When You Feel the Urge but Still Have to Strain to Have a Bowel Movement

You feel the urge to have a bowel movement.

You go to the bathroom and sit on the toilet. You know stool is there and your body is telling you that it is time to go.

But it does not come out easily.

So you push.

Sometimes you push harder. You hold your breath, tighten your abdomen, and bear down repeatedly. What should have been a simple bowel movement may take 10, 20, or even 30 minutes.

Eventually, you may be able to pass the stool — but only after significant effort.

For some people, this happens occasionally. For others, straining becomes a regular part of almost every bowel movement.

Because the stool eventually comes out, many people assume this is normal.

But regularly needing significant force or prolonged straining to empty your bowels is something worth paying attention to.

Having the Urge Does Not Always Mean Stool Will Pass Easily

The urge to have a bowel movement usually means that stool has entered the rectum and triggered the body's normal sensation that it is time to empty.

But recognizing the urge and actually evacuating stool are two different parts of the process.

Successful bowel evacuation requires several things to work together:

• Stool needs to have an appropriate consistency.
• The rectum needs to generate and respond to pressure.
• The anal sphincter needs to relax.
• The pelvic floor needs to coordinate properly.
• The anorectal passage needs to allow stool to move outward.

When this process is not working efficiently, a person may have a perfectly recognizable urge to go but still have difficulty getting the stool out.

The natural response is often:

Push harder.

And if that does not work:

Push longer.

That repeated straining is where another problem can begin.

What Happens to Your Body When You Strain?

During forceful straining, many people instinctively hold their breath, tighten their abdominal muscles, and bear down.

This greatly increases pressure inside the abdomen and pelvis.

That pressure is directed downward toward the rectum, anus, and pelvic floor.

At the same time, holding the breath and bearing down changes pressure inside the chest and temporarily affects blood flow and blood pressure.

Doing this briefly once in a while is very different from doing it repeatedly for many minutes, day after day or year after year.

1. Hemorrhoids Can Develop or Become Worse

Repeated straining increases pressure around the anus and lower rectum.

Over time, this pressure may contribute to swollen or symptomatic hemorrhoidal tissue.

A person may begin to experience:

• Swelling around the anus
• Itching or irritation
• Pain or discomfort
• A lump near the anus
• Bright red bleeding during or after a bowel movement

Once hemorrhoids become painful or swollen, bowel movements may become even more uncomfortable.

The person may still need to strain to evacuate, creating a difficult cycle:

Difficulty passing stool → straining → irritation and swelling → more difficult or uncomfortable bowel movements → more straining.

2. Anal Fissures Can Occur

If stool is firm, large, or difficult to pass, forcing it through the anal canal may overstretch and injure the delicate tissue around the anus.

A small tear, called an anal fissure, can develop.

Anal fissures may cause sharp pain during a bowel movement, burning afterward, and sometimes bright red blood.

The pain can become severe enough that a person begins delaying bowel movements.

But delaying can allow stool to become harder and more difficult to pass.

Again, a cycle can develop:

Pain → delaying bowel movements → harder stool → more force needed → more pain.

3. The Pelvic Floor Is Repeatedly Placed Under Pressure

The pelvic floor supports the rectum, bladder, reproductive organs, and other structures within the pelvis.

Every time you bear down forcefully, pressure is transmitted downward onto these tissues.

Occasional pressure is part of normal body function.

But repeatedly straining for prolonged periods places much greater stress on the pelvic floor.

This can be particularly important for people whose pelvic floor support has already been affected by pregnancy, childbirth, aging, previous pelvic surgery, chronic constipation, or other factors.

4. Pelvic Organ Prolapse May Be Worsened

In women, weakened pelvic support can allow pelvic organs to descend from their normal position.

This is known as pelvic organ prolapse.

Chronic straining is one of several factors associated with increased stress on pelvic support structures.

Depending on which structures are affected, a person may experience:

• Pelvic pressure or heaviness
• A bulging sensation
• Urinary symptoms
• Difficulty emptying the bowel
• The sensation that stool is trapped

This creates an especially important problem:

Difficulty evacuating can cause a person to strain, while changes in pelvic support can themselves make evacuation more difficult.

