Can Hemorrhoids Make It Hard to Poop?

Hemorrhoids can absolutely make it harder to have a bowel movement, though the way they do it is more complicated than most people assume. Large internal hemorrhoids that prolapse into the anal canal can physically get in the way of stool, but pain, swelling, elevated pressure in the anal sphincter, and the instinct to clench and avoid the toilet all play roles too. The relationship also runs in both directions: straining from constipation is one of the leading causes of hemorrhoids in the first place, so the two problems often feed each other in a frustrating loop.

How Prolapsed Hemorrhoids Physically Block Stool

Internal hemorrhoids are classified in grades from I to IV based on how far they protrude. Grade I hemorrhoids stay inside the anal canal and rarely interfere with defecation in a mechanical way. But once hemorrhoids reach grade III or IV, they can prolapse out of the anus during a bowel movement and may not retract on their own. That mass of swollen tissue sitting in or just outside the anal canal creates a partial obstruction. Stool has to pass around and through tissue that was not meant to be in the way, and many people describe the sensation as incomplete evacuation, like something is stuck.

Research on patients with prolapsed hemorrhoids has found measurably abnormal anorectal physiology. One study published in the British Journal of Surgery found that people with prolapsed hemorrhoids had significantly higher resting anal pressures, lower rectal compliance, and more perineal descent compared to healthy controls.¹ In plain terms, the anal canal was squeezing tighter than it should at rest, and the rectum was stiffer and less able to stretch to accommodate stool. Both of those changes make passing a bowel movement more difficult. After surgical removal of the hemorrhoids, pressures and compliance returned to normal within about three months, suggesting the hemorrhoids themselves were driving the dysfunction rather than merely coexisting with it.

Pain and the Reflex to Clench

When hemorrhoids are thrombosed (containing a blood clot) or inflamed, they hurt. That pain triggers a reflexive tightening of the internal anal sphincter, a ring of smooth muscle you cannot consciously control. The sphincter clamps down in response to the pain, which makes the canal narrower and passing stool more difficult. This is sometimes called sphincter hypertonicity, and it creates a vicious cycle: pain causes clenching, clenching makes the next bowel movement harder, and harder bowel movements make the hemorrhoid worse.

A randomized trial of botulinum toxin injections for thrombosed external hemorrhoids demonstrated how central sphincter tightness is to the problem. Patients who received the injection saw a significant drop in maximum resting pressure and reported meaningfully less pain within 24 hours, while the placebo group took a full week to see similar improvement.² By relaxing the sphincter chemically, the treatment broke the pain-clenching-pain loop. The clinical takeaway is that a significant portion of the difficulty pooping with hemorrhoids is not from the hemorrhoidal tissue itself blocking things, but from the body’s pain response making the exit tighter.

Beyond the involuntary clenching, there is a voluntary component. When you know a bowel movement is going to hurt, you delay going to the bathroom. You sit on the toilet and tense up. You bear down harder because the usual gentle push does not seem to work against a clenched sphincter. All of this extra straining further engorges the hemorrhoidal tissue and damages the supporting connective tissue, making future episodes worse. Breaking the cycle usually requires addressing the pain first so the person can relax enough to let stool pass without excessive force.

The Overlap With Functional Constipation

Here is where things get murky: many people who have hemorrhoids also have an underlying pattern of constipation or disordered defecation that existed before the hemorrhoids developed. A systematic review and meta-analysis published in the European Journal of Gastroenterology and Hepatology found that functional constipation, dyssynergic defecation, and higher basal anal pressures were all more common in patients with hemorrhoids compared to controls.³ Dyssynergic defecation is a condition where the pelvic floor muscles contract when they should be relaxing during a bowel movement, essentially working against you. The review’s authors hypothesized that the high straining forces generated during these paradoxical contractions are causally related to the development of hemorrhoids in the first place.

