Can Hemorrhoids Cause Urinary Issues?

Hemorrhoids on their own rarely block urine flow or cause incontinence, but the relationship between hemorrhoids and urinary trouble is more tangible than many people realize. The rectum and bladder share nerve pathways in the pelvis, and irritation in one organ can spill over to the other. The most common and best-studied link, though, is not the hemorrhoids themselves but what happens after hemorrhoid surgery, where urinary retention rates can run anywhere from about 8 percent to 25 percent depending on the study and the procedure.

Why the Rectum and Bladder Talk to Each Other

The rectum and the urinary bladder sit close together in the pelvis and share branches of the same nerve network. When tissue in the rectal area becomes chronically irritated, sensory nerves in that region can become hyperactive, and some of that heightened activity crosses over to bladder-related nerves. Animal research has demonstrated this directly: in rats, chemically irritating the colon roughly doubled the resting firing rate of bladder nerve fibers, and at moderate-to-high bladder pressures the nerve response was amplified dramatically.¹ In plain terms, inflammation in the rectal neighborhood can make the bladder more sensitive and reactive than it normally would be.

This cross-talk helps explain why people with severely inflamed or thrombosed hemorrhoids sometimes report urinary urgency, a feeling of incomplete bladder emptying, or mild discomfort while urinating. The hemorrhoids are not physically pinching the urethra or pressing on the bladder. Instead, the shared nerve circuitry is picking up the rectal distress signal and relaying a version of it to the bladder. The effect is usually subtle with everyday hemorrhoids and fades as the hemorrhoid flare settles, but it can be noticeable enough to worry people.

The Prostate Connection in Older Men

In older men, there is an additional layer. An enlarged prostate (benign prostatic hypertrophy) slows urine flow by squeezing the urethra from the inside. It also raises pressure in the pelvic veins, and that venous pressure can contribute to hemorrhoid development. A prospective study screened 62 elderly men with benign prostatic hypertrophy for hemorrhoids before and after prostate surgery. Twenty-five had hemorrhoids going in. Three months after prostatectomy, the hemorrhoids had regressed on their own in 80 percent of those men.²

The takeaway is that for some older men, hemorrhoids and urinary symptoms are both downstream effects of the same prostate problem. Treating the hemorrhoids in isolation may provide temporary relief, but the recurrence rate is high if the underlying prostate issue goes unaddressed. If you are an older man dealing with both hemorrhoids and a weak or hesitant urine stream, it is worth asking your doctor whether the prostate is the real driver.

Constipation as a Common Thread

Chronic constipation is one of the clearest bridges between hemorrhoids and bladder trouble. Straining hard on the toilet raises intra-abdominal pressure, and over time that repeated pressure can damage both the hemorrhoidal cushions and the pelvic floor muscles that help control the bladder. Hard stools and chronic straining are recognized as contributing factors not just for hemorrhoids and anal fissures but also for a range of pelvic floor problems.³ A weakened pelvic floor does a poorer job supporting the bladder, which can contribute to stress urinary incontinence or difficulty fully emptying the bladder.

This means that a person dealing with hemorrhoids and urinary leakage or urgency may not have one condition causing the other. Instead, both conditions may share the same root cause: years of straining. Fixing the constipation with dietary fiber, adequate water, and if needed a stool softener can improve both problems simultaneously, because the pelvic floor finally gets a break from the constant high-pressure episodes.

Postpartum Hemorrhoids and Bladder Trouble

Pregnancy and vaginal delivery are a classic scenario where hemorrhoids and urinary issues appear together. The weight of the uterus during pregnancy increases pelvic venous pressure and promotes hemorrhoid formation, while the stretching and potential injury to pelvic floor muscles and nerves during delivery can lead to urinary incontinence, constipation, and worsened hemorrhoids all at once. Postpartum anorectal and pelvic floor disorders are recognized as a cluster that can include hemorrhoids, fecal incontinence, constipation, pelvic organ prolapse, and urinary incontinence.⁴

For new mothers, it is easy to attribute bladder trouble to the hemorrhoid pain or to assume one is causing the other. In reality, both are usually products of the same mechanical and hormonal stresses of pregnancy and labor. Pelvic floor physical therapy can address both the urinary symptoms and the straining patterns that keep hemorrhoids from healing, making it one of the more effective two-for-one interventions available.

