Straining At Stool

Published: 13th December 2011
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Babies who are trying to move their bowels commonly turn red in the face, perspire, and grunt for a while. Some bear down so hard that a small rim of the baby's anus gets pushed out of the opening. This nm may ooze a pink, watery fluid at the peak of the baby's straining. Of course if the stool is hard and dry, the explanation is constipation. But what if the stool comes out soft and moist? Why was the baby working so hard to push out a soft, wet stool? Using an old tradition, I'll answer that question by asking you another question. What happens when you squeeze the middle of a compressible tube that has two open ends, one larger than the other? You guessed it. The contents will squirt out the end having the larger opening.

The larger outlet offers less resistance. This is exactly what goes on in the infant's large intestine when he attempts to empty his tectum. He squeezes his abdominal muscles, trying to increase the pressure within the lower bowel. Since the size of the baby's anal opening is smaller than the large intestine, the stool has an easier time going up than going down, and much of the baby's straining is unproductive. What can the baby do? If he were a baby anything-other-than- human, he would get up on his haunches and push out his stool. Even baby hippopotamuses know that getting into a squatting position puts a ctimp in the "tube" above rhe squeeze, changing the downward di- tection to the one of least resistance. All the baby human can do is look pitiful, and if someone hearing his grunts knows about emptying compressible tubes, the baby is in luck. By bending the baby's hips back and pushing his knees up against his chest, you'll be easing the baby into the position of squatting on his back and he'll have an easier time pushing out his stool. He'll be grateful.

Tight Anus Many doctors routinely insert a pinkie into the baby's anus to determine its size. Since the anus contracts reflexively around the inserted finger, it now becomes very difficult to know if the anus was too tight to begin with. Despite this difficulty, some doctors feel that a slight stricture (narrowing) of the rectum can be diagnosed in 25 to 40 percent of newborns. Of these, only one in four has any difficulty with bowel movements, and by three to six months of age virtually all of the "narrow anuses" become "normal" with no "treatment" ever applied. All that means to me is that some normal newborns have narrower rectums than others.

Blood in Vomit or Stool Don't panic.
This may not be as bad as it seems. The blood you see in your baby's vomit or stool may not even be his. It might be his mother's. There's still no reason to panic; she (or you) won't miss it. Babies who swallowed tiny amounts of maternal blood can show bloody vomit or stools for hours. Your doctor can do a simple chemical test on the hemoglobin of the passed blood and determine whether it's the fetal type (coming from the baby) or the adult type (coming from the mother). Obviously, if the blood belongs to the baby, any further discussion doesn't belong in this book. If it's the mother's blood, there are only a few possibilities that can explain its presence in the baby's intestine. If blood from Mother's placenta or cervix gets into the amniotic fluid, it will eventually be swallowed by the baby.

Blood from the amniotic fluid is a common cause of bloody vomit and stool during the baby's first day and, despite its alarming nature, it's usually clear that the baby is well. Swallowed maternal blood later on in the baby's life is less obvious, but can usually be traced to cracks in the mother's nipples. Mother's nipple sores may not look very impressive, but when the baby sucks on them, enough blood can be drawn out to produce bloody stools. The blood won't hurt the baby or his mother, and all that's needed is additional nipple care to heal the sores. We have been taught that gastrointestinal bleeding is a sign of cancer. While this is true sometimes in adults, it is almost never true in infants or older children.


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