Constipation can make a bowel movement much more than an inconvenience.

When stool becomes hard and difficult to pass, people often respond by sitting on the toilet longer and pushing harder. Over time, difficult bowel movements and repeated straining may contribute to problems around the anus and rectum.

Two of the most common are hemorrhoids and anal fissures.

They are different conditions, but both can be associated with difficult bowel movements — and both can make going to the bathroom even more uncomfortable.

This can create a frustrating cycle:

Hard stool → difficult bowel movement → straining or injury → pain and discomfort → greater difficulty with the next bowel movement.

Understanding this cycle is one reason it is important to address constipation before bowel movements become increasingly difficult or painful.

What Are Hemorrhoids?

Hemorrhoidal cushions are normal structures within the anal canal that contain blood vessels and supporting tissue.

Problems occur when these tissues become enlarged, displaced, inflamed, thrombosed, or otherwise symptomatic. This is commonly referred to as hemorrhoidal disease, or simply hemorrhoids.

Hemorrhoids are generally classified as internal or external, depending on their location.

Possible symptoms include:

• Bright red rectal bleeding
• Itching or irritation
• Swelling around the anus
• A lump near the anus
• Discomfort or pain
• Prolapse, in which internal hemorrhoidal tissue protrudes outside the anus

Not every hemorrhoid causes symptoms, and not every episode of rectal bleeding is caused by hemorrhoids.

Does Constipation Cause Hemorrhoids?

The relationship is more complicated than a simple yes or no.

Constipation has traditionally been considered an important contributor to hemorrhoidal disease because hard stools, prolonged toilet sitting, and repeated straining can increase pressure in the anal region.

Research has found associations between hemorrhoids and abnormal bowel habits, including constipation and difficult evacuation.

However, studies have not consistently demonstrated that constipation by itself directly causes hemorrhoids.

A 2022 systematic review and meta-analysis found that functional constipation was significantly more common in people with hemorrhoids than in control groups. The same review also found that dyssynergic defecation and higher anal resting pressures were more common among people with hemorrhoids. However, the available evidence did not establish a simple one-way causal relationship.

Therefore, the more accurate statement is:

Constipation, difficult evacuation, prolonged straining, and abnormal bowel habits may contribute to or aggravate hemorrhoidal symptoms, but hemorrhoids have multiple contributing factors and should not be attributed to constipation alone.

Why Does Straining Matter?

When stool is difficult to pass, people often instinctively push harder.

Forceful straining increases pressure within the abdomen and anorectal region.

Occasional straining does not mean someone will automatically develop hemorrhoids. But repeated or prolonged straining can place unnecessary stress on the tissues involved in bowel evacuation.

Spending long periods sitting on the toilet may also prolong pressure on the anorectal area.

This is why a healthier bowel routine focuses not simply on getting stool out, but on making bowel movements easier to complete with less unnecessary force.

What Is an Anal Fissure?

An anal fissure is a small tear in the lining of the anal canal.

Unlike hemorrhoids, which involve hemorrhoidal tissue and blood vessels, an anal fissure is an actual tear in the tissue.

One common cause is mechanical trauma when a hard or bulky stool stretches the anal canal during a bowel movement. Anal fissures are also seen more frequently in people with chronic constipation.

Typical symptoms may include:

• Sharp or tearing pain during a bowel movement
• Burning pain that continues afterward
• Bright red blood on toilet paper or on the surface of stool
• Fear or hesitation about having another bowel movement because of the pain

The pain can sometimes be intense.

The Pain–Constipation Cycle

Anal fissures demonstrate particularly well how one bowel problem can reinforce another.

Imagine someone passes a very hard stool and develops a small tear.

The next bowel movement hurts.

Because it hurts, the person may delay going to the bathroom or unconsciously tighten the anal muscles.

Meanwhile, stool remains in the colon longer and may become drier and harder.

The next bowel movement can then be even more difficult and painful.

A cycle may develop:

Hard stool → anal injury → pain → withholding or muscle spasm → harder stool → another painful bowel movement.

Clinical literature has long described a cycle involving anal pain, constipation, stool trauma, and sphincter spasm in anal fissure.

Breaking this cycle often begins with making stool easier and less traumatic to pass.

Hemorrhoids and Anal Fissures Are Not the Same Thing

Because both conditions may cause discomfort or bleeding around bowel movements, people sometimes confuse them.

But they are different.

It is not always possible to determine the cause of rectal symptoms without an appropriate medical examination.

Don't Assume Every Episode of Rectal Bleeding Is “Just Hemorrhoids”

This is especially important.