Urinary Retention After Hemorrhoid Surgery

The strongest and most thoroughly studied connection between hemorrhoids and urinary problems is not about the hemorrhoids themselves but about what happens after hemorrhoidectomy. Difficulty urinating after surgery, known as postoperative urinary retention, is one of the most common complications of hemorrhoid procedures. Across multiple studies, the rates range from roughly 8 percent to 25 percent depending on the patient population, surgical method, and how retention is defined.

A large retrospective study of over 2,100 patients undergoing semiclosed hemorrhoidectomy found that about 14 percent developed urinary retention afterward.⁵ A separate study looking at various hemorrhoid-related procedures reported an overall retention rate of 25 percent.⁶ A systematic review and meta-analysis that pooled data from both randomized trials and observational studies placed the rate at roughly 8 to 9 percent for both stapled hemorrhoidopexy and traditional excisional hemorrhoidectomy, with no meaningful difference between the two approaches.⁷

The mechanism is a combination of factors. Surgical pain and tissue swelling in the anal area can trigger reflex spasm in the pelvic muscles that help control the bladder outlet. The nerves serving the anus, perineum, and lower urinary tract overlap enough that pain signals from the surgical site can temporarily inhibit the bladder’s ability to contract and empty. Anesthesia compounds the problem by numbing the pelvic region and disrupting normal voiding reflexes, sometimes for hours after the procedure ends. Intravenous fluids given during surgery fill the bladder faster than the recovering nervous system can respond to, adding another layer of difficulty.

Who Faces the Highest Risk

Not everyone has the same chance of developing urinary retention after hemorrhoid surgery. Several patient characteristics consistently emerge as risk factors across studies. In the large semiclosed hemorrhoidectomy study, the risk was about one and a half times higher in men than in women, roughly 1.6 times higher in older patients, and about 1.4 times higher in people with a high body mass index. Having four or more hemorrhoid columns removed also raised the odds by about 46 percent. Notably, patients who used supplementary analgesics (pain medications beyond the standard protocol) had roughly double the odds of retention.⁵

The other study identified additional risk factors including diabetes and having more severe hemorrhoidal disease requiring more tissue removal.⁶ Diabetes can impair nerve function in the bladder, and patients with long-standing diabetes may already have subtle voiding dysfunction that gets pushed over the threshold by surgical stress.

If you are heading into hemorrhoid surgery and fit several of these categories, it is worth having a candid conversation with your surgeon about the likelihood of needing a urinary catheter after the procedure. It does not change the decision to have surgery in most cases, but knowing what to expect reduces anxiety and allows the surgical team to plan accordingly.

How Anesthesia Choice Changes the Picture

The type of anesthesia used for hemorrhoid surgery has a meaningful impact on urinary retention rates. Spinal anesthesia, which numbs the lower body by injecting medication near the spinal cord, is particularly associated with higher retention because it paralyzes the bladder’s detrusor muscle along with everything else below the waist. That muscle needs to contract for you to urinate, and it can take hours to regain function.

A study comparing general anesthesia with local wound infiltration against spinal anesthesia found the retention rate was cut roughly in half: about 16 percent versus 32 percent.⁸ An earlier study found even more dramatic results when using a pudendal nerve block instead of spinal anesthesia: only 6 patients in the pudendal block group required catheterization compared to 57 in the spinal group.⁹ The pudendal block targets the nerve bundle that serves the perineum and anus while largely sparing the nerves that control the bladder, which is why the difference is so stark.

When it comes to the surgical technique itself, a network meta-analysis comparing different approaches for advanced internal hemorrhoids found that tissue-selecting therapy (a newer stapling method) had the lowest urinary retention rates among the techniques studied.¹⁰ However, the meta-analysis comparing stapled versus traditional excisional surgery found no significant difference in retention rates between the two most common approaches.⁷ So while the choice between stapled and excisional procedures does not appear to matter much for bladder outcomes, the anesthesia strategy can make a significant difference and is something worth discussing with your anesthesiologist.

