With their grunting and turning red or blue in the face, colicky babies look and act “constipated,” and in fact, many of them are constipated. My first encounter with a colicky baby was in 1973. That three-week old infant acted and looked constipated, so I performed my first digital rectal exam (DRE) on a colicky infant. As I removed my examining finger from his rectum, the backed up stool shot out 3 feet, shocking the baby’s Mom and me! We could only agree, “I guess he had to go.”
And, in examining the ano-rectal canals of infants over the years since my first cases in 1973, I came to appreciate the vast difference between normal openings and those of colicky infants. A healthy canal has appropriate muscle resistance (and, no residual membrane), but abnormal canals are much tighter and constricted. I conduct the exam with a gloved and lubricated pinky finger. In medical terms, it is called a digital (finger) rectal examination (the DRE). We call it The Soothee because it usually provides rapid relief of an infant’s constipative colic and excessive fussing or crying.
The paradox today is that If a colicky infant does not have a digital rectal examination ( DRE), it is impossible to know that he/she does not have constipative colic. The DRE simultaneously diagnoses an outlet obstruction and possibly cures the cause of the blockage.
Our VISION is that if every newborn had the benefit of a Soothee soon after birth, infant colic caused by rectal stenosis and the resulting constipation would become a thing of the past. See the CAUSE section for further details on the two major causes of “potentially curable” constipative colic.
There is a momentary discomfort associated with performing the DRE with a properly gloved and lubricated finger. We have researched many avenues of “pain relief,” and provide details and discussion in the Professional Edition of our book. They usually are potentially harmful or cause more discomfort than the DRE itself. Swaddling and either nursing or bottle-feeding after the exam easily soothes the brief discomfort for most babies. And on balance, we believe most parents of colicky infants would agree that momentary discomfort is MUCH BETTER than several months of inconsolable crying and suffering!
It is preferable to PREVENT problems whenever possible. I’d like to share my “favorite colic case.” I had just delivered a healthy baby boy. He cried lustily but seemed “extra fussy.” As he was placed on the scale, he pooped a large amount of meconium (green newborn poop) so there was no concern about the ano-rectal canal being open, and the meconium counted in his birth weight (well over 8 lbs.!). His general examination was normal, but his flailing arms and thrusting legs raised my suspicion, and I asked the mother if I might check his rectum. She consented and I did a careful rectal exam. His sphincter was much tighter than normal, but no membrane was present. However, when I removed my finger, another gush of meconium was expelled. Almost immediately, he quieted down, stopped crying and moving about and appeared much more “peaceful,” if that term can be used with newborn babies. He nursed like a champ and never developed any further colicky symptoms. It appeared to be an early cure of hIs colic. I can’t help wondering how much infant colic could be prevented if every newborn had a DRE soon after birth.
We recommend that the DRE should be performed by a medical professional. But you may be wondering if there is anything that can be done RIGHT NOW to receive your baby’s discomfort. Two suggestions may be helpful.
First, you can try using an adult-sized glycerin suppository to relieve the constipation. Position your baby lying on their left side with their right leg bent toward the stomach. Using your finger, gently insert the pointed side of the suppository into the rectum and push it all the way in, plus a bit more so the sphincter muscle doesn’t push the suppository right back out. Hold the legs and buttocks together for a few seconds until your baby relaxes. Put on a diaper. Swaddle with a blanket or hold your baby close to keep the suppository in place for 10-15 minutes. The suppository will melt, and hopefully stool and gas will be released into the diaper. The suppository insertion may need to be repeated daily for several days. The best time is right before (or at the beginning of) your baby’s usual fussiest time of the day. Note that if insertion of the suppository is difficult, or increases the baby’s discomfort, it would be wise to seek professional help.
The second option is the Windi, a 6 mm. diameter device marketed by FridaBaby to relieve infant gasiness. The Windi is a flexible plastic tube with a rounded tip that is inserted in the rectum like a thermometer. It is long enough to reach past the muscle that traps the gas, but has a stopper so you can’t insert it too far. The Windi stimulates the baby’s powerful recto-colic reflex and can cause dramatic release of backed-up stool and gas. My favorite Windi review by a father advises: “You should wear eye protection and stay out of the blast zone.” Note again that if insertion of this small device is difficult, professional consultation for DRE should be sought.
The ultimate detection and cure of constipative colic, however, is a digital rectal exam by a medical professional.
We have worded this presentation of Cause and Cure of infant constipative colic “Our Thesis,” because it has not been “scientifically proven.” It is based on our decades of experiences with colicky infants, our research into published information on colic, and on contemporary cultural elements, such as parents’ comments on their experience with the Windi device. Definitive proof would come from a “Double Blind Study,” where neither the patient/family nor the physician/nurse/provider knows which is the “real” treatment and which is the placebo treatment. Comparing the results of these two groups then reveals whether the proposed treatment works better than a placebo (fake or inactive) treatment. BUT, because the diagnosis and cure of constipative colic is the same thing – a carefully performed digital rectal examination – it is impossible to perform the traditional Double Blind Study. But there are other types of study that can be performed; I’ve listed several in the Professional Edition.
AND YOU CAN HELP. Our statistician colleague told us that 10,000 documented “cures” by DRE would be statistically significant and just as relevant as a Double Blind Study. So you will have a chance to register your infant’s experience with DRE and the results. Please click on “YOUR EXPERIENCE” to add to the world’s medical literature. You can return anytime to complete the brief questionnaire.
It has been observed that most colicky babies will “clear up” by 3 or 4 months of age. We theorize that increased abdominal muscle strength finally allows the colicky baby to overcome their ano-rectal canal’s resistance to defecation, resulting in a self-cure. However, a substantial number of colicky infants go on to have persistent problems, such as GERD (gastro-esophageal reflux disorder) and chronic bowel problems, such as chronic constipation. Our colleagues in Colo-Rectal Surgery encourage formal digital rectal exams soon after delivery to avoid the need for surgery in later childhood to “fix” the persistent overly-constricted or enlarged internal anal sphincter, which they characterize as a “Grade 1 ano-rectal malformation” (ARM).
Additional details, documentation and stories are available in the two digital format books below. Detailed instructions on performing a DRE are presented in the Professionals Edition. Click on the book images to go to Amazon/Kindle for sample reading or purchase.