By Dr. Carmen Fong, MD, FACS, Chief Medical Officer at Bummed
As the Chief Medical Officer for Bummed, the first digital health platform dedicated to anorectal care, and someone who wrote a book on constipation (Constipation Nation) I can tell you that butt health and gut health are inherently linked I’ve seen again and again how bloating and constipation aren’t just uncomfortable issues in themselves.
Left unaddressed, they’re often the tipping point that leads to symptomatic hemorrhoids. Not all people who have constipation have hemorrhoids, and, in fact, plenty of people who have hemorrhoids don’t have constipation (diarrhea, pregnancy, and sitting too much are other factors), but, most people who have hemorrhoids have constipation as well. In this post, I want to explain exactly why that happens — and how we can break the cycle before it causes real damage.
The Anatomy of the Problem: How Constipation & Bloating Can Stress the Anus
A hemorrhoid isn’t a “new growth” — it’s a swelling or distension of the normal vascular cushions that lie just under the lining of the lower rectum and anus. We are all born with hemorrhoids. Under ideal conditions, these cushions help with continence and normal anorectal pressure regulation. (Harvard Health)
But when stool becomes hard, dry, or bulky — as often happens with constipation and irregular bowel habits — everything changes. Passing that stool usually requires straining. That straining sharply increases pressure in the lower rectum and anal veins, causing those cushions to become distended and engorged. Over time, repeated stress can cause them to bulge, prolapse, and become symptomatic hemorrhoids (painful, itchy, or bleeding). (mayoclinic.org)
Compounding the issue: bloating often means delayed emptying, gas-related distension, and inefficient bowel motility — all of which worsen constipation or make stool harder. Feeling bloated may also lead to more time spent on the toilet, trying to ‘get it out’ to relieve that bloated feeling.
More time on the toilet means– you guessed it– more pressure on your hemorrhoids. While bloating itself doesn’t directly cause hemorrhoids, it is a sign that the GI tract is not working optimally and has therefore created the ideal conditions for hemorrhoidal disease– the perfect storm, if you will.
Constipation & Chronic Hard Stools: A Well-Accepted Risk Factor for Hemorrhoids
Classic risk factors for hemorrhoids include chronic constipation, straining during bowel movements, prolonged sitting (especially on the toilet), low-fiber diets, and inadequate hydration. (mayoclinic.org)
Even in a large review of patients with hemorrhoids, researchers found chronic constipation (and its sequelae: hard/dry stool, straining, irregular bowel habits) to be significantly associated with hemorrhoidal symptoms. (PMC)
Thus, managing bowel consistency, frequency, and ease — which is the core of what we advocate at Bummed and in Constipation Nation— isn’t optional; it's foundational.
The Vicious Cycle: Hemorrhoids ↔ Constipation ↔ Bloating
One of the tougher truths in anorectal medicine is that hemorrhoids and constipation often feed off each other. Once hemorrhoids develop — especially external ones or prolapsed internal hemorrhoids — they can make passing stool painful or uncomfortable. That discomfort often leads patients to delay bowel movements, which worsens constipation and stool hardening. (Medical News Today)
Bloating, gas, and irregular bowel habits (common in conditions such as IBS) can further destabilize bowel habits and stool consistency — increasing the chance of repeated straining and hemorrhoidal exacerbations. (Healthline)
Left unchecked, this cycle can lead to recurrent hemorrhoid flares, chronic pain, bleeding, and even need for procedural or surgical intervention — something I see all too frequently in clinical practice and at Bummed, where we provide custom prescription treatments to patients nationwide.
Prevention Starts With Gut-Friendly Habits
If there's one point I hope readers take away from Constipation Nation, it's that hemorrhoid prevention isn’t a mystery. It’s discipline. It’s consistency. And it’s in the everyday — what you eat, how much water you drink, how you respond when your gut tells you to go, how you treat bloating, how you move your body. It’s the One Bowel Commandment — go when you have to go, and don’t go when you don’t (although bloating can confuse that equation!).
Here’s a practical roadmap:
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Prioritize fiber and hydration. Fiber (from fruits, vegetables, whole grains, legumes) softens and bulks stool. Coupled with adequate water, it reduces the need for straining. (mayoclinic.org)
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Respond promptly to bowel urges — don’t delay. Waiting can lead to harder stool and harder passage. (Nuvance Health)
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Address bloating and gas early. Gas, delayed transit, or disrupted motility often precede constipation. If you feel bloated consistently, think about diet (FODMAPs? fiber timing?), hydration, movement, or even gut-friendly probiotics and supplements, such as FODZYME.
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Avoid prolonged toilet sitting or straining. Spending long minutes on the toilet — especially straining — is a major contributor to hemorrhoid formation. (Temple Health)
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Stay active. Regular movement helps maintain healthy gut motility, reduces pressure on pelvic veins, and supports overall bowel regularity. (Harvard Health)
Call to Readers: Don’t Wait for Hemorrhoids to Go Away
Because hemorrhoids are common– and you’re born with them— many people believe hemorrhoidal disease is “just part of aging” or something to tolerate. But I argue that’s a dangerous mindset. Waiting until you have symptomatic hemorrhoids before paying attention to bowel habits is like waiting for a flooded basement before paying attention to failing gutters.
If you take steps now — optimize your fiber, hydration, bowel timing, manage bloating — you’re not just avoiding temporary discomfort. You’re protecting the integrity of your anorectal anatomy. You’re reducing the risk of recurring hemorrhoids, irritation, bleeding, and the cascade of interventions that often follow.
The bottom line is, managing bloating and constipation isn’t cosmetic, it’s preventative medicine. Your butt and gut will thank you.
And if all else fails, and you need some relief from hemorrhoidal symptoms, you can head to Bummed and check out our symptoms quiz, and a licensed medical provider will provide a prescription treatment that’s safe and effective for you.
