Can Constipation Cause Haemorrhoids?

What Are Haemorrhoids?

Haemorrhoids — also called piles — are swollen or displaced anal cushions. Your anal cushions are small, specialised pads of tissue that normally sit inside the anal canal and help keep it sealed at rest. They contain a network of small blood vessels, muscle, and connective tissue.

When these cushions become engorged, slide out of position, or their supporting tissues weaken and stretch over time, they cause symptoms. Internal haemorrhoids form above the main sensory line inside the canal — they are typically painless, but they can bleed bright red blood and may bulge out of the anal opening. External haemorrhoids form below that line and can cause pain, swelling, and irritation, especially if a blood clot forms inside them (called a thrombosed external haemorrhoid).

How Constipation Causes Haemorrhoids

The link between constipation and haemorrhoids is well established. When your stool is hard and difficult to pass, straining becomes necessary. Each time you strain:

• Pressure inside your abdomen and rectum rises sharply
• The veins inside the anal cushions fill with blood under increased pressure
• The blood vessels inside the cushions become engorged
• The connective tissue and muscle fibres that hold the cushions in place are stretched and weakened

Over months and years, repeated straining causes the cushions to gradually slide downwards — which is how haemorrhoidal disease develops. This explains why haemorrhoids are much more common in countries where people eat low-fibre diets, and rare in populations where high-fibre eating makes bowel motions easy and effortless.

It is also worth knowing that sitting on the toilet for a long time — reading or scrolling your phone — adds to the problem. The sitting position puts continuous pressure on the anal cushions even when you are not actively straining.

Constipation: What It Causes and What It Makes Worse

Constipation and Anal Fissures

Hard or large stools passing through the anal canal can tear the delicate lining — this is called an anal fissure. Fissures cause severe, sharp pain during and after a bowel motion, and they may bleed. The pain causes the sphincter muscle to go into spasm, which reduces blood flow to the wound site and stops it from healing properly — and that is how an acute tear becomes a chronic, recurring problem.

Softening your stools is the most important step in treating an anal fissure. Without consistently soft, easy stools, even effective treatments like topical creams (glyceryl trinitrate, diltiazem) or Botox injections will have limited long-term success. Read more in our article on constipation and anal tears.

Why Treating Constipation Is Central to Haemorrhoid Treatment

Any haemorrhoid treatment — dietary, procedural (rubber band ligation, injection sclerotherapy), or surgical (haemorrhoidectomy) — is undermined by ongoing constipation. If the constipation is not treated alongside the haemorrhoids:

• Symptoms are likely to come back even after a successful procedure
• Hard stools pressing on recently treated tissue increase pain and the risk of bleeding
• The anal cushions keep being damaged by each episode of straining

For milder haemorrhoids (Grades I and II), dietary and lifestyle changes alone — more fibre, more fluid, more movement — can resolve symptoms entirely, without any procedure at all. Softening the stool takes the pressure off the anal cushions and allows them to settle.

Practical Steps to Break the Cycle

If you have both constipation and haemorrhoids, the goal is to achieve consistently soft, comfortable stools. Here is what that involves in practice:

• Aim for 25–30 g of dietary fibre daily — from fruit, vegetables, legumes, and wholegrains
• Drink at least 1.5–2 litres of water per day (fibre works much better when you are well hydrated)
• Add a fibre supplement like psyllium (Metamucil) if diet alone is not enough
• Use an osmotic laxative (Movicol, Osmolax) short-term if your stools remain hard despite the above
• Use a small footstool under your feet on the toilet — raising your knees above hip height puts your body in a more natural position that makes emptying easier
• Limit your time on the toilet to what you actually need — do not sit there scrolling your phone
• Applying a cold compress or witch hazel pad to the area after a bowel motion can help reduce external swelling and discomfort

When to See a Specialist

It is worth seeing a colorectal surgeon if:

• You have any rectal bleeding — even if you suspect it is from haemorrhoids, it is important to rule out other causes including bowel cancer
• Your haemorrhoids are coming out and not going back in on their own
• The pain is severe, or you have developed a sudden, very painful lump (which may be a thrombosed external haemorrhoid — a blood clot inside a haemorrhoid)
• Your symptoms have not improved after four to six weeks of dietary and lifestyle changes
• You are over 45 and have not had a recent colonoscopy

A colorectal surgeon will grade your haemorrhoids, assess your constipation, and put together an individualised management plan — including procedural options if they are needed.

Haemorrhoids During Pregnancy

Pregnancy is one of the most common times for haemorrhoids to develop or flare up. A combination of things works against you: the hormone progesterone relaxes smooth muscle throughout the body (including the tissue supporting the anal cushions), blood volume increases, constipation is very common in the third trimester, and the growing uterus puts pressure on the veins returning blood from the lower body.

The good news is that most pregnancy-related haemorrhoids improve significantly after the birth. During pregnancy, the focus is on stool softening through fibre and fluids, soothing topical preparations, and cold compresses for comfort. Procedures are usually deferred until after delivery unless symptoms are particularly severe.

Frequently Asked Questions