This means that if you have hemorrhoids and find it hard to poop, the hemorrhoids may be only part of the story. The straining pattern that caused or worsened the hemorrhoids could be a sign of pelvic floor dysfunction that will persist even if the hemorrhoids are treated. If you have surgery to remove hemorrhoids but never address the underlying coordination problem, you may continue to struggle with bowel movements and eventually develop new hemorrhoids. This is one reason specialists sometimes recommend anorectal manometry testing, which measures sphincter pressures and coordination, to figure out whether a pelvic floor issue is lurking beneath the hemorrhoid symptoms.⁴

Pregnancy, Hemorrhoids, and Constipation Together

Pregnant and postpartum women are hit particularly hard by this combination. Hemorrhoids and anal fissures affect roughly 40% of women during pregnancy and the postpartum period, according to a study in Frontiers in Surgery.⁵ Constipation during pregnancy was identified as a significant risk factor, along with prolonged straining (over 20 minutes), instrumental delivery, high newborn birth weight, and having had perianal problems in a previous pregnancy.

The hormonal changes of pregnancy slow gut motility, while the growing uterus presses on pelvic veins and increases pressure in the hemorrhoidal vascular cushions. Iron supplements, commonly prescribed for pregnancy, also tend to cause constipation. So pregnant women often face a triple hit: constipation from hormonal and mechanical causes, hemorrhoids from increased pelvic venous pressure, and then the hemorrhoids making the already-difficult bowel movements even more painful and obstructed. Treatment options are also more limited during pregnancy because many medications are off-limits, leaving fiber supplementation, stool softeners, sitz baths, and topical treatments as the main tools.

Toilet Posture and How Long You Sit

How you sit on the toilet affects how easily stool can pass, and this becomes especially relevant when hemorrhoids are already making things harder. Standard Western toilets place the body in a seated position that keeps the anorectal angle partially kinked. Squatting straightens that angle, which allows higher rectal pressure and lower anal resistance during defecation. A study in the Journal of Clinical Gastroenterology found that devices that modify defecation posture by elevating the feet (mimicking a squat) reduced strain, increased the sensation of complete emptying, and decreased the time spent on the toilet.⁶

Time spent sitting on the toilet matters too. A study published in PLOS ONE examining smartphone use on the toilet proposed that sitting on a standard toilet seat without support to the pelvic floor disproportionately increases pressure in the hemorrhoidal cushions, and that as this pressure persists over time, the cushions become engorged and develop into symptomatic hemorrhoids.⁷ The practical advice is simple: use a footstool to raise your knees above hip level, go when you feel the urge rather than forcing things, and leave your phone outside the bathroom. Every extra minute you spend sitting there adds pressure to tissue that is already swollen and vulnerable.

Breaking the Cycle With Conservative Treatment

Most people with hemorrhoids that make pooping difficult do not need surgery. The first-line approach is breaking the constipation-straining-hemorrhoid cycle using measures that soften stool, reduce pain, and allow the swollen tissue to calm down.

• Fiber and fluids: Increasing soluble fiber intake (through foods or supplements like psyllium) adds bulk and water to stool, making it softer and easier to pass without straining. The goal is a stool that passes with minimal effort.
• Topical treatments: Over-the-counter creams with hydrocortisone or lidocaine can reduce inflammation and numb pain temporarily, making it psychologically and physically easier to have a bowel movement without clenching.
• Sitz baths: Sitting in a few inches of warm water for 10 to 15 minutes relaxes the sphincter muscles and improves blood flow to the area, which can ease both pain and the reflex tightness that makes defecation difficult.
• Stool softeners: Osmotic laxatives like polyethylene glycol draw water into the colon and soften stool without stimulating contractions, which is gentler on irritated tissue than stimulant laxatives.

Topical nitroglycerin ointment, usually associated with anal fissures, has also been used off-label in some hemorrhoid patients. It works by causing nitric oxide-mediated relaxation of the internal anal sphincter, reducing the elevated resting pressure that contributes to both pain and difficulty passing stool.⁸ Headaches are a common side effect, which limits its appeal, but for people whose main issue is a painfully tight sphincter it can be effective.

