Women get hemorrhoids for many of the same reasons anyone does, like straining during bowel movements and sitting for long periods, but they also face several biological factors that men don’t. Pregnancy, childbirth, hormonal shifts, and pelvic floor changes all increase pressure on the veins around the rectum and anus. A 2025 meta-analysis in Annals of Medicine found that hemorrhoid prevalence is higher in women (about 27%) than in men, and the reasons trace directly to the female reproductive system and the demands it places on the body over a lifetime.
Pregnancy Changes Nearly Everything Below the Waist
Pregnancy is the single biggest reason women develop hemorrhoids at higher rates than men. Three things happen simultaneously that all push rectal veins toward swelling. First, blood volume increases substantially to support the growing baby, which means more blood flowing through veins that weren’t designed for the extra load. Second, rising progesterone levels relax the walls of veins throughout the body, making them softer and more prone to stretching out of shape. Third, the growing uterus sits directly on top of the major veins that drain blood from the lower body, creating a bottleneck that backs pressure into the rectal area.
These factors compound as pregnancy progresses. By the third trimester, the weight of the baby pressing on the pelvic floor and anal region can make existing hemorrhoids worse or trigger new ones. Constipation, which is extremely common during pregnancy due to hormonal slowdown of the digestive tract and iron supplements, adds even more straining pressure.
Childbirth Creates a Second Wave of Risk
In a study of 280 women who gave birth, 43% had hemorrhoids. Many of those women had experienced constipation during pregnancy and pushed for more than 20 minutes during the second stage of labor. The intense, sustained bearing down required to deliver a baby vaginally puts enormous force on the rectal veins, sometimes for hours. Even women who didn’t have hemorrhoids during pregnancy can develop them during or immediately after delivery.
Postpartum hemorrhoids often improve on their own within a few weeks, but not always. For women who are breastfeeding and wondering about treatment options, hydrocortisone-based creams and ointments for hemorrhoids are considered safe to use during breastfeeding, though ideally for short periods. The amount that passes into breast milk is likely very small, and a baby absorbs little of it.
Pelvic Floor Weakness and Hemorrhoids Feed Each Other
The pelvic floor is a hammock of muscles that supports the bladder, uterus, and rectum. In women, this structure takes repeated hits over a lifetime: pregnancy, delivery, hormonal changes, and aging all weaken it. MRI studies show that people with hemorrhoids are more likely to have defects in key pelvic floor muscles and reduced muscle mass in the area compared to people without hemorrhoids.
A weak or dysfunctional pelvic floor contributes to hemorrhoids through three pathways. The first is uncoordinated bowel movements. Instead of relaxing the anal sphincter when passing stool, some people inadvertently clench it, forcing them to strain harder and longer. That extra pressure pushes directly on rectal veins. The second is loss of structural support. When the muscles holding the rectum and anal canal in place weaken, the veins in the area have less scaffolding and become more likely to swell and protrude. The third is poor pressure management. A weak pelvic floor can’t absorb sudden increases in abdominal pressure from things like lifting, coughing, or carrying extra body weight, so that force transmits straight to the rectal veins.
The relationship goes both ways. Chronic hemorrhoids can alter normal bowel habits and increase strain on the pelvic floor muscles, creating a cycle where each condition worsens the other.
Hormonal Shifts After Menopause
Estrogen plays a quiet but important role in keeping connective tissues throughout the pelvis strong and elastic. After menopause, falling estrogen levels thin the support structures that hold pelvic organs in place and reduce the strength of surrounding connective tissue. This is the same mechanism behind pelvic organ prolapse, and it affects the rectal area too. Veins that were once supported by firm tissue lose that cushion, making them more vulnerable to the kind of stretching and bulging that defines hemorrhoids.
This helps explain why hemorrhoid problems can resurface or appear for the first time in women over 50, even if they didn’t have significant issues during their childbearing years.
Uterine Fibroids Can Add Physical Pressure
Fibroids, which are noncancerous growths in or on the uterus, affect a large percentage of women by midlife. When fibroids grow large enough, particularly subserosal fibroids that develop on the outer wall of the uterus, they can press against the rectum and bowel. That constant pressure causes constipation by making it physically harder for stool to pass, and constipation is one of the top drivers of hemorrhoid development. Some women dealing with persistent hemorrhoids and bowel difficulty don’t realize that fibroids may be contributing to the problem.
How to Reduce Your Risk
Since many of the female-specific causes involve pressure and straining, the most effective prevention strategies target both. Fiber is the foundation. The recommended daily intake for women is 28 grams for ages 19 to 30, 25 grams for ages 31 to 50, and 22 grams for women over 51. Most people fall well short of these numbers. Getting enough fiber from fruits, vegetables, whole grains, and legumes softens stool and reduces the time and effort spent on the toilet.
Staying hydrated matters just as much as fiber. Without adequate water, fiber can actually make constipation worse. Aim to drink enough that your urine stays pale throughout the day.
Pelvic floor exercises can address the structural side of the equation. Strengthening those muscles improves bowel coordination, provides better support for rectal veins, and helps the body manage sudden changes in abdominal pressure. This is relevant at every stage of life, not just after childbirth. Avoiding prolonged sitting on the toilet, not delaying bowel movements, and staying physically active round out the practical steps that make a real difference over time.