotation in the newborn
• Necrotizing Enterocolitis
• Human milk for the premature infant
• Iron supplementation in preterm infants: a study comparing the effect and tolerance of a Fe2+ and a nonionic FeIII compound
• Failure to Pass Meconium: Diagnosing Neonatal Intestinal Obstruction

Paula Dennholt

Paula Dennholt founded Easy Baby Life in 2006 and has been a passionate parenting and pregnancy writer since then. Her parenting approach and writing are based on studies in cognitive-behavioral models and therapy for children and her experience as a mother and stepmother. Life as a parent has convinced her of how crucial it is to put relationships before rules. She strongly believes in positive parenting and a science-based approach.

Paula cooperates with a team of pediatricians who assist in reviewing and writing articles.