Straining to Poop? Heres what that Can Do to Your Butt

By Rozalynn S. Frazier, C.P.T. and Zahra Barnes

Medically reviewed by Rachel Issaka, MD, MAS

“Almost everyone experiences the feeling of having a hard time having a bowel movement,” Alex Sherman, MD, board-certified gastroenterologist at Vanguard Gastroenterology and a clinical professor at NYU Grossman School of Medicine, tells ishonest.

While that piece of information won’t exactly make you feel better when you’re stuck on the toilet, it should reassure you that straining to poop isn’t necessarily concerning. In fact, if it happens every once in a while, you’re likely okay and things can often be resolved with something as simple as increasing the fiber intake in your diet.

Straining to poop causes | What happens if you strain too hard while pooping? | What to do if you’re straining to poop | When to see your doctor

First, let’s talk about why you’re straining to poop.

“Someone sits down and they are trying to push, push, push—that’s really what straining is,” Felice Schnoll-Sussman, MD, professor of clinical medicine and director of the Jay Monahan Center for Gastrointestinal Health at Weill Cornell Medicine, tells ishonest.

People can strain to poop for all sorts of reasons, but constipation is really the main cause of this. By definition, constipation symptoms include passing hard, dry stools, having fewer than three bowel movements a week, or feeling like you haven’t really gotten everything out (if you know what we mean), according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

It’s important to understand that people poop at different frequencies, so pooping less than three times a week doesn’t always mean you’re constipated. For example, one person may poop twice a week for as long as they can remember and feel completely fine. “There is no rulebook for how often someone should go to the bathroom,” Dr. Schnoll-Sussman says. “The only time we are concerned is when there is a significant change for you.” If you’re frustrated because it feels impossible to poop and nothing comes out, then that’s also a problem.

So, then, what causes constipation? A number of things, but dietary habits are a big contributor to this particular problem, Shilpa Ravella, MD, assistant professor of medicine at Columbia University Medical Center, tells ishonest. “I see a lot of patients coming in who have way too little fiber in their diets. That can lead to hard stools and constipation that can cause people to strain a lot when they go to the bathroom,” Dr. Ravella says.

That’s why constipation treatment typically includes eating more fiber-rich food, which adds weight to your stool and helps it stay soft, making it easier to pass. Drinking more fluids than you’re currently getting and increasing your physical activity can also help move stool through your digestive tract, according to Johns Hopkins Medicine.

Some medications, including things like blood pressure drugs, opioids, antacids, and antidepressants, can also cause constipation, according to Dr. Ravella. And finally, constipation can be a symptom of certain medical conditions like irritable bowel syndrome (IBS) and celiac disease.

Your body mechanics might also explain why you’re straining to poop. There are two sphincter muscles in the rectum (the inner and the outer sphincter) that assist with bowel movements.1 The inner sphincter is controlled involuntarily, meaning your brain tells that muscle it’s time to relax (so you can poop) when your rectum is full. Your outer sphincter is a muscle that you knowingly control. And some people may not have good control over the outer sphincter, so they tense their muscles, holding poop in when they should really be relaxing that muscle to let poop out.2 This can make you feel like you’ve never really emptied everything in your bowels.

What happens if you strain too hard while pooping?

Not only is straining to poop super uncomfortable on its own, but it can cause a number of health issues that can make you feel worse. Here are some common problems that may arise if you’re frequently having a hard time going:

Straining to poop is one of the prime causes of hemorrhoids, which are piles of bulging veins that can be internal (nestled inside the rectum) or external (under the skin around your anus), according to the Mayo Clinic. When you strain to poop, the veins in your butt can swell and bulge, kind of like how a bodybuilder’s veins bulge when they’re lifting weights, Dr. Schnoll-Sussman says. “Bodybuilders push up the weights and you see the veins popping out in their necks or temples—that is exactly what can happen in our anus, resulting in hemorrhoids,” she says. If those hemorrhoidal veins get really big and you start to pass hard bowel movements, your poop can nick a blood vessel, resulting in some bleeding, according to Dr. Schnoll-Sussman. Pregnancy is another common hemorrhoid cause, partially because being pregnant can cause constipation, and partially because your growing uterus can lead to more pressure in your lower body, including your anus. Voilà , hemorrhoids.

So how do you know if you have hemorrhoids? Hemorrhoids can be asymptomatic, meaning you might not know. Other times, hemorrhoids can cause symptoms like itching, discomfort, anal swelling, and bleeding, which can make it hard to poop, according to the Mayo Clinic.

These are little wounds that can feel like paper cuts on your butt (*cringe*). Anal fissures typically arise when you have to work too hard to pass large, hard stools. They can also happen due to chronic diarrhea or conditions like Crohn’s disease or ulcerative colitis since spending what feels like ages on the toilet can irritate your anal mucosa, especially if you’re using rough toilet paper or one that has a fragrance.

Anal fissures can be painful, itch, bleed, or feel irritated, according to the Mayo Clinic. Luckily, they tend to heal on their own, but if it hurts to poop for a few weeks, you might need to seek medical treatment. Your doctor can prescribe a cream with lidocaine or another anesthetic to relieve the pain until the tiny tear heals. And if you have chronic anal fissures, you may need to discuss other treatment options like nitroglycerin creams to increase blood flow and speed healing or even surgery in severe cases.

