Anal Sex and Hemorrhoid Risk
No, anal sex does not increase the risk of developing hemorrhoids. The presence of hemorrhoids does not appear to be caused by anal intercourse according to high-quality guideline evidence.
Evidence Against Anal Sex as a Hemorrhoid Risk Factor
The ESMO (European Society for Medical Oncology) clinical practice guidelines explicitly state that "dietary habits, chronic inflammatory diseases and the presence of haemorrhoids do not appear to predispose to epidermoid anal cancer," and importantly, while anal intercourse increases HPV infection risk, hemorrhoids themselves are not listed among the risk factors associated with anal intercourse. 1
The guidelines clearly distinguish between conditions caused by anal intercourse (HPV infection leading to anal cancer) versus conditions not caused by it (hemorrhoids). 1
What Actually Causes Hemorrhoids
The pathophysiology of hemorrhoids involves:
- Abnormal swelling of anal cushions with stretching of suspensory muscles and dilation of the submucosal arteriovenous plexus 2
- Elevated anal resting pressure (though causality remains unclear) 2
- Commonly cited but unproven risk factors include: constipation, diarrhea, inadequate fiber intake, prolonged toilet sitting, and chronic straining—none rigorously proven despite widespread clinical belief 2
Established Contributing Factors
The American Gastroenterological Association emphasizes that rigorous proof for most commonly believed risk factors is lacking. 2
Proven associations include:
- Pregnancy (affects ~80% of pregnant persons, primarily third trimester) 2
- Constipation and straining (though not rigorously proven, consistently associated) 3, 4
- Increased intra-abdominal pressure and prolonged straining 4
Clinical Pitfall to Avoid
Do not confuse anal intercourse as a hemorrhoid risk factor with its well-established role as an HPV transmission route. Anal intercourse increases risk of persistent HPV infection leading to anal cancer (35 per 100,000 in MSM, 75-135 per 100,000 in HIV+ MSM), but this is an entirely separate pathophysiologic process from hemorrhoid formation. 1