Can hemorrhoids cause constipation? Explanation, treatments, and FAQs

Yes, hemorrhoids can cause or contribute to constipation, sometimes even worsening it. However, the reverse is also true, with constipation being an underlying factor for developing hemorrhoids.

Hemorrhoids can cause discomfort and make passing stools more difficult. Also, the fear of pain may cause some people to avoid having a bowel movement, leading to stool buildup.

Sometimes, hemorrhoids obstruct the stool passageway and can further exacerbate constipation.

Treatment may include increasing fiber intake, regular exercise, and using hemorrhoidal ointments. Any person with long-term constipation should consult a doctor.

This article discusses hemorrhoid-related constipation, how to relieve it, and answers some FAQs on hemorrhoids and constipation.

Hemorrhoids, or piles, are inflamed and swollen veins around the anus, the opening at the end of the rectum through which stools pass. Hemorrhoids are common; approximately 50% of people older than 50 in the United States have hemorrhoids.

There are two types of hemorrhoids – internal and external. Internal hemorrhoids develop in the lining of the anus and lower rectum, and external hemorrhoids form under the skin surrounding the anus.

Expert opinion

Medical News Today reached out to Dr. Onikepe Adegbola, Ph.D., founder of Casa de Sante — a digital gut platform for people with gastrointestinal conditions — for her explanation of why hemorrhoids might cause or worsen constipation.

“When inflamed, hemorrhoids cause discomfort, pain, and itching in the affected area, which makes passing stools difficult and leads to constipation,” said Dr. Adegbola. She added, “They may also cause bleeding during bowel movements, further aggravating constipation. Another factor is that people with hemorrhoids may avoid going to the bathroom due to discomfort or fear of pain, which in turn leads to stool buildup and constipation. ”

Aside from the above factors, hemorrhoids can act as an obstruction, which compounds constipation.

Medical News Today also spoke with Dr. David Seltz, medical director for Ascendant Detox — a drug and alcohol detox center — who explained, “The swollen veins can block or slow down the passage of stool.”

Learn more about the causes and treatment for itchy hemorrhoids.

The reverse — can constipation cause hemorrhoids?

The link between hemorrhoids and constipation goes both ways, as sometimes, constipation can cause hemorrhoids. This can happen in various ways.

Constipation and straining during bowel movements are common risk factors for hemorrhoids. Excessive abdominal pressure from both can stretch the small veins around the anus and rectum. The stretching reduces the elasticity in the veins, causing them to enlarge and swell with blood. When this happens, the veins have a high risk of fragility and blood clot formation.

Learn what happens when hemorrhoids fill with blood.

Treatment for hemorrhoid-related constipation differs slightly from the treatment for other causes of constipation. Dr. Adegbola suggests the following strategies to relieve constipation from hemorrhoids:

• “Increase fiber intake: Eating more fiber can help soften the stool, making it easier to pass. Individuals can get this from daily servings of fruits, vegetables, and whole grains. Taking some fiber supplements can provide extra convenience.
• Drink plenty of water: Staying hydrated is essential for softening stools and avoiding constipation.
• Exercise regularly: Physical activity can help stimulate bowel movements and prevent constipation.
• Take a sitz bath: A sitz bath involves soaking in a warm, shallow tub to help reduce pain and inflammation in the anal region. A daily soak for 10–15 minutes may be helpful.
• Use topical treatments: Over-the-counter creams, ointments, and suppositories can help relieve hemorrhoid symptoms and reduce pain and itching. ”

Learn about some other home remedies to relieve hemorrhoids.

Taking laxatives

Dr. Adegbola recommends the type of laxatives called stool softeners, which increase the amount of fat and water in the stool. “They can help ease bowel movements and reduce straining,” she said. “A person should talk with their doctor about which stool softener would be most beneficial for them.”

It is best to use laxatives only on a short-term basis and after other measures have not been effective. Any person with long-term constipation should consult a doctor.

Learn about some natural stool softeners.

Below are some answers to common questions on this topic:

Do hemorrhoids go away?

According to one source, the pain and swelling usually decrease in 2–7 days if a person uses nonsurgical treatment. It may take 4–6 weeks for a firm lump to recede.