5. Rectal Prolapse Can Be Associated With Chronic Straining

With rectal prolapse, part of the rectum moves downward and may eventually protrude through the anus.

Rectal prolapse usually has multiple contributing factors, but long-term constipation and repeated straining are recognized risk factors.

Early symptoms may include a feeling of incomplete emptying, pressure, mucus leakage, or tissue appearing during bowel movements.

Repeatedly pushing harder is not an appropriate solution when these symptoms are present.

6. Straining May Aggravate Hernias

Forceful bearing down increases pressure throughout the abdomen.

A hernia does not usually result from one difficult bowel movement. However, repeated increases in abdominal pressure may place additional stress on an already weakened area of the abdominal wall.

For someone who already has a hernia or is susceptible to one, chronic straining may aggravate symptoms.

7. Straining Also Affects the Cardiovascular System

The effects of forceful straining are not limited to the bowel.

When you hold your breath and bear down strongly, pressure inside the chest changes. This temporarily alters blood returning to the heart and can cause changes in heart rate and blood pressure.

Most healthy people tolerate brief straining.

But repeatedly holding the breath and straining forcefully for prolonged periods can be more concerning for older adults and people with certain cardiovascular conditions.

Dizziness, fainting, chest pain, or severe shortness of breath during a bowel movement should not be ignored.

What If You Have the Urge but Still Cannot Empty Easily?

This is an important question.

If you clearly feel the need to have a bowel movement but regularly need substantial effort to get stool out, the problem may not simply be that you are “not pushing hard enough.”

Possible contributing factors include:

• Stool that is too hard, dry, or bulky
• Incomplete rectal evacuation
• Pelvic floor muscles that do not relax appropriately
• Poor coordination between abdominal pressure and pelvic floor relaxation
• Structural changes involving the rectum or pelvic floor
• Certain medications or medical conditions

Some people also describe a very specific sensation:

“I know it is there, but I just can't get it out.”

Others say:

“I can get some out, but I never feel completely empty.”

If this sounds familiar, learn more about   👉 Why Do I Feel Like I Can’t Fully Empty My Bowels?

These experiences deserve attention, especially when they happen regularly.

Taking Longer Does Not Necessarily Make the Bowel Movement Better

Many people respond to difficult evacuation by staying on the toilet longer.

Five minutes becomes 15 minutes.

Fifteen minutes becomes 30 minutes.

During that time, they may repeatedly push, stop, wait, and push again.

But prolonged toilet sitting combined with repeated straining continues to place pressure on the anorectal and pelvic tissues.

The fact that stool eventually comes out does not necessarily mean the process is healthy or efficient.

The Better Question Is Not “How Can I Push Harder?”

If you regularly have the urge to have a bowel movement but cannot empty without significant effort, pushing harder should not automatically become the long-term solution.

Instead, ask:

Why does my body need so much force to complete a bowel movement?

And:

Is there a gentler way to support bowel emptying while reducing unnecessary straining?

Adequate hydration, appropriate dietary fiber, regular physical activity, proper toilet positioning, and healthy bowel habits may help many people.

For persistent difficulty, a healthcare professional can also evaluate whether stool consistency, medications, pelvic floor dysfunction, structural problems, or another medical condition may be contributing.

• 👉 How to Poop Without Straining

Bowel Movements Should Not Require a Workout

Having the urge to go is only the beginning.

Ideally, bowel evacuation should occur without prolonged breath-holding, repeated forceful pushing, or spending excessive amounts of time sitting on the toilet.

If every bowel movement feels like a physical workout, it may be time to stop thinking only about getting the stool out at any cost and start thinking about how to make evacuation easier and gentler on the body.

At EaseFlow®, this is an important part of how we think about bowel care:

Less unnecessary straining. More comfortable bowel care.

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Let’s Flow it Easy!

👉 Explore our complete Constipation Relief Guide to learn more about gentle, effective solutions.       

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Medical Disclaimer

This article is provided for general educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Difficulty with bowel movements can have many causes. Persistent constipation, rectal bleeding, significant pain, unexplained weight loss, new or worsening changes in bowel habits, or persistent difficulty emptying the rectum should be evaluated by a qualified healthcare professional.