A class of oral medications called phlebotonics, which include plant-derived flavonoids and synthetic compounds like calcium dobesilate, work differently. They improve venous tone, stabilize capillary walls, and increase lymphatic drainage. A Cochrane systematic review found that phlebotonics showed significant benefits for bleeding, itching, discharge, and overall symptom improvement compared to placebo.⁹ One specific formulation, micronized purified flavonoid fraction, has been shown to reduce bleeding, pain, anal discomfort, discharge, and itching in acute hemorrhoidal flares.¹⁰ A randomized trial comparing Centella extract with flavonoids found that bleeding stopped at a median of two weeks with the Centella-based treatment versus three weeks with flavonoids, and that flavonoid treatment was associated with greater tissue fibrosis on biopsy.¹¹ These drugs do not directly fix constipation, but by reducing the swelling and pain that make bowel movements difficult, they can help indirectly.

When Surgery Helps and When It Creates New Problems

For hemorrhoids that do not respond to conservative measures, procedures ranging from rubber band ligation to formal surgical hemorrhoidectomy can remove the problematic tissue. From the standpoint of defecation difficulty, the evidence is encouraging: as noted earlier, patients who underwent hemorrhoidectomy for prolapsed hemorrhoids saw their elevated sphincter pressures and reduced rectal compliance return to normal within three months.¹ For people whose difficulty pooping was primarily caused by the mechanical and physiological effects of the hemorrhoids themselves, surgery can be genuinely transformative.

However, surgery carries its own risk of making defecation harder. Anal stenosis, a narrowing of the anal canal from scar tissue, is a rare but serious complication of hemorrhoid surgery. One review noted that about 90% of anal stenosis cases are caused by overly aggressive hemorrhoidectomy, where too much tissue is removed and the remaining canal heals with excessive scarring.¹² Anal stenosis makes passing stool extremely difficult and painful, and correcting it often requires additional surgery. This risk is relatively low in experienced hands, but it underscores why surgical treatment is generally reserved for cases that have truly failed conservative management.

Conditions That Look Like Hemorrhoids but Are Not

If you are having persistent difficulty with bowel movements and assume hemorrhoids are the cause, it is worth knowing that other conditions can mimic prolapsed hemorrhoids while causing their own form of obstruction. Internal rectal intussusception, where the rectal wall telescopes into itself during straining, and mucosal prolapse can both look and feel similar to prolapsed hemorrhoids but create a different kind of blockage called outlet obstruction.¹³ The treatment for these conditions is different from hemorrhoid treatment, and misdiagnosis can lead to failed procedures and ongoing symptoms.

Rectal prolapse, where the full thickness of the rectal wall protrudes through the anus, is another mimic. Unlike hemorrhoids, which involve the vascular cushions in the anal canal, rectal prolapse involves the rectum itself sliding downward. The distinction matters because surgery for rectal prolapse is an abdominal or perineal procedure, not a hemorrhoidectomy. If you are experiencing a sense of something bulging out during bowel movements combined with difficulty evacuating, a proper examination by a colorectal specialist is important to make sure the right condition is being treated.

Pelvic Floor Rehabilitation

For people whose hemorrhoids coexist with dyssynergic defecation, the most effective long-term solution often involves retraining the pelvic floor. Biofeedback therapy teaches you to recognize when you are paradoxically contracting muscles that should be relaxing, and to practice the correct pattern using real-time visual or auditory feedback. This is not the same as generic “do more Kegels” advice, which can actually make things worse if the problem is muscles that are already too tight.

Anorectal manometry with a balloon expulsion test can identify whether disordered coordination is contributing to your symptoms.⁴ If the test reveals dyssynergia, biofeedback therapy has strong evidence of effectiveness for improving defecation. The connection to hemorrhoids is direct: if you fix the underlying straining pattern, you reduce the forces that caused the hemorrhoids and remove a major reason why bowel movements were difficult in the first place. Treating the hemorrhoids alone, whether with banding, surgery, or medication, addresses the symptom without fixing the root cause. For people caught in the straining-hemorrhoid-difficulty cycle, the combination of hemorrhoid treatment and pelvic floor rehabilitation is often what finally breaks the pattern for good.