Bright red blood with a bowel movement can occur with hemorrhoids or an anal fissure.

But rectal bleeding has other possible causes as well.

The 2024 American Society of Colon and Rectal Surgeons clinical guideline specifically cautions that rectal bleeding should not automatically be attributed to hemorrhoids. Appropriate evaluation depends on the person's symptoms, history, examination, and risk factors.

Seek medical evaluation for unexplained, persistent, recurrent, or significant rectal bleeding, particularly when accompanied by symptoms such as:

• A persistent change in bowel habits
• Unexplained weight loss
• Abdominal pain
• Weakness or symptoms of anemia
• Black or tarry stool
• Significant or worsening pain

The goal is not to create fear.

It is simply important not to self-diagnose every episode of bleeding as hemorrhoids.

Prevention Begins With Easier Bowel Movements

One of the most practical ways to protect the anorectal area is to reduce unnecessary trauma during bowel movements.

The goal should be:

Soft enough stool + a natural urge + comfortable evacuation + minimal unnecessary straining.

Healthy bowel habits may include:

• Drinking adequate fluids
• Eating an appropriate amount of dietary fiber
• Staying physically active when possible
• Responding to the natural urge to have a bowel movement
• Avoiding repeatedly delaying bowel movements
• Avoiding unnecessarily prolonged toilet sitting
• Avoiding repeated forceful straining
• Paying attention when stool repeatedly becomes hard or difficult to pass
• Seeking professional advice when constipation persists

The 2024 ASCRS hemorrhoid guideline recommends dietary and behavioral modifications as primary first-line therapies for symptomatic hemorrhoidal disease and specifically emphasizes adequate fluid and fiber intake and counseling regarding bowel habits.

More Force Is Not Always the Answer

This idea connects hemorrhoids and anal fissures with something we have discussed throughout our bowel-health education:

A difficult bowel movement should not automatically be answered with more force.

If you regularly need to sit for long periods, strain repeatedly, feel that stool is stuck, or cannot completely empty your bowels, the question should not only be:

“How can I push harder?”

A better question is:

“Why is this bowel movement difficult, and how can evacuation become easier and more comfortable?”

Sometimes the issue is hard stool.

Sometimes bowel habits contribute.

Sometimes medications or medical conditions play a role.

And in some people, the pelvic floor and anal muscles may not coordinate properly during defecation.

Persistent difficulty deserves attention.

Comfortable Bowel Movements Matter

Hemorrhoids and anal fissures are different conditions, and neither should be reduced to a simple statement that “constipation causes them.”

But hard stool, difficult evacuation, prolonged toilet sitting, and repeated straining can be important parts of the picture.

That gives us a practical lesson:

Don't wait until every bowel movement becomes a struggle.

Pay attention when stool repeatedly becomes hard, when bowel movements require excessive effort, or when pain causes you to avoid going to the bathroom.

Supporting regular, comfortable bowel movements and addressing constipation early may help reduce unnecessary stress and trauma to the anorectal area.

At EaseFlow®, we believe bowel care should focus on making bowel movements gentler, more comfortable, and easier to complete — not simply pushing harder.

Let’s Flow it Easy!

👉 Explore our complete Constipation Relief Guide for more information on constipation, bowel health, and gentle ways to support easier bowel movements.

References

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids.
Diseases of the Colon & Rectum. 2024;67(5):614–623.
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DOI: 10.1097/DCR.0000000000003276.
PubMed: View this guideline on PubMed

2. Kalkdijk J, Broens P, Ten Broek R, et al.
Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis.
European Journal of Gastroenterology & Hepatology. 2022;34(8):813–822.
PMID: 35412490.
DOI: 10.1097/MEG.0000000000002361.
PubMed: View this study on PubMed

3. Peery AF, Sandler RS, Galanko JA, et al.
Risk Factors for Hemorrhoids on Screening Colonoscopy.
PLoS ONE. 2015;10(9):e0139100.
PMID: 26406337.
DOI: 10.1371/journal.pone.0139100.
PubMed: View this study on PubMed

4. Ansari P.
Anal Fissures.
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PubMed: View this clinical review on PubMed

5. Ramakrishnan K, Scheid DC.
Anorectal conditions: anal fissure and anorectal fistula.
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PMID: 24742084.
PubMed: View this review on PubMed

Medical Disclaimer

This article is for general educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment.

Persistent or significant rectal bleeding, severe or worsening pain, black or tarry stool, unexplained weight loss, significant changes in bowel habits, or other concerning symptoms should be evaluated by a qualified healthcare professional.