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ગુજરાતી: બાળકોમાં કબજિયાત: મળત્યાગમાં દુખાવો, ડર અને રોકવાની ટેવ, કારણ, ઘરેલુ ઉપાય અને આયુર્વેદિક સંભાળ
हिंदी: बच्चों में कब्ज़: मल त्याग में दर्द, डर और रोकने की आदत, कारण, घरेलू उपाय और आयुर्वेदिक देखभाल
After toilet training started, three-year-old Tanvi once passed a hard, painful stool, with a little blood too. Since then, whenever she felt the urge, she would go into a corner, cross her legs, stand on her toes, go red in the face and hold it in. Once every four or five days came a big, hard stool and a lot of crying. Poor appetite, a bloated tummy, sometimes stains in her underwear. Her parents got angry and scolded her, which increased her fear. The paediatrician explained that this is the “stool withholding cycle”. With stool-softening treatment as advised by the doctor, water and fibre, ghee, sitting on the toilet for 5 minutes after every meal with a stool under her feet, praise and a sticker chart, and oil massage of the tummy, within three months Tanvi was passing stools daily without fear.
Constipation in children means passing stools fewer than three times a week, or hard, dry, painful stools that are difficult to pass. It is very common in children, about one or two in every ten children have it at some point, and in 95% of cases there is no serious disease (“functional constipation”). The most common cause is holding back stool out of fear after one painful episode, which makes the stool drier and harder in the bowel. In Ayurveda, constipation is called Vibandha, Malavarodha or Anaha, in which the main dosha is Apana Vata, especially its Ruksha (dry) quality; and Charaka named Vega Dharana (suppressing natural urges) as the root of many diseases.
Key Takeaways
- Childhood constipation is mostly functional, not a serious disease.
- Pain → fear → withholding → harder stool: breaking this cycle is the main treatment.
- Water, fibre, ghee, a regular toilet time and a stool under the feet are simple and effective.
- Ayurveda: apana vata anulomana, ghee and unctuous food, tummy massage and gentle formulations like bala harade, gulkand and avipattikar (in the vaidya’s child dose) break the stool-holding cycle, reduce the need for stool softeners and prevent constipation from returning.
“Normal” Stools by Age
- Exclusively breastfed (0 to 6 months): anywhere from many times a day to once in 7 to 10 days can be normal, as long as the stool is soft and the baby is happy. True constipation is rare in breastfed babies.
- Bottle or formula: slightly thicker stool, 1 to 2 times a day.
- Straining and going red while passing stool is common in young babies (“infant dyschezia”), if the stool is soft.
- After 1 year: from 3 times a day to 3 times a week; a soft, easy stool matters, not the number.
Symptoms
- Stools fewer than three times a week
- Hard, dry, pellet-like or very large stools (that block the toilet)
- Pain while passing stool, crying
- Withholding behaviour: crossing legs, standing on toes, clenching the buttocks, hiding
- A little fresh blood on the stool or tissue (a tear in the anus, fissure)
- Tummy pain, bloating, poor appetite
- Stains in the underwear (encopresis: loose stool leaks around hard stool; often mistaken for “diarrhoea”)
- Urinary problems: frequent urination, bedwetting, urine infection (a full bowel presses on the bladder)
- Irritability
When to Worry? (Red Flags)
- First stool (meconium) not passed within 48 hours of birth
- Constipation from birth, a very bloated tummy
- Greenish vomiting
- Poor weight gain
- Fever, vomiting, severe tummy pain
- More blood in the stool
- Weakness in the legs, change in walking, a mark, dimple or tuft of hair near the lower back (suspicion of a spine or nerve problem)
- Abnormal position or appearance of the anus
- No improvement despite treatment
With these signs, a paediatrician’s examination is needed for conditions such as Hirschsprung disease, thyroid problems, celiac disease or spinal cord and nerve problems.
Causes
Modern View
- Withholding stool: fear of pain, busy playing, a dirty or non-private school toilet, shyness
- Toilet training that is too early, forced or pressured
- Change in diet: from breastfeeding to formula or cow’s milk, starting solid food
- Too little water
- Too little fibre: refined flour, biscuits, bread, junk; little fruit, vegetables and whole grains
- Too much milk and cheese: more than 500 ml of milk a day
- Little physical activity, more screen time
- Change in routine: travel, new school, heat, illness
- Stress: a new sibling, tension at home
- Some medicines: iron, some allergy or cough medicines
- Cow’s milk protein allergy, in some young children
Ayurvedic View
- Vega Dharana: suppressing the urge to pass stool → Apana Vata turns Pratiloma (reverse direction).