Learn more about how long hemorrhoids last.

Can constipation cause hemorrhoids to bleed?

Yes, constipation is one of the factors that may cause this.

“When stools are hard, they can be difficult and painful to pass,” said Dr. Seitz. “This increases pressure on the veins in the rectum and may cause them to swell and bleed. Straining during bowel movements will also put extra pressure on the veins, which can lead to bleeding.”

Learn more about bleeding hemorrhoids.

Can hemorrhoids affect bowel movements?

In addition to worsening constipation, hemorrhoids can affect bowel movements in another way.

“They can cause a feeling of fullness or pressure in the rectum due to the enlarged veins,” said Dr. Seitz. “This can trigger the need to have a bowel movement even after going to the bathroom.”

Learn more about why a bowel movement may hurt.

Several factors relating to hemorrhoids can cause or contribute to constipation. The associated discomfort with hemorrhoids can make passing stools more difficult, and the dread of pain can sometimes cause a person to delay going to the bathroom. Delaying bowel movements can lead to stool accumulation.

Also, hemorrhoids can block the passageway through which stools exit the body, worsening constipation.

Relief can come from drinking more water and consuming more fiber, such as fruits, vegetables, and whole grains. Over-the-counter ointments for hemorrhoids may also help. When such measures are ineffective, a person should talk with a doctor.

Constipation | Hemorrhoid Centers of America

What is Constipation?

Constipation is the infrequent passage of stool that may be hard, dry, and leads to straining. There may be a feeling of incomplete evacuation and pressure on the rectum. The abdomen may feel bloated and the colon distension can cause abdominal pain. More than 20 % of Americans suffer from constipation at some point. It is more common in women and the elderly.
You should have an easy to pass, moist formed stool at least every two to three days. This will decrease your risk of symptomatic enlarged hemorrhoids. Time on the commode should be less than two minutes. Straining should be avoided.

Causes?

In most cases there is no obvious cause. A low fiber diet without enough fluid will make constipation worse. Increasing fiber, water, and exercise will help. Eating large amounts of dairy products may cause constipation. Slow transit time or colonic inertia is due to the colonic muscles not moving the stool through the colon normally. Pregnancy can make constipation worse and is a good time to increase fiber and water. Irritable bowel syndrome may be associated with constipation and diarrhea. Hemorrhoids can add to the obstruction of stool which may cause a flattening of the stool.

Constipation may be caused by high calcium, low thyroid, diabetes mellitus, low potassium, or renal failure. Neurological conditions such as Parkinson’s disease, spinal cord lesions, stroke, multiple sclerosis, Hirschsprung’s disease, or autonomic neuropathy can lead to constipation as well. The muscle disorders of amyloidosis or scleroderma are associated with constipation. Anxiety, depression, and somatization may exacerbate it as well. Constipation is frequently worse around menstrual periods.

Antacids that contain calcium (Tums) or aluminum (Amphojel or Basaljel), calcium supplements, anticholinergics, antidepressants (Elavil and Tofranil), cholestyramine, catapres, sinemet, narcotic pain medicines (codeine, oxydodone, hydrocodone, hydromorphone), diuretics, NSAID’s, psychotropics, sympathomimetics, anticonvulsants (Dilantin or Tegretol), iron supplements, or calcium channel blockers ( Cardizem or Procardia) may all lead to constipation.

The pelvic floor muscles may fail to relax causing difficulty with passage of the stool. This may be helped by biofeedback.

Colon or rectal cancer can lead to a smaller stool, no stool, or blood in the stool. The acute onset of constipation, weight loss, severe pain, or change in the caliber of the stool demands immediate medical attention.

An acute bowel obstruction may cause abdominal pain, cramps, bloating, nausea, vomiting, distension, decreased stools and also requires immediate medical evaluation.

Complications

Chronic constipation may lead to bloating, abdominal pain, nausea, cramps, rectal pain or pressure, or rectal bleeding. The passage of a large or dry stool can cause a tear or anal fissure.