Simple Measures That Reduce the Risk

Two surprisingly straightforward interventions can cut the rate of post-surgical urinary retention substantially: limiting fluids around the time of surgery and staying ahead of pain. A prospective study of patients undergoing benign anorectal surgery found that restricting intravenous fluids during the procedure dropped the retention rate from about 17 percent to roughly 8 percent. Separately, giving prophylactic pain medication before pain had a chance to ramp up cut the rate from about 26 percent to the same 8 percent level.¹¹

The fluid restriction works because an overfilled bladder stretching against a temporarily sluggish detrusor muscle is exactly the recipe for retention. By limiting fluids, the bladder does not reach that critical overfilling point during the vulnerable recovery window. The pain control angle works because postoperative pain triggers reflex spasm in the pelvic floor, and that spasm mechanically impedes urination. Preventing the pain spike preemptively is more effective than chasing it after it has already set off the reflex.

Performing the procedure in an ambulatory (outpatient) setting, combined with patient education about not overdrinking fluids beforehand, has also been linked to very low retention rates.¹² Patients who go home the same day tend to move around sooner, sit on a toilet in their own bathroom (a more natural voiding position than a bedpan), and receive fewer intravenous fluids overall. These seemingly minor details add up.

When to Be Concerned and What to Ask Your Doctor

If you have hemorrhoids and notice changes in your urinary habits, the hemorrhoids are rarely the sole explanation, but they can be a piece of the puzzle. A few signs suggest something beyond garden-variety hemorrhoid irritation is going on and deserve a medical conversation:

Persistent weak stream: If your urine stream has gradually weakened over months, especially if you are a man over 50, the prostate is a more likely culprit than the hemorrhoids, even if both are present.
New incontinence with constipation: If you are leaking urine and also chronically constipated, a pelvic floor evaluation may be more productive than treating either symptom alone.
Inability to urinate after surgery: If you have had a hemorrhoidectomy and cannot pass urine within 6 to 8 hours, contact your surgical team. Catheterization is straightforward and temporary, but delaying it can overstretch the bladder and prolong the problem.
Postpartum symptoms: If hemorrhoid pain and bladder control issues appeared together after delivery, mention both to your obstetrician rather than treating them as separate complaints.

The biggest misconception surrounding this topic is that hemorrhoids physically press on the bladder or urethra. Outside of extraordinarily rare cases of massive prolapse, that is not what is happening. The connections are neurological (shared nerve cross-talk), muscular (pelvic floor strain from chronic constipation), vascular (the prostate-hemorrhoid venous connection in men), and iatrogenic (surgery-related retention). Understanding which mechanism applies to your situation points you toward the right fix, whether that is pelvic floor rehab, prostate evaluation, constipation management, or careful surgical planning to minimize bladder complications.

1
American Journal of Physiology-Renal Physiology. Colonic irritation in the rat sensitizes urinary bladder afferents to mechanical and chemical stimuli: an afferent origin of pelvic organ cross-sensitization
2
PubMed. Relationship between haemorrhoids and prostatism: results of a prospective study
3
Clinical Gastroenterology and Hepatology. A Gap in Our Understanding: Chronic Constipation and Its Comorbid Conditions
4
Current Gastroenterology Reports. Postpartum Anorectal and Pelvic Floor Disorders: Evaluation, Treatment, and Prevention
5
PubMed Central. Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy
6
Journal of the American College of Surgeons. Identification of risk factors for postoperative urinary retention after various hemorrhoid-related procedures
7
American Journal of Surgery. The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis
8
PubMed Central. General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy
9
Diseases of the Colon & Rectum. The effect of pudendal block on voiding after hemorrhoidectomy
10
PubMed. Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and IV internal hemorrhoids
11
PubMed. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention
12
PubMed. Ambulatory surgical hemorrhoidectomy–a solution to postoperative urinary retention?