- Dry food: dry snacks, biscuits, khakhra, too little ghee.
- Cold, light, too little food.
- Too little water.
- Irregular Agni, especially Vata-type irregular digestive fire.
- Staying awake late, fear, worry.
- Too many astringent foods: raw bananas, too much tea (in older children).
Ayurvedic Understanding
In Ayurveda, moving stool down and out is the function of Apana Vata, whose seat is the Pakvashaya (large intestine). The dry quality of Vata makes the stool dry, and suppressing the urge makes Vata move in the reverse direction (Udavarta), causing bloating, pain and loss of appetite. Because Agni and the tissues are delicate in children, Ayurveda emphasises Snehana (unctuousness with ghee or oil) and gentle Anulomana (gently bringing Vata back to its right direction) instead of strong purgatives.
Samprapti (pathogenesis): dry, scanty food, too little water, suppression of urges, fear → aggravation of dry Apana Vata, reverse movement → stool dries and hardens in the Pakvashaya → constipation, pain, bloating, loss of appetite.
Samprapti Vighatana (breaking the pathogenesis): rule out serious causes → avoid the causes (do not hold urges, water, fibre) → Snehana (ghee, oil) → gentle Anulomana → tummy massage and warmth → remove fear, regular toilet routine.
Classical References
- Charaka Samhita, Sutra Sthana, Chapter 7, Navegandharaniya: results of suppressing the urge to pass stool.
- Charaka Samhita, Chikitsa Sthana, Chapter 26, Trimarmiya: Udavarta and Anaha.
- Ashtanga Hridaya, Sutra Sthana, Chapter 4, Roganutpadaniya: suppression of urges.
- Kashyapa Samhita, childhood diseases, references to Vibandha (chapter level).
The “Stool Withholding Cycle”: Understand It and Break It
- For some reason, one hard, painful stool
- The child remembers the pain and becomes afraid
- Holds back when the urge comes
- Stool stays in the bowel, water is absorbed, it becomes harder and larger
- Next time more pain → more fear → more withholding
- Over time the bowel stretches, sensation falls, leaking and stains
To break the cycle: (1) soften the stool with diet and water, and if needed a stool softener as advised by the doctor for some time; (2) remove fear by letting the child experience pain-free stools again and again; (3) a regular toilet habit; (4) patience, it can take months. Many parents stop treatment as soon as they see improvement, and the cycle starts again.
Safe Home Remedies by Age
0 to 6 Months
- Continue exclusive breastfeeding, frequently
- If on formula, the correct proportion (not extra powder)
- Gentle clockwise massage of the tummy with warm oil
- “Bicycle” leg exercise: lay the baby on the back and gently move the legs in circles
- A lukewarm bath
- No gripe water, homemade ghutti, soap sticks, oil or thermometer in the anus
- No water, juice or honey before 6 months without the doctor’s advice
6 Months to 2 Years
- Enough water, between meals
- Mashed fruit: papaya, pear, ripe fig (soaked), ripe banana (not raw), plum
- A little ghee in food
- Whole grains: dalia, ragi, oats
- Vegetables: mashed carrot, sweet potato, spinach, bottle gourd
- Not too much rice, banana, milk or biscuits
2 Years and Older
- 4 to 8 glasses of water a day (according to age), especially lukewarm water on waking
- Fruit daily: papaya, guava, pear, apple with peel, orange (without throwing away the pulp)
- Vegetables, dal, pulses, whole grains, roti, bajra, jowar, dalia
- 1 to 2 spoons of ghee in food daily
- 2 to 3 figs or black raisins soaked at night, eaten in the morning
- Lukewarm milk before bed with a little ghee (Ayurvedic tradition; if there is not much Kapha)
- Milk limited to 400 to 500 ml a day
- One hour of running around daily
Toilet Habits: The Most Important Treatment
- 15 to 30 minutes after meals (especially after breakfast), sit the child on the toilet for 5 to 10 minutes, to use the bowel’s natural “gastro-colic reflex”
- A small stool under the feet, knees higher than the hips (a squat-like posture) makes passing stool easier; the Indian toilet naturally helps in this way
- A small toilet seat for the child, so there is no fear of falling
- Comfortable and calm: a book, a song; no mobile phone (it makes them sit too long)
- Teach gentle pushing, like “blowing up a balloon”
- Praise the effort, for sitting, not for the result; a sticker chart
- Never scold, shame or punish; fear grows and so does the cycle
- Permission to use the toilet at school; talk to the teachers
- Toilet training when the child is ready (usually 2 to 3 years), without pressure; if there is constipation, wait a little
Useful Ayurvedic Medicines (in the Vaidya’s child dose)
The right medicine, dose, vehicle (Anupana) and timing are decided by the Vaidya according to the person’s constitution, age, other illnesses and current medicines. Do not get children used to strong purgatives (senna, strong castor oil).