In some cases, straining to poop can lead to a condition called rectal prolapse. 3 This happens when you push so hard that your rectum drops through your anus, Dr. Schnoll-Sussman says. If this happens, you may have pain in your anus or rectum, feel a bulge in your anal area, notice blood in your stool, or have trouble controlling your bowel movements, according to the Cleveland Clinic. Generally, surgery is necessary to repair the prolapse.

There’s a very small possibility you could pass out on the pot. Losing consciousness while straining to poop is called defecation syncope, which is a kind of fainting that happens when your body overreacts to certain stimuli, according to the Mayo Clinic. “Basically, your blood pressure drops, and you can’t maintain the blood pressure to your brain, and you can pass out on the toilet,” Dr. Schnoll-Sussman says. Some people lose consciousness while other people only feel like they might pass out, David Poppers, MD, PhD, gastroenterologist and clinical professor of medicine at NYU Langone Health, tells ishonest. Before you panic, know two things: This is less likely to happen in otherwise healthy young people than in older people, and even if it does happen, it doesn’t automatically mean something foreboding about your health.

What to do if you’re straining to poop

If you have chronic constipation that’s not related to medications you take or medical conditions that you’re aware of, then reviewing your fiber intake is a good place to start. People assigned female at birth between the ages of 19 and 30 should aim for at least 28 grams of fiber per day, according to the United States Department of Agriculture’s Dietary Guidelines.4 That number drops to 25 grams per day for people assigned female at birth who are between the ages of 31 to 50. Some good sources of fiber include fruits, vegetables, legumes, and whole grains, according to the Mayo Clinic.

As you increase your fiber intake, be sure to stay hydrated, Dr. Poppers says. Going all-in on fiber without sufficient hydration can lead to issues like bloating, gas, diarrhea, and the very constipation you might be trying to fix.

If you’re straining to poop, Dr. Schnoll-Sussman recommends keeping a stool diary (yes, for real) to better understand your bowel movements. This also comes in handy so you can talk to your doctor about your symptoms if you decide to seek treatment. She recommends tracking your answers to a few key questions each day if you can:

• How often do I go to the bathroom?
• What do my bowel movements look like?
• How do I feel when I don’t have a bowel movement?
• What am I eating?
• How much water am I drinking each day?
• How much am I exercising?

You may notice that you’re not really eating as much fiber as you think. Or you could find that you go to the bathroom more frequently when you exercise regularly. If changing your habits doesn’t do the trick, then it might be time to schedule a doctor’s appointment to see if there’s something else going on, such as IBS, IBD, or even a food allergy or intolerance. Or if you take prescription medications that can cause constipation, you’ll want to talk to your doctor about the best way to deal with that.

When to see a doctor if you’re frequently straining to poop

When lifestyle changes don’t help, it may be time to see your primary care doctor or a gastroenterologist to help determine the cause of your constipation. Depending on your particular situation, your doctor might run a few tests to determine if you have an underlying medical condition, causing your gastrointestinal distress. For example, you might take a blood test to rule out a food-related condition like celiac disease. Or if your doctor suspects you have trouble controlling your outer sphincter muscle, then you might have an anorectal manometry test, which involves inserting a tube into your anus to test that muscle, according to the Cleveland Clinic.

If you have any straining-related complications that don’t heal on their own, like rectal prolapse, it’s really important to get checked out by a doctor so you can get treatment and avoid possible complications.

Generally, it’s safest to see your doctor if you are having any form of consistent rectal bleeding, according to Dr. Poppers. “It’s always a good idea to contact your doctor if you have any unexpected change in bowel habits and certainly any rectal bleeding—even a small volume—if that’s not typical for you or otherwise explained by a prior diagnostic workup,” he says.

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Further, if your bleeding is recurrent and you have other symptoms, such as nausea and dizziness, or if there’s a lot of blood in your stool, Dr. Schnoll- Sussman recommends getting an evaluation immediately. “You could be potentially having a life-threatening bleed that could happen for many, many different reasons,” she says. “It could be a sign of colon cancer. It could be a sign of inflammatory bowel disease. It could be a sign of some abnormal blood vessels in the colon.”

All of that said, having a small amount of blood on your toilet paper might indicate you have hemorrhoids or anal fissures, which can typically be treated easily, Dr. Schnoll-Sussman says. If you really think you just pushed too hard and have hemorrhoids, you can try at-home treatments before going to the doctor. Hemorrhoids can be pretty responsive to over-the-counter creams, an ice pack, soaking in a sitz bath, or using a suppository with corticosteroid creams to alleviate pain and swelling. But if they don’t clear up, then you may need to schedule an appointment with your doc.

Bottom line: Many people strain to poop at some point, but it’s worth seeing a doctor if it’s bothering you. And there’s no need to feel bashful about the situation either. Again, pooping is part of human nature, which means constipation is, too. “Gastrointestinal symptoms are very common,” Dr. Poppers says. “There’s nothing to be embarrassed about.” Plus, gastroenterologists are so fascinated by the digestive system they spent years in medical school just to learn more about it. Your poop problems will be nothing new to them.

1. Institute for Quality and Efficiency in Health Care, How do Bowel Movements Work?
2. UNC School of Medicine, Chronic Constipation
3. Clinics in Colon and Rectal Surgery, Rectal Prolapse
4. Dietary Guidelines for Americans, 2020-2025