Hemorrhoids can contribute to incontinence, but usually not in the way you might think
Hemorrhoids themselves do not directly cause loss of bladder or bowel control. However, they can create conditions that make incontinence worse or trigger it in specific situations. The connection depends on the type of hemorrhoid, where it is located, and what else is happening in your pelvic floor.
Internal hemorrhoids (inside the rectum) rarely affect continence directly. External hemorrhoids (under the skin around the anus) can cause problems differently: they may weaken the anal sphincter through repeated straining, inflammation, or surgery to remove them. If you have hemorrhoids and are experiencing leakage, the hemorrhoids may be part of the picture, but other factors are usually involved too.
Key Takeaways
- Hemorrhoids do not cause incontinence on their own, but chronic straining to have bowel movements can weaken the muscles that control continence.
- Surgery to remove hemorrhoids carries a small risk of damaging the anal sphincter, which can lead to fecal incontinence afterward.
- Hemorrhoids and incontinence often share the same root cause—chronic constipation or straining—rather than one causing the other.
- If you have both hemorrhoids and incontinence, treating the constipation or straining usually helps both conditions.
How straining for bowel movements weakens continence control
The real link between hemorrhoids and incontinence is chronic straining. When you strain repeatedly to pass stool, you put pressure on the anal sphincter—the ring of muscle that holds stool in. Over time, this muscle can weaken or become damaged.
Hemorrhoids develop for the same reason: straining increases pressure in the veins around the anus, causing them to swell. So if you have hemorrhoids, you have likely been straining. That same straining is what can eventually lead to fecal incontinence (leakage of stool or mucus).
The longer the straining continues, the greater the risk. Someone with hemorrhoids for years may gradually notice they cannot hold stool as well as they used to, especially during coughing, sneezing, or physical activity. This is not the hemorrhoid itself causing the problem—it is the years of strain on the sphincter muscle.
Hemorrhoid surgery and incontinence risk
If you have hemorrhoids removed surgically, there is a small but real risk of developing fecal incontinence afterward. Procedures like hemorrhoidectomy (surgical removal) or stapled hemorrhoidopexy (stapling internal hemorrhoids) can damage the anal sphincter or the nerves that control it.
The risk is higher with hemorrhoidectomy than with less invasive procedures like rubber band ligation or infrared coagulation. Studies show that about 1 to 5 percent of people who have hemorrhoidectomy report some degree of fecal incontinence in the months or years after surgery, though most cases are mild.
Before agreeing to surgical removal, ask your surgeon about the incontinence risk and whether a less invasive option might work for your situation. Many hemorrhoids can be managed without surgery through diet, hydration, stool softeners, and treating constipation.
When hemorrhoids and incontinence share the same cause
Chronic constipation is the most common cause of both hemorrhoids and incontinence. When stool is hard and difficult to pass, you strain. Straining causes hemorrhoids. Straining also weakens the sphincter over time, leading to incontinence.
Other shared causes include pregnancy (which increases pressure in the pelvic area and weakens pelvic floor muscles), aging (both muscles and blood vessels weaken), and conditions like inflammatory bowel disease that affect the entire digestive tract.
If you have both conditions, the first step is usually to address constipation: increase water intake, eat more fiber, move your body regularly, and use stool softeners if needed. Reducing straining often improves both the hemorrhoids and the incontinence, because you are treating the root problem rather than just the symptoms.
Internal versus external hemorrhoids and incontinence risk
Internal hemorrhoids sit inside the rectum, above the sphincter muscle. They rarely damage the sphincter directly because they are not in contact with it. However, internal hemorrhoids can bleed or leak mucus, which some people confuse with fecal incontinence.
External hemorrhoids are under the skin at the anal opening, very close to the sphincter. Repeated inflammation, itching, and the urge to scratch can irritate the sphincter area. Severe external hemorrhoids or their surgical removal carry a higher risk of sphincter damage than internal hemorrhoids do.
If you have internal hemorrhoids and are experiencing incontinence, the hemorrhoids are probably not the cause. Look instead at constipation, pelvic floor weakness, or other factors. If you have external hemorrhoids, the connection is more likely, especially if you have been straining for years.
What to do if you have both hemorrhoids and incontinence
Start by seeing your primary care doctor or a gastroenterologist. They can examine you, confirm what type of hemorrhoids you have, and rule out other causes of incontinence like pelvic floor dysfunction, nerve damage, or inflammatory bowel disease.
If constipation is the problem, treatment is straightforward: dietary fiber (from food or supplements), adequate water, regular physical activity, and sometimes a stool softener like docusate. Avoid straining—if stool does not come easily, stop and try again later rather than pushing hard.
If the incontinence persists after you treat the constipation, ask for a referral to a pelvic floor physical therapist. They can assess whether your sphincter muscle is weak and teach you exercises to strengthen it. This is often more effective than surgery and works for both hemorrhoid-related and non-hemorrhoid-related incontinence.
When to see a specialist
See a colorectal surgeon or gastroenterologist if hemorrhoids are painful, bleeding heavily, or not improving with conservative treatment. They can discuss whether you need a procedure and what the risks are for your specific situation.
See a urogynecologist or pelvic floor specialist if incontinence is new or worsening, especially if it happens during activities like coughing or exercise. They can determine whether the incontinence is related to the hemorrhoids, pelvic floor weakness, or something else entirely.
If you are considering hemorrhoid surgery and are concerned about incontinence risk, ask your surgeon about their complication rates and whether a less invasive option is available. Getting a second opinion is reasonable when surgery carries the risk of a new problem.
Frequently Asked Questions
Can internal hemorrhoids cause fecal incontinence?
Internal hemorrhoids rarely cause fecal incontinence directly because they are above the sphincter muscle. However, if you have been straining for years to manage internal hemorrhoids, that chronic straining can weaken the sphincter. The hemorrhoids themselves are not the cause—the straining is.
Will my incontinence go away if I treat my hemorrhoids?
If the incontinence is caused by straining related to constipation, treating the constipation usually helps both conditions. If the incontinence is from sphincter damage that happened years ago, treating the hemorrhoids alone may not fix it. A doctor can help determine whether the two are connected in your case.
Is hemorrhoid surgery safe if I already have incontinence?
Surgery carries a small risk of making incontinence worse by further damaging the sphincter. Tell your surgeon about your incontinence before the procedure. They may recommend a less invasive option or want to assess your sphincter strength first with a test called anorectal manometry.
What is the difference between hemorrhoid bleeding and fecal incontinence?
Hemorrhoid bleeding is bright red blood on toilet paper or in the bowl, usually during or right after a bowel movement. Fecal incontinence is leakage of stool or mucus that happens without your control, often during coughing, sneezing, or physical activity. They are different problems, though someone can have both.
Can pelvic floor exercises help if hemorrhoids caused my incontinence?
Yes. Pelvic floor physical therapy can strengthen the sphincter muscle whether the weakness came from hemorrhoid straining, surgery, or another cause. A pelvic floor therapist can teach you the right exercises and monitor your progress over several weeks.