- Cow’s ghee: the gentlest Snehana; in food or milk.
- Avipattikar / pediatric formulations: as per the Vaidya, according to constitution.
- Triphala (very small amount, in older children): gentle Anulomana; astringent taste, with honey or jaggery.
- Haritaki (Bal Harde): traditional use in children, “rubbed Bal Harde”; only in the Vaidya’s dose.
- Gulkand: in older children, Pitta constitution and hot weather.
The tradition of applying hing roasted in ghee around the navel is used for gas; take care that it does not irritate the skin. If the doctor gives a stool-softening medicine, these are considered safe and non-habit-forming for children; take it regularly for the advised period, and do not stop suddenly.
Gradual Ayurvedic approach: If the doctor has given a stool softener, Ayurvedic treatment starts alongside it, without stopping anything suddenly. Cow’s ghee in food, soaked figs and black raisins at night, water and fibre, gulkand, bala harade or avipattikar in the vaidya’s child dose, clockwise tummy massage and a warm compress near the navel, toilet time with a footstool after meals. When stools come soft and painless every day, the doctor slowly reduces and stops the medicine, and then ghee, water, fibre and toilet habits prevent constipation from returning (apunarbhava).
Diet Summary
Take: water, fruit (with peel where possible), vegetables, dal and pulses, whole grains, ghee, soaked figs, raisins and dates, isabgol (in older children, with enough water, as advised).
Reduce: refined flour, bread, biscuits, noodles, cheese, too much milk, chips and junk, raw bananas, chocolate, cold drinks, dry snacks.
Tummy Massage
With warm sesame oil (or ghee), gently massage in circles around the navel in a clockwise direction (up the child’s right side, across, and down the left side) for 5 to 10 minutes, then place a warm towel on the tummy. In Ayurveda this Abhyanga-Swedana brings Vata into its right direction; it also gives the child comfort and closeness with the parents. Not immediately after meals.
The Parents’ Mind
The daily “toilet battle” with a constipated child exhausts parents. Stained clothes make you angry, but remember, the leaking is not in the child’s control. Scolding increases fear and makes the cycle longer. Patience, praise and regularity, with consistency for three months, bring success in most children.
According to Season and Prakriti
In summer, water is lost through sweat and constipation increases; more water, fruit, buttermilk. In winter, children drink less water and dryness increases; lukewarm water, ghee and sesame. Thin, restless children of Vata Prakriti tend towards constipation more: ghee, warm unctuous food, regular timings, oil massage. In Kapha Prakriti, laziness and less play: exercise, light food. In Pitta Prakriti it is less common, but in hot weather gulkand and fruit help.
Common Myths
- “No stool every day means constipation”: not if the stool is soft and easy.
- “Stains mean diarrhoea”: often it is leakage from constipation.
- “Stool softeners are habit-forming”: many medicines prescribed by the doctor are safe for children; avoid the habit of strong purgatives.
- “Bananas cure constipation”: a ripe banana helps a little; a raw one causes constipation.
- “A soap or oil stick in the anus”: injury and fear; no.
Precautions
- In a newborn, no stool within 48 hours, green vomiting, a very bloated tummy: emergency.
- Constipation with fever, severe tummy pain or vomiting: see a doctor immediately.
- No honey for children under 1 year.
- No strong purgatives, home enemas or objects in the anus without a doctor.
- No isabgol without enough water.