Evaluation

A rectal exam, sigmoidoscopy, or colonoscopy should be done. For chronic constipation that does not respond to dietary changes the workup may include a physical exam, history, blood work, rectal exam, colonoscopy, barium enema, rectal manometry and transit time or motility studies.

Treatment

$800 million dollars are spent each year on laxatives. The chronic use of stimulants such as mineral oil, cascara sagrada, Ex-lax, Senokot, Correctol, Dulcolax, Feen-a-mint may lead to a dependency and should be avoided.
Avoid the frequent use of stimulant laxatives such as Bisacodyl (Ducolax or Correctol), castor oil, Perdiem (Psyllium and Senna), Senna (Senokot or Ex-Lax), cascara sagrada, mineral oil, or saline osmotic laxatives such as magnesium citrate and sodium phosphate. Renal failure patients cannot use magnesium products. Milk of magnesia usually works within a few hours but should not be used on a regular basis. The abuse of the stimulants can lead to the weakening of the intestinal muscles and a worsening of the constipation.

No one product is perfect and trial and error is required. Usually, it takes 1-2 weeks to see the full benefit of the additive. Foods rich in fiber include whole grains, beans, fruits and vegetables. Many cereal products or snack bars now have good fiber content. Read the product contents and look for cereals with four or more grams of fiber. A trial of fiber and water may be helpful. An occasional prune may be helpful.

Drink up to 6 glasses of water and add 5 grams of fiber per day for the first 5 days. You may add an additional 5 grams of fiber per day every five days or so until you reach 15 grams of fiber per day. Fiber may cause gas or bloating. This may be decreased by adding the increased amounts of fiber over a weeks’ time to allow you intestines to get use to the slower transit time and increased bacterial load that fiber may cause. Fiber helps make a soft bulky stool that stretches the rectum and gives you a signal to go to the bathroom. Smaller stool can lie in the rectum undetected and obstruct blood flow leading to worsening of the hemorrhoids. Increasing fiber in your diet will help lower cholesterol, decrease the risk of heart disease and diverticulosis, and may decrease the risk of colon cancer.

Safe laxatives include stool softeners such as Colace which contains docusate sodium, fiber, or the osmotic laxative Miralax. Stool softeners are wetting agents and may be taken with fiber. Docusate sodium (Colace or Surfak) 100 mg may be taken one to three per evening to help the morning motion. Do not take mineral oil with Colace as it may increase the absorption leading to inflammation of lymph nodes or liver. Miralax may cause less bloating and gas. It pulls water into the intestines. Take 17 grams per day. Adjust dose or frequency downward if stools are too loose.

Flaxseed and Flaxseed oil are helpful but may reduce the absorption of some medications such as Digitalis. They may potentiate the anticoagulation effect of Coumadin or aspirin.

Lactulose may occasionally be prescribed for constipation that does not respond to other measures.

Linzess is now available for chronic constipation that does not respond to any of the other measures.

If the stool is dry you may apply Vaseline, with your finger, inside the rectum to try and aid the passage of the stool and help prevent a fissure. Chronic constipation will exacerbate hemorrhoids and can cause an anal fissure.

Reducing the size of internal hemorrhoids with the banding procedure helps many patients have a more normal bowel movement. If you are having trouble with constipation and hemorrhoids or fissures call our office today-find nearest location.

• Magnesium for Constipation
• Fiber in your diet – 30 grams a day helps keep hemorrhoids away
• Metamucil
• Benefiber
• Citrucel
• Fiberwell Gummies

*This is not an endorsement of any particular product.

Read the ingredients of herbal treatments carefully as many of them have stimulants. There is no proven benefit to colonics or colon cleansing routines.

Very large dry stools may lead to and obstructing ball of stool in the rectum. This may lead to pain, lack of normal stool, and leakage. This impaction requires careful removal with lubricants, enemas, and gentle digital breaking up of the impaction. This may require the help of a medical professional.

Enemas should not be used on a regular basis as they may injure the rectum or disturb the electrolyte balances. Fleet phosphosoda enemas stimulate the muscles of the colon. Mineral oil enemas lubricate and soften hard stools.
Suppositories work by stimulating the rectum. They may occasionally be used for constipation. Dulcolax contains bisacodyl and is a stimulant. Glycerin works by irritating the rectum. Do not use laxatives on a regular basis without having your colon evaluated by a physician. A consultation with an internist or gastroenterologist may be helpful.

