Why haemorrhoids develop: the main risk factors

2026-10-09

• The main causes of haemorrhoids are constipation, straining and sitting on the toilet for too long.
• Too little fibre and water, desk work, heavy lifting, excess weight, pregnancy and age all raise the risk.
• Cold seats and spicy food do not cause haemorrhoids by themselves, though spicy food can worsen burning.
• Many factors can be changed: fibre, water, movement and relaxed toilet habits.
• Show any bleeding from the back passage to a doctor; heavy bleeding needs urgent help.

Many people believe haemorrhoids come from sitting on a cold bench or are the price you pay for loving spicy food. In reality, they have a far more everyday origin: what matters most is how we eat, how we go to the toilet and how much we move during the day.

The good news is that most causes of haemorrhoids are linked to habits, which means you can do something about them. Let's go through the main risk factors, separate them from the myths and see what you can change today.

What happens in the body when haemorrhoids develop?

Everyone has haemorrhoidal cushions in the anal canal: soft pads full of blood vessels that help keep the bowel contents in. Fine ligaments and connective tissue hold them in place.

When pressure in the abdomen and the anal canal rises often and for long periods, blood pools in the cushions, they swell, and the supporting tissues gradually stretch. The cushions start to slide downwards, are easily damaged and bleed. That is why almost all causes of haemorrhoids come down to two things: raised pressure and weakened supporting tissue.

Why are constipation and straining considered the main cause of haemorrhoids?

Hard stools make you strain, and every bout of straining sharply raises the pressure in the haemorrhoidal cushions. If this happens day after day, they gradually enlarge. Constipation sets in more easily when your diet is low in fibre and water, when you move little and when you hold on for a long time instead of going to the toilet, for example on a hectic morning or on a journey without a decent toilet.

The opposite is unhelpful too: frequent loose stools also irritate the anal canal and can make symptoms worse. And sitting on the toilet for a long time scrolling on your phone increases blood flow to the cushions, even if you are not straining.

How diet affects your bowels

A typical table full of flatbread, meat and pastries, with few vegetables, especially in winter, is a common recipe for constipation. Fibre holds water in the bowel and makes stools softer. According to a systematic review, adding fibre reduces bleeding and other symptoms of haemorrhoids. Good sources of fibre include:

• vegetables and fresh herbs with every meal;
• pulses: mung beans, chickpeas, beans and lentils;
• fruit and dried fruit such as apricots, prunes and figs;
• wholegrain bread and porridge.

Fibre needs water. Tea at the dastarkhan is part of our life, but it does not replace plain water through the day.

How do desk work and heavy lifting affect haemorrhoids?

Long hours behind the wheel or at a computer slow down blood flow in the pelvis and the work of the bowels. Intercity taxi drivers, office workers and programmers often notice the first symptoms during busy periods. Short walking breaks every hour or hour and a half are a simple and effective step; you will find ready-made exercises in our article on leg exercises at your desk.

Lifting heavy loads while holding your breath raises abdominal pressure in the same way as straining on the toilet. This applies to market porters and cart-pushers, builders and anyone who lifts heavy weights at the gym. You don't need to give up sport: the key is to breathe out on the effort and not hold your breath.

Excess weight also keeps abdominal pressure constantly higher and is considered one of the risk factors.

Pregnancy, childbirth and age: who else is at risk?

During pregnancy the growing womb presses on the pelvic veins, hormones relax the vessel walls and constipation becomes more common. Childbirth itself, with strong pushing, can also trigger a flare-up. We explained how pregnancy affects the veins in our article on why pregnancy and chronic venous disease are closely linked. During this time any medicine should only be taken on a doctor's advice.

With age the supporting tissues become less firm, which is why haemorrhoids are more common in middle-aged and older people. The role of heredity is debated, but reliable data are scarce: families may simply share eating habits and lifestyles.

Which myths about the causes of haemorrhoids don't hold up?

• 'You get haemorrhoids from sitting on something cold.' There is no scientific evidence for this. A cold stone is unpleasant, but it does not cause haemorrhoids.
• 'Spicy food causes haemorrhoids.' There is no evidence that spicy food causes the condition by itself. During a flare-up, though, spicy dishes make burning worse for many people, so cutting back is sensible.
• 'It's an old person's disease.' Haemorrhoids occur in adults of all ages, including young people and pregnant women.
• 'Lifting something heavy once is enough.' One heavy bag can trigger a flare-up if the cushions are already enlarged, but the condition itself develops gradually through repeated straining.

How can you lower your risk of haemorrhoids today?

Most of these steps are simple and good for more than just your bowels:

1. Increase fibre gradually, over one or two weeks, to avoid bloating.
2. Drink enough water, especially in hot weather and as you add more fibre.
3. Don't hold on when you feel the urge to go, and don't strain as hard as you can.
4. Don't linger on the toilet: leave your phone outside and don't stay longer than a few minutes.
5. Move every day and take breaks if you work sitting down.
6. Lift heavy things properly: bend your knees, keep the load close to your body and breathe out as you lift.

When is it time to see a proctologist?

If you are already noticing blood on the paper, itching, discomfort or haemorrhoids slipping out, don't wait for the symptoms to get worse. We explained in detail how to recognise the condition early in our article on the early signs of haemorrhoids. Similar symptoms can occur with other bowel conditions, so an examination by a specialist is important.

The key points

The causes of haemorrhoids lie in everyday details: on your plate, in a glass of water, in how long we sit and how we go to the toilet. That means protection is in your hands too. Start with one step, such as a plate of vegetables at lunch and a short walk after work, and add the rest gradually. You will find more useful information in our article on the most important facts about haemorrhoids.

Sources: 1. van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22(6):650–662. 2. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2018;61(3):284–292. 3. Alonso-Coello P, Mills E, Heels-Ansdell D, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(1):181–188.

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