Can Stress Cause Hemorrhoids? An Expert Describes How
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
December 13, 2023

Clinical evidence suggests that there is a strong relationship between stress and a negative effect on your physical, emotional, and mental health.

Specifically, increased stress can cause hemorrhoids, but our current knowledge points to an indirect mechanism by which this occurs.

In other words, stress does not DIRECTLY cause hemorrhoids; rather, it starts a cascade of processes within our bodies that ultimately results in their formation.

What are hemorrhoids?

Hemorrhoids are swollen veins in the lower part of the anus and rectum.

They can affect up to 75% of people in the United States at some point in their lives.

There are four types of hemorrhoids:

  1. External hemorrhoids: These hemorrhoids are visible and felt outside the anus.
  2. Internal hemorrhoids: Internal hemorrhoids are inside the anal area and cannot be seen, and tend to be painless.
  3. Thrombosed hemorrhoids: These hemorrhoids can be internal or external, and the blood has collected inside clots. In the case of external hemorrhoids, these can be very painful.
  4. Prolapsed hemorrhoids: These can be very severe and painful forms of internal hemorrhoids. If mild, they protrude from the anus when straining. If severe, they remain protruding outside the anus.


The causes and symptoms of hemorrhoids

Common causes of hemorrhoids

Now that we’ve established the potential connection between anxiety and bowel problems, let’s focus on the specifics of hemorrhoids.

There are several different causes of hemorrhoids.

Pregnancy, constipation, heavy lifting, and straining during bowel movements can all contribute to the development of hemorrhoids.

Additionally, people who spend a lot of time sitting, such as truck drivers and office workers, may be at an increased risk of developing hemorrhoids due to the added pressure on the veins in the anus and rectum.

Hemorrhoid symptoms

The symptoms of hemorrhoids can vary, but common signs include rectal bleeding, itching, and pain or discomfort during bowel movements.

External hemorrhoids may also be visible as lumps or bumps outside the anus.

If you experience these symptoms, you must see a healthcare professional for an accurate diagnosis and treatment plan.

So, can anxiety cause hemorrhoids? 

The answer is more complex.

While some evidence suggests that anxiety and other stressors can contribute to gastrointestinal issues, including hemorrhoids, more research is needed to understand the relationship between the two thoroughly.

In the next section, we’ll delve into the link between anxiety and digestive problems and how the gut-brain axis might play a role in this connection.

How does stress affect the gut-brain axis?

If you’ve ever felt a wave of butterflies in your stomach before a big presentation or an upset stomach after a particularly stressful day, you’re not alone.

It’s a common experience to have our emotional state reflected in our physical body. For many people, anxiety can manifest in the form of digestive issues.

But what’s behind this connection between anxiety and our guts?

There’s a complex communication network between the brain and the digestive system known as the gut-brain axis.

The gut-brain axis explainedgut brain axis

The gut-brain axis is the complex and bidirectional communication network between the gastrointestinal tract and the central nervous system.

This communication regulates various physiological and behavioral functions, including digestion, immunity, mood, and behavior.

One of the main ways that the gut and brain communicate is through the enteric nervous system, a network of neurons embedded in the gastrointestinal tract’s walls that controls the movement and secretion of digestive enzymes and hormones.

The enteric nervous system is sometimes called the “second brain” because it can function independently of the brain and spinal cord.

The gut and brain also communicate through various signaling pathways, including the autonomic nervous, endocrine, and immune systems.

For example, the gut produces and releases many hormones, such as serotonin, that can affect mood and behavior.

The gut microbiota, the community of microorganisms that live in the gastrointestinal tract, also plays a role in the gut-brain axis.

The gut microbiota produces several neurotransmitters and other signaling molecules that can influence brain function.

Disruptions in the gut-brain axis, such as those that can occur with certain gastrointestinal disorders or imbalances in the gut microbiota, can have many adverse effects on overall health, including digestive issues, mood disorders, and immune system dysfunction.

Hence, the gut-brain axis is a complex and essential system that is vital in maintaining overall health and well-being.

In the video below, Dr. Tracey Marks, a well-known and respected psychiatrist, explains the relationship between stress and stomach problems:

Examples of how stress can affect the digestive system

So, when we’re stressed or anxious, it can disrupt this delicate balance and cause problems like stomach cramps, diarrhea, constipation, and more.

It’s worth noting that these issues can also be caused by other factors, such as diet and medical conditions, so it’s important to work with a healthcare professional to determine the root cause of your digestive issues.

But how might anxiety or stress contribute to the development of hemorrhoids specifically?

That’s a question that researchers are still trying to answer.

In the next section, we’ll look at current research on the potential link between anxiety and hemorrhoids and offer some possible explanations for how stress might play a role.

Can stress cause hemorrhoids?

Now we come to the million-dollar question: Can anxiety really cause hemorrhoids or hemorrhoid flare-ups?

Not directly. High levels of stress or anxiety may contribute to the development of hemorrhoids or exacerbate existing hemorrhoids.