If you are having constipation that aggravates your hemorrhoids please seek help from an expert in the non-surgical treatment of hemorrhoids. We hope this has been helpful. Please call us to make an appointment with Hemorrhoid Centers of America – find closest location.

Alarming symptoms requiring medical attention

1) PAIN AND ITCHING IN THE ANUS : complaints may occur during walking, prolonged sitting. May be permanent or occur intermittently. The pain may be sharp or dull in nature. Pain can also occur during bowel movements.

2) RECTAL BLEEDING , blood may be in the form of streaks on toilet paper or may drip onto the toilet bowl, or may be in the form of blood blots on linen.

Anemia in diseases of the colon often develops due to chronic or acute blood loss. In cancer, which are localized in the right sections of the colon, anemia is often observed and is caused by both chronic blood loss and impaired hematopoiesis due to intoxication, which develops early and quickly with this localization of the tumor. Refusal to visit a doctor increases the number of cancer patients!

3) CONSTIPATION AND DIFFICULTY DURING DEFICACY : Difficulty emptying bowels, frequent constipation, feeling of incomplete emptying after stools or, on the contrary, frequent stools, diarrhea, incontinence of feces and flatus, unreasonably loose stools, false urge to defecate, and also alternating states of constipation and loose stools. Such symptoms may further lead to the development of the disease and the need for surgery.

4) FORMATION OF PAINFUL KNODS, SEALS IN THE ANUS AND AROUND THE ANUS :

With hemorrhoids, complications come on suddenly, without warning. If a knot (nodes) suddenly appeared in the anus, or bleeding developed from the hemorrhoid, you should contact a doctor – a coloproctologist immediately!

The appearance of painful seals in the anus or near the anus may be the first sign of the development of acute purulent inflammation (paraproctitis).

In the postpartum period, hemorrhoids are a fairly common problem in women. Typical early symptoms of this disease are itching, discomfort in the anal region, pain during defecation, mucous, and then bloody discharge from the rectum. Do not be afraid to consult a doctor, effective treatment of hemorrhoids is possible while breastfeeding.

5) INJURY OF THE ANUS, RECTUM, PERINEAL ZONE : Bumps, tears, foreign bodies, cuts and other injuries of the anus with violation of the integrity of the skin and mucous membranes. You should not try to extract them yourself, as this can lead to disastrous consequences (rupture of the rectum, rectal bleeding).

6) PURULENT MUCOUS DISCHARGE FROM THE ANUS intestines.

7) ABDOMINAL PAIN : occurs with intestinal obstruction, the so-called. “Irritable bowel syndrome”, colitis, including ulcerative colitis and Crohn’s disease, adhesive disease, tumors of the large intestine. Pain can occur with biliary dyskinesia, pancreatitis, gastric ulcer, gastritis, renal colic, diverticula.

8) BLOAT : bloating can occur not only with constipation and intestinal obstruction, but also with pancreatitis, colon dysbacteriosis, irritable bowel syndrome, cystic fibrosis, abuse of farinaceous, sweet foods, with lactase deficiency.

9) DIARRHEA : occurs in: ulcerative colitis, Crohn’s disease, familial juvenile polyposis, infectious enterocolitis. Often diarrhea is accompanied by tenesmus.

10) TENESYSMUS (false urge to defecate): frequent false urge to defecate (without excretion of feces or with the separation of a small amount of mucus, blood or liquid intestinal contents) is a consequence of reflex excitation of the motor activity of the distal colon. Observed with intestinal obstruction, the so-called. “Irritable bowel syndrome”, colitis, including ulcerative colitis and Crohn’s disease, adhesive disease, tumors of the large intestine.

11) FEcal INCONTINENCE : fecal and gas incontinence is observed in congenital or acquired anatomical lesions of the sphincter apparatus of the rectum or violation of its reflex regulation.

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Constipation – health articles

The concept “constipation” means difficulty in emptying the bowels, the absence of defecation for more than three days.

