Hemorrhoids get worse when pressure builds in the veins around your rectum and anus, causing the cushions of tissue there to swell, stretch, and eventually lose their support. The most common culprits are straining during bowel movements, sitting too long on the toilet, low fiber intake, not drinking enough water, and heavy lifting. Understanding exactly how each of these factors works can help you avoid flare-ups and keep existing hemorrhoids from progressing.
How Hemorrhoids Develop and Progress
Your anal canal naturally contains cushions of tissue filled with a dense network of blood vessels. These cushions are held in place by a small muscle and connective tissue that act like an anchor. When that support system weakens, the cushions slide downward and become what we recognize as hemorrhoids.
The damage happens through a predictable cycle. Repeated straining stretches and relaxes the anchoring muscle until it eventually breaks down. At the same time, increased pressure in your abdomen pushes blood into the rectal veins, and because those veins have no valves to prevent backflow, the blood pools and the tissue swells. The connective tissue that once supported the vascular network loosens and can no longer hold things in place. Over time, the swollen cushions become engorged, enlarged, and prone to slipping out of the anal canal.
Tightness in the internal anal sphincter also plays a role. When the sphincter squeezes harder than normal, it blocks blood from draining out of the area, making congestion worse. This is why anything that increases abdominal pressure or interferes with blood flow in the pelvic region can turn a minor problem into a painful one.
Straining and Spending Too Long on the Toilet
Straining during a bowel movement is the single most direct way to worsen hemorrhoids. Each time you bear down, you spike the pressure inside your abdomen, forcing blood into the hemorrhoidal veins and stretching the tissue that holds them in place. Do this repeatedly over weeks and months, and the anchoring structures begin to disintegrate permanently.
Sitting on the toilet for extended periods compounds the problem even without active straining. A standard toilet seat offers no support to your pelvic floor, so the longer you sit, the more pressure concentrates on the hemorrhoidal cushions. A study published in PLOS One found that 37.3% of people who used smartphones on the toilet spent more than five minutes per session, compared to just 7.1% of those who didn’t bring their phones. The researchers recommended keeping toilet time under five minutes to reduce hemorrhoidal pressure. If you’re scrolling through your phone, you’re almost certainly sitting longer than your body needs.
Low Fiber and Not Enough Water
Diet is one of the strongest predictors of hemorrhoid problems, largely because it determines how easy or difficult your bowel movements are. A case-control study found that eating less than 12 grams of fiber per day made people about 7 times more likely to develop internal hemorrhoids. Drinking less than 2 liters of water daily raised the risk even higher, by roughly 8.7 times. Constipation was present in nearly every patient with hemorrhoidal disease in that study.
The connection is straightforward: without enough fiber and water, stool becomes hard and dry. Hard stool forces you to strain, and straining is the mechanical trigger that congests and displaces hemorrhoidal tissue. Fiber softens and bulks up stool so it passes with minimal effort, while water keeps things moving through the digestive tract at a healthy pace. Most adults need 25 to 30 grams of fiber per day, which means the 12-gram threshold in the study represents a diet seriously lacking in vegetables, fruits, and whole grains.
Heavy Lifting and Exercise
Any activity that sharply increases abdominal pressure can aggravate hemorrhoids, and heavy lifting is the most common offender. Research measuring intra-abdominal pressure during various lifting tasks found that picking up just 2.5 kilograms (about 5.5 pounds) produced significant pressure increases regardless of technique. The way you lift matters too: squatting to pick something up off the ground generated more abdominal pressure than lifting the same weight from counter height. In fact, squatting with no weight at all created more pressure than lifting 10 kilograms off a counter or receiving 15 kilograms into outstretched arms.
This doesn’t mean you need to avoid all physical activity. Moderate exercise, particularly walking and swimming, generally helps by improving circulation and preventing constipation. The risk comes from chronic, heavy exertion that repeatedly drives pressure into the pelvic floor. If you lift weights regularly and have hemorrhoid issues, focusing on lighter loads, exhaling during exertion instead of holding your breath, and avoiding deep squats with heavy weight can reduce the strain on hemorrhoidal tissue.
Prolonged Sitting and Sedentary Habits
Sitting for long periods, whether at a desk, in a car, or on a couch, keeps continuous pressure on the rectal area. This sustained compression slows venous return from the hemorrhoidal veins, encouraging the same blood pooling that happens during straining. The effect builds over hours, which is why people with desk jobs or long commutes often notice their symptoms flare during the workweek.
Standing up and moving around for a few minutes every hour can relieve that pressure. Even a short walk breaks the cycle of compression and helps blood circulate out of the pelvic region.
Pregnancy
Pregnancy is one of the most common triggers for new or worsening hemorrhoids. The growing uterus puts increasing pressure on the pelvic veins, restricting blood flow from the rectal area. Hormonal changes during pregnancy also relax the walls of blood vessels, making them more prone to swelling. Vaginal delivery adds an intense burst of straining that can push hemorrhoids to a more advanced stage. Many women develop hemorrhoids for the first time during the third trimester or immediately after giving birth.
Age and Weakening Tissue
Hemorrhoids become dramatically more common with age. Among adults over 50, roughly half report hemorrhoid symptoms, compared to fewer than 5% of people under 20. The prevalence rises steadily through each decade: about 8% in the 20-to-30 age group, 20% in the 30-to-40 group, and 44% among those between 40 and 50.
This pattern reflects the gradual weakening of connective tissue and the anchoring muscle that holds anal cushions in place. Years of bowel movements, even without excessive straining, slowly degrade these structures. The vascular network also changes with age as blood vessel walls lose tone, making the tissue more vulnerable to congestion. You can’t stop aging, but managing the controllable factors (fiber, hydration, toilet habits, lifting technique) becomes increasingly important as these natural support structures weaken.
Other Habits That Add Up
Several less obvious factors can quietly make hemorrhoids worse over time:
- Diarrhea: Frequent loose stools irritate the anal canal and can cause as much damage as constipation. Chronic diarrhea keeps the tissue inflamed and prevents healing.
- Ignoring the urge to go: Delaying bowel movements allows stool to dry out in the colon, making it harder to pass later and increasing the likelihood of straining.
- Excessive wiping: Aggressive wiping with dry toilet paper irritates already swollen tissue. Gentle cleaning with water or unscented wipes is less abrasive.
- Obesity: Carrying excess body weight increases baseline abdominal pressure throughout the day, creating the same mechanical stress as repeated heavy lifting.
Hemorrhoids worsen through a cumulative process. Rarely does a single bad day cause a major flare. It’s the repeated combination of hard stools, prolonged toilet sitting, insufficient fiber, and sustained pressure that gradually breaks down the tissue holding everything in place. Addressing even one or two of these factors, particularly fiber intake and time spent on the toilet, can meaningfully slow or reverse that progression.