Do’s and Don’ts
Do: water, fruit, vegetables and whole grains, ghee, toilet time after meals, a stool under the feet, praise, tummy massage, play, consistency in treatment.
Don’t: scold, shame or punish, force toilet training, too much milk, biscuits and junk, the habit of strong purgatives, stopping treatment suddenly when improvement appears.
Case Studies
Case 1: The cycle after toilet training
3 years; after one painful stool he started holding, hard stools every 4–5 days, soiling; the pediatrician gave a stool softener. In Ayurvedic terms vata predominant, apana vata moving upward; the vaidya gave ghee in meals, soaked figs at night, gulkand in a child dose, daily tummy massage and a warm compress, toilet time with a footstool after meals, a sticker chart, and no scolding. Within two weeks, soft stools daily; at six weeks the doctor reduced the medicine and at three months stopped it, and for six months ghee and habits alone kept him regular. (Results may vary from person to person.)
Case 2: Biscuit and milk diet
5 years, vata prakriti; a lot of milk daily, biscuits and bread, little fruit, vegetables or water; sometimes the doctor’s syrup. The vaidya reduced the milk, gave thepla and fruit in the tiffin, figs at night, ghee in meals, cycling in the evening, and bala harade in a child dose for a few days. Within a week the syrup was no longer needed, within a month stools were regular and soft, and with diet and habits constipation did not return. (Results may vary from person to person.)
Case 3: The school toilet
7 years; because the school toilet was dirty he held stool and urine all day, constipation, urine infection, tummy ache; the doctor treated the infection. The vaidya gave toilet time after breakfast before school, a water bottle, ghee and fibre, avipattikar in a child dose at night and tummy massage; the school was spoken to. Within two weeks, regular morning stools and no tummy ache, and the urine infection did not return. (Results may vary from person to person.)
When to See a Doctor (Red Flags)
- Constipation from birth or no first stool within 48 hours
- Green vomiting, a very bloated tummy
- Fever, severe tummy pain
- Poor weight gain
- More blood in the stool
- Weakness in the legs, an unusual mark near the lower back
- No improvement with home remedies in 2 to 4 weeks
About Dr. Nikul Patel
Dr. Nikul Patel (BAMS) is an Ayurvedic physician at LifeCare Ayurveda and has been practising since 1999, that is, for 27 years. In childhood constipation, he works in coordination with the paediatrician and gives parents patient, practical guidance on diet, water and toilet habits, tummy massage, Snehana and gentle Anulomana medicines in child doses.
Frequently Asked Questions
After how many days without stool is it constipation in a child?
When it is fewer than three times a week, or the stool is hard and painful.
What gives quick relief from a child’s constipation?
Water, ripe fruit, ghee, tummy massage, a lukewarm bath; the doctor’s medicine if needed.
What should I do if my child holds back stool?
Soften the stool, do not scold, keep a regular toilet time after meals and give praise.
Why are there stains in the underwear?
Often loose stool leaks around hard stool, a sign of constipation.
What is the Ayurvedic remedy for childhood constipation?
Snehana like ghee, tummy massage, a Vata-balancing diet and gentle medicines in the Vaidya’s child dose.
People Also Ask
Do breastfed babies get constipated?
Rarely; even a soft stool once in 7 to 10 days can be normal.
Why a stool under the feet?
With the knees raised, passing stool becomes easier.
Does too much milk cause constipation?
Yes, more than 500 ml of milk a day can increase constipation.
What is Bal Harde?
The traditional use of Haritaki for children; the Vaidya decides the dose.
Why is there blood in the stool?
A tear in the anus (fissure) from hard stool; if there is more blood, see a doctor.
Conclusion
Constipation in children is common and usually easy to improve, provided there is patience and consistency. Soften the stool, remove the fear, build a regular toilet habit, and make Ayurveda the main path: apana vata anulomana, ghee, water, fibre, tummy massage and gentle formulations like bala harade and gulkand in the vaidya’s child dose break the “stool-holding cycle”, reduce the need for medicine and give the child comfort and confidence. Every child’s results may differ.
Dr. Nikul Patel (B.A.M.S.)
307, 3rd Floor, Shalin Complex, Above Farki Lassi, Krishnabaug Char Rasta, Maninagar, Ahmedabad – 380008
Timings: 10:00 AM to 1:00 PM and 3:00 PM to 6:30 PM | Saturday–Sunday: Closed
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