I will expand more on this theory in the section below.

A 2014 review of clinical studies published in the World Journal of Gastroenterology found an association between high stress levels and the development of constipation and irritable bowel syndrome (IBS).

Constipation, in turn, leads to the development of hemorrhoids because it puts additional strain on the blood vessels in the anus and rectum and potentially lead to the development of hemorrhoids.

Additionally, anxiety may cause people to engage in behaviors that put added pressure on the veins in the anus and rectum, such as straining during bowel movements or avoiding the bathroom due to social anxiety.

Limitations of current research on this topic

It’s worth noting that these studies are limited, and more research is needed to understand the relationship between anxiety and hemorrhoids fully.

It’s also important to remember that anxiety is just one potential factor in the development of hemorrhoids, and other factors, such as diet and lifestyle, may also play a role.

Treatment of Hemorrhoids

Hemorrhoids can be painful and inconvenient, but fortunately, several treatment options are available. Here’s a closer look at how hemorrhoids are typically treated:

Lifestyle changes

Changing your diet and lifestyle can help mitigate the stress response, prevent constipation, and reduce the pressure on the veins in the anus and rectum.

Positive changes can include:

  • Dietary changes – eating a high-fiber diet (fresh fruits, vegetables, legumes, grains, etc)
  • Making sure to drink enough water
  • Exercising regularly
  • Avoiding straining during bowel movements

Over-the-counter medications

There are many over-the-counter products and home remedies available that can help to reduce the symptoms of hemorrhoids.

These include creams, ointments, and suppositories that relieve hemorrhoid pain and itching.

One particularly effective hemorrhoid treatment is the use of sitz baths:

Sitz bath

A sitz bath is a type of hydrotherapy involving warm water to help alleviate discomfort and promote healing.

It can be an effective treatment option for hemorrhoids because it can help to reduce swelling and inflammation, as well as provide relief from pain and discomfort.

To use a sitz bath for hemorrhoids, you’ll need a shallow tub or basin that fits over the toilet.

You can purchase a Sitz bath kit at a pharmacy or online or use a small plastic tub or basin from home.

Fill the tub with warm water, making sure the water covers the anal opening.

For added benefits, you may also add Epsom salt or baking soda to the water.

Sit in the tub for about 15-20 minutes, submerging the affected area in the water.

You can do this several times a day or as your healthcare provider recommends.

After the Sitz bath, pat the area dry and apply a cream or ointment to help soothe the skin.

It’s important to note that Sitz baths are just one treatment option for hemorrhoids and may not be suitable for everyone.

If you find that the Sitz bath is not working for you, consulting with a healthcare professional for a more individualized treatment plan is always a good idea.

They can help you determine the best treatment plan for your needs.

Another effective treatment is the use of witch hazel:

Witch Hazel

Witch hazel is a plant native to North America that has been traditionally used to treat various ailments, including hemorrhoids.

It is believed to have astringent and anti-inflammatory properties, which may be beneficial for reducing the swelling and discomfort associated with hemorrhoids.

Witch hazel is usually applied topically as a cream, ointment, or suppository.

It is important to follow the instructions on the product label and only to use witch hazel as directed.

To prevent the passing of hard stools and straining, which can worsen hemorrhoid symptoms, you can use an OTC stool softener such as docusate (Brand name Colace).

Prescription medications

Sometimes, your healthcare provider may prescribe medications to help reduce swelling and inflammation.

These may include corticosteroids or other types of medication.


In more severe cases, your healthcare provider may recommend a surgical procedure to remove the hemorrhoids.

Several types of procedures are available, including rubber band ligation, which involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, and surgical removal of the hemorrhoids.

It’s important to note that the best treatment option for you will depend on your hemorrhoids’ severity and circumstances.

Your healthcare provider can recommend the most appropriate treatment plan for your needs.

How to prevent hemorrhoids

So, what can you do to manage anxiety and potentially reduce your risk of developing hemorrhoids?

Here are a few tips:

  1. Safeguard your emotional health – Practice stress-reducing techniques such as meditation, yoga, or deep breathing.
  2. Get regular exercise: Physical activity can help to reduce stress and improve overall physical health, but go easy on lifting heavy objects.
  3. Incorporate fiber supplements, such as my go-to product, Supergut’s  Prebiotic Fiber mix.
  4. Eat a healthy diet: A diet high in fiber and fluids can help to prevent constipation, a common cause of hemorrhoids.
  5. Manage your time effectively: Avoid overcommitting and prioritize self-care to reduce stress.
  6. Don’t ignore the problem: If you’re experiencing symptoms of anxiety or hemorrhoids, don’t be afraid to seek help from a healthcare professional. They can identify the underlying cause and help you develop a treatment plan to manage your symptoms.


To summarize, some evidence suggests that anxiety may contribute to the development of hemorrhoids.

Still, more research is needed to understand the relationship between the two entirely.

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