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  • Post last modified:September 23, 2021

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

Let’s take a look att why it is common that pooping is difficult for preemies and what you can do about it.

pooping is difficult for preemiesMom’s Question:
Is it common that pooping is difficult for preemies? 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 and it seems to help. When she pushes, she gets very tense.

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 When Preemie and Newborn

When Pooping is Difficult for Preemies – The Normal Situation

I’m actually wondering if your baby is having problems pushing out her poop at all – 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 quite normal – and the fact that your baby’s stools are loose when she passes them really can indicate that she’s not experiencing any real ‘problem’.

Constipation in Premature Babies

That said, it is true that preemies are more prone to constipation than full-term babies. There are a few reasons for this, such as getting special high-calorie formula with iron, reduced muscle tone (hypotonia), and infections.

It is possible that your daughter has a somewhat reduced muscle tone, resulting in that she needs to work harder to push the poop out.

Some signs of constipation are hard pebble-like stools and blood on the outside of the poop. You can find more signs of constipation in babies in this article. Since your daughter’s poop is loose, she in definitely not constipated.

Medical Reasons when Premature Babies are Not Pooping

In addition to actual constipation, babies can have medical reasons for pooping difficulties, such as anal stenosis and Hirschsprung’s disease.

Anal stenosis is a too narrow anal opening and Hirschsprung’s is a case of missing nerve cells in the muscles of the baby’s colon. Both these conditions make it more difficult for the baby to poop. Depending on severity, there are different treatments, including surgery.

What happens if you DON’T use a Q-tip?

Does it seem to you that she can’t poop at all unless you help her? If your baby really can’t poop on her own, and especially if this is the case despite the stools being soft, have her examined by a doctor and mention these conditions. Hirschsprung’s disease is in most cases discovered already within 48 hours of birth because these babies do not even pass meconium.

Another, quite severe possible reason when 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 whentissue 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 to mention some. In case your baby has these symptoms, do not wait with contacting a doctor.

Learn more about NEC in this video:

What is Necrotizing Enterocolitis or NEC? The NICU Doc Explains!

 

What to do When Preemies Have Difficulties Pooping

For Normal Newborn Straining, It is Best to Not 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 is very natural to do as a parent, may very well delay the learning process.

Baby Massage

Instead of intervening, you can try clockwise tummy massage and a warm bath.

An efficient “exercise” for your baby to help her poop is to lay her down on her back, lift her legs up and shake then a little bit. After that, bend her knees and push her knees towards her tummy. This really helps for releasing gas and also poop. 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 formulafed babies, it is a good idea to talk to your baby’s health care provider to see if the formula can be changed in any way to improve the situation. As I wrote above, premature babies often drink special high-calorie, iron rich formula, which can certainly contribute to constipation. In such a case, there may be alternatives available.

For those who breastfeed and suppment with formula, increasing the share of breastmilk may help. Human milk has also show to reduce the risk of NEC, so it is prefered for premature babies, whether they are constipated or not.

Babies that Appear to be Ill or Weak Need Immediate Assessment

Finally, if your baby appears to be ill – he or she is weak, appears to be in pain, has a swollen belly, poor feeding or other symptoms, no home remedies should be tried. Contact a doctor immediately.

Takeaway

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

If her pooping difficulties are due to hypotonia, she will grow out of it.

I hope this helps,
Paula

Helpful Resources on Baby Poop and Premature Babies

If you want more in-depth information and tips on baby poop issues, here are a few books to check out. (Links to Amazon)

More Babies With Pooping Difficulties

References

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This Post Has 10 Comments

  1. Zama

    Hello I have same problem my baby she’s premature gave birth at 32 weeks and she’s having problems when it’s time to poop and I’m not breastfeed she’s taking formula and she’s 36 weeks old so I don’t know what to do anymore.

    1. Paula @ EasyBabyLife

      Hi Zama, Have you had help from your baby’s health care provider regarding which type of formula to give to your baby? Since she is premature, her digestive system is not fully developed and she may also have reduced muscle tone, which increases the risk of constipation. Some preemie formulas are high-calorie with iron – something that may also contribute to constipation.

      So, please talk to your baby’s doctor to get advice on what to do!

      Take care,

  2. Maja

    My baby is two months now, she’s experiencing difficulty when coming to poo. I hate seeing her like this cz now it’s three days without pooping Her stomach is getting bigger and bigger. I tried warm water still doesn’t help, also. I tried to massage her belly still nothing. Mommies out there, plz help me!

  3. Mama

    My son is 7 weeks pre and is a minute younger than his sister. He had difficulty pooping so I tried the q-tip idea, except I wet the tips with warm water, got results instantly, now he is very happy that he got to poop finally. His poop was also loose. The doctor says that most newborns will hold back a poop sometimes and that there is nothing to worry about. So no panicking new parents. :-)

  4. miraclebaby

    Had my baby at 31 weeks she is now 36 weeks had not pooped for 3 days she is breastfed, what do I do?

    1. Paula @ EasyBabyLife

      Since your daughter is breastfed, her pooping frequency is completely normal! Don’t do anything. She is just digesting everything she eats and she is probably growing quickly. You can learn more about when it is normal and not for a baby not to poop here.

      Good luck!

  5. Sarah

    I’m experiencing the same thing with my boy. He was born at nearly 28 weeks (now technically 5 weeks old) and he strains for a really long time to poo. He is breastfed and his stools are loose but I need to lift his legs to help him. This normally helps but can still take a long time- sometimes up to an hour. I have asked nurses and they say it is normal but it breaks my heart to see him struggling so much. Any advice is much appreciated.

  6. Jen

    My 1-month-old son had the same problems when he did go it was soft/runny like any infant on formula. He is on the Similac sensitive soy.

    I took him to the pediatrician’s and they told me when babies are born their bodies do everything for them until they are capable of controlling it. When he was 1 day to 3 weeks old his body would go potty on its own. But when he was a month old his little muscles in his bottom were not letting him go.

    The dr. told me not to do suppositories but just stimulate around the anus to let him know he had to work those muscles or more or less to wake them up. It was like a bubble in there shutting everything off. When I did give him a suppository at the beginning it was like it was opening the door to let it come out. He was very fussy and wasn’t going for 5 days so that is why I tried the suppositories. When I found out that constipation wasn’t the problem the dr.’s more or less told me NOT to help him go let him figure it out on his own. If you continue to do it for him he will rely on you for it. He figured it out in about a week to a week and a half.

    He still only goes about every 3rd day but no longer fussy. Now we are hanging in there through colic. Hopefully, it is only the 6wk colic.

    To all you moms out there have a great day!

  7. Nath Carty

    My baby was 2 months premature and she came home on Monday which she was 2 weeks and 6 days old and ever since Monday she has only opened her bowels twice and she is on formula milk, she does try and squeeze and makes herself go dark red and she lifts her legs up to her tummy as she’s tenses but it seems like she is struggling to open her bowels

    1. Paula @easybabylife

      Hi Nath, how is it going with your daughter? What you describe can be just normal newborn behavior or she is a little bit constipated. What type of formula is she on? And when she does poop, is it firm at all? Formula poop is typically firmer – like peanut butter – than breast milk poop, and therefore might be a bit tougher to push out. But being so young, her situation is worth double-checking with her doctor. Let me know how things go!