Can hemorrhoids cause difficulty defecating or altered stool habits?

From the Guidelines

Hemorrhoids can indeed cause difficulty defecating and altered stool habits due to physical obstructions and pain during bowel movements. Hemorrhoids are swollen blood vessels in the rectum and anus that can lead to straining, incomplete evacuation, and changes in stool patterns. External hemorrhoids may cause pain and discomfort during defecation, while internal hemorrhoids can prolapse and interfere with normal bowel function. Patients often report constipation as they may avoid bowel movements due to pain, or experience a sensation of blockage. Alternatively, some may develop looser stools that pass around the hemorrhoidal tissue. Blood on toilet paper or in the bowl is another common symptom that may accompany these changes.

Key Points to Consider

• The pathogenesis of enlarged, prolapsing cushions is unknown, but factors such as inadequate fiber intake, prolonged sitting on the toilet, and chronic straining at stool may contribute to the development of symptomatic hemorrhoids 1.
• Multiple studies have shown elevated anal resting pressure in patients with hemorrhoids when compared with controls, which may be caused by or due to enlarged hemorrhoids 1.
• Treatment options include increasing fiber intake to 25-30 grams daily, drinking plenty of water, using over-the-counter creams containing hydrocortisone for temporary relief, and warm sitz baths for 10-15 minutes several times daily.
• Non-operative management as first line therapy, with dietary and lifestyle changes, is recommended for patients with complicated hemorrhoids, along with the administration of flavonoids to relieve symptoms 1.

Recommendations for Management

• Increase fiber intake to 25-30 grams daily and drink plenty of water to soften stool and reduce straining during bowel movements.
• Use over-the-counter creams containing hydrocortisone for temporary relief of pain and discomfort.
• Take warm sitz baths for 10-15 minutes several times daily to help reduce pain and discomfort.
• Consider the use of flavonoids to relieve symptoms, as suggested by recent guidelines 1.

From the Research

Haemorrhoids and Defecation Difficulty

• Haemorrhoids can cause difficulty defecating or altered stool habits, as suggested by a study published in 2005 2, which found that patients with hemorrhoids reported excessive straining, feeling of incomplete evacuation, and repeated toilet visits.
• Another study from 2020 3 found a linear association between the time spent on the toilet and the degree of haemorrhoids, suggesting that prolonged toilet habits may contribute to the development of haemorrhoids.
• However, a study from 1994 4 notes that constipation and abnormal bowel habit are commonly blamed for haemorrhoidal disease, despite largely contrary evidence.

Altered Stool Habits

• A study published in 2005 2 found that patients with hemorrhoids reported altered stool habits, including bloating, abdominal pain associated with bowel evacuation, and reduced feeling of well-being.
• Another study from 1988 5 found that patients with haemorrhoids did not necessarily have constipation, but tended to have abnormal anal pressure profiles and anal compliance.
• A study from 1975 6 found that treatment of haemorrhoids by rubber band ligation can lead to symptoms such as moderate pain with a sense of incomplete evacuation in the rectum, and some frequency of call to stool lasting up to 7 days.

Relationship between Haemorrhoids and Bowel Habits

• The study from 2005 2 suggests that patients with hemorrhoids may have concomitant functional bowel symptoms, possibly associated with irritable bowel syndrome.
• The study from 2020 3 suggests that modification of toilet habits may be advised as a part of treatment and preventive measure for patients with haemorrhoids.
• The study from 1994 4 notes that the exact pathophysiology of haemorrhoidal disease is poorly understood, and further research is needed to understand the relationship between haemorrhoids and bowel habits.