Chronic constipation must be distinguished from situational (episodic) constipation. Situational constipation occurs in various provocative situations (pregnancy, travel – “tourist constipation”, the use of products that impede the transit of intestinal masses, insufficient fluid intake, psycho-emotional experiences, stress). In addition, constipation can be caused by taking medications. Situational constipation occurs for a short time and, as a rule, resolves successfully on its own or with the help of laxatives. These conditions are not considered diseases.

Chronic constipation is a regular delay in defecation for 48 hours or more. At the same time, a small amount of dense and dry feces is excreted. Often after a bowel movement there is no feeling of complete emptying of the intestine. You can talk about constipation taking place if the patient has one, several or all of these signs. An important diagnostic sign is a change in the usual frequency and nature of bowel movements.

Causes

The following variants can be distinguished as the most common causes of constipation: the use of certain medications, pregnancy, hormonal changes, dietary errors, combined with a lack of fiber in it, trauma to the spine, dysfunction of the pelvic floor.

There are a number of specific diseases that can also cause constipation: bowel cancer, hypothyroidism, anal fissure, irritable bowel syndrome, depression, stress, hemorrhoids, diverticulitis, Hirschsprung’s disease, etc.

Symptoms

Manifestations of constipation: feeling of heaviness and pain in the abdomen, loss of appetite, headache, dizziness, nausea, coated tongue, bad breath, heartburn, insomnia.

A diagnosis of chronic constipation can be made if:

• stool frequency becomes less than 3 times a week;
• defecation requires exertion; hard or lumpy stools;
• there is a feeling of incomplete emptying of the intestine.

The symptoms of constipation are very varied and largely depend on the nature of the disease that caused them. In some cases, constipation is the only complaint, in others, patients pay attention to other ailments. Sometimes patients are disturbed by pain and a feeling of fullness in the abdomen; relief comes after a bowel movement or passing flatus.

A rather painful symptom of constipation can be bloating (flatulence), which is due to the slow movement of feces through the colon and increased gas formation as a result of the activity of bacteria in the intestines. Bloating, in addition to the actual intestinal symptoms, may be accompanied by reflex reactions of other organs: pain in the heart, palpitations, etc. In patients with constipation, appetite may decrease, belching with air, bad taste in the mouth.

Diagnosis

First of all, it is necessary to clarify whether the constipation is sudden (acute) or chronic. Further, from the anamnesis, it turns out the presence of diseases that may be associated with impaired bowel function. In the case of such a connection, constipation is eliminated during the treatment of the underlying disease. In its absence, it is necessary to carefully analyze the “drug” history and stop drugs that can cause constipation. In the absence of a connection between constipation and diseases and drugs, the patient should examine the gastrointestinal tract, during which intestinal diseases are detected – the cause of constipation.

An x-ray is taken to assess the condition of the large intestine. Irrigoscopy clearly reveals intestinal obstruction.

The second stage of diagnostic measures is colonoscopy (endoscopic examination of the large intestine), sampling of biopsy specimens, mucous membranes and their histological and, if necessary, cytological examination.

Then methods for studying the functional state of the intestine are assigned, depending on preliminary assumptions. These can be bacteriological tests, a coprogram, a study to detect occult blood, manometry techniques, muscular intestinal walls, laboratory tests to detect functional disorders of the secretory organs of the digestive tract, etc.

Treatment

The best way to get rid of constipation is diet. More specifically, a diet rich in plant fiber. The fiber content in the diet can be increased by including whole grain bread and bran in the menu. It is very useful not to forget about fresh vegetables and fruits, which are very rich in fiber. Daily use of prunes or prune juice helps to improve peristalsis and regularity of the stool. And the last, but very valuable advice for maintaining your health is to drink at least a liter of fluid daily.

As a rule, such dietary measures are enough to get rid of constipation. If, despite following the above recommendations, constipation does not stop, then two teaspoons of raw bran can be added to the daily diet. They can simply be sprinkled on food. Bran should be added to food gradually. If you immediately add a full dose of bran, then the result will be uncontrollable diarrhea and flatulence. In the intestines, bran combines with zinc and calcium salts and removes them from the body, which can cause a deficiency of these metals.