Yes, hemorrhoids can cause mild bowel incontinence, particularly when they’ve progressed to the point of prolapsing outside the anal canal. The leakage is usually minor, often described as soiling or finding unexpected material in your underwear, rather than a complete loss of bowel control. Understanding why this happens starts with the surprisingly important role hemorrhoidal tissue plays in keeping your anal canal sealed shut.
How Hemorrhoids Help Control Your Bowels
Most people think of hemorrhoids only as a problem, but the tissue they develop from, called anal cushions, is a normal and essential part of your anatomy. Your internal anal sphincter, the muscle that keeps the anal canal closed at rest, actually leaves a gap of 7 to 8 millimeters. Anal cushions fill that gap. When they’re healthy, they act like a plug, contributing roughly 15 to 20% of the pressure that keeps you continent. They also help you distinguish between gas and stool, which is why you can usually tell what’s waiting to come out without any conscious effort.
When hemorrhoids develop, those cushions become swollen and distorted. In early stages, this doesn’t affect continence much. But as hemorrhoids grow larger and begin to prolapse, the cushions can no longer form a reliable seal. The tissue that once filled the gap now bulges outward, leaving the anal canal partially open after a bowel movement.
What Hemorrhoid-Related Leakage Feels Like
The incontinence caused by hemorrhoids is typically mild. You might notice staining on your underwear, mucus discharge, or a feeling of wetness around the anus. It’s not the kind of dramatic loss of control that people usually picture when they hear “bowel incontinence.” Many people with this symptom describe it as soiling rather than full accidents.
Two specific things go wrong with prolapsed hemorrhoids. First, the swollen tissue physically prevents the anal canal from closing completely, so small amounts of stool or mucus can seep out. Second, the ability to sense what’s in the rectum becomes impaired. Normally, the lining of the anal canal can detect whether the contents are solid, liquid, or gas. Prolapsed hemorrhoids disrupt that sensory feedback, so you may pass gas expecting nothing else and find that some liquid stool came with it.
People with prolapsed hemorrhoids also commonly feel a sense of fullness in the rectum or a sensation that they haven’t completely emptied after a bowel movement. This can lead to repeated wiping or straining, which further irritates the tissue and worsens swelling.
Which Grades of Hemorrhoids Cause This
Internal hemorrhoids are classified into four grades based on how much they prolapse. Grade I hemorrhoids bleed but don’t protrude. Grade II hemorrhoids prolapse during straining but slide back in on their own. Grade III hemorrhoids prolapse and need to be manually pushed back in. Grade IV hemorrhoids are permanently prolapsed and can’t be reduced.
Leakage and soiling become a significant concern starting around grade III and IV, when the tissue is outside the anal canal often enough to prevent a proper seal. However, even grade II hemorrhoids can contribute to minor seepage in some people, particularly if the cushions are large. In a clinical survey involving a patient with daily soiling and blood loss, experts were split on grading: 45% classified the case as grade III, 43% as grade II, and 11% as grade IV. This overlap suggests that soiling isn’t exclusive to the most advanced cases.
External Hemorrhoids and Skin Tags
External hemorrhoids and the skin tags they leave behind can create a different kind of problem that mimics incontinence. Large skin tags around the anus make thorough cleaning after a bowel movement difficult. Stool residue gets trapped in the folds of skin, leading to moisture, itching, and staining that can look and feel like leakage even though the sphincter is working fine. This is sometimes called pseudoincontinence. It’s not a failure of bowel control but a hygiene challenge caused by excess tissue.
Nerve Damage and Hemorrhoids
There’s a deeper connection between hemorrhoids and continence that goes beyond the mechanical seal. The pudendal nerve, which controls the muscles responsible for bowel control, can show abnormal function in people with hemorrhoids. Chronic straining during bowel movements, which is both a cause and consequence of hemorrhoids, stretches this nerve over time. Prolonged pudendal nerve damage weakens the sphincter muscles themselves, potentially contributing to incontinence that persists even after hemorrhoids are treated.
This nerve involvement helps explain why some people with hemorrhoids experience leakage that seems disproportionate to the size of their hemorrhoids. The visible swelling may be only part of the picture, with underlying nerve and muscle changes playing a role.
Hemorrhoids vs. Rectal Prolapse
If you’re experiencing tissue protruding from the anus along with incontinence, it’s worth knowing that rectal prolapse can look very similar to prolapsed hemorrhoids but is a different condition requiring different treatment. The key visual difference: hemorrhoid tissue has folds that run in a radial pattern (like spokes of a wheel), while rectal prolapse produces circular, ring-like folds. Rectal prolapse involves the full thickness of the rectal wall telescoping through the anus, which causes more significant incontinence. If you’re unsure which you’re dealing with, a physical examination can distinguish the two.
How Treating Hemorrhoids Affects Continence
For most people, treating the hemorrhoids improves or resolves the leakage. Conservative approaches are the first step. Increasing your fiber intake and fluid consumption helps produce softer, bulkier stools that pass more easily, reducing the straining that worsens hemorrhoids. Pelvic floor exercises (Kegels) strengthen the muscles around the anal canal and can improve continence symptoms. Bowel training, which involves establishing regular bathroom habits to reduce urgency and accidents, also helps.
In the short term, absorbent pads worn inside your underwear are the most commonly used management strategy for ongoing leakage.
When surgery is needed for advanced hemorrhoids, the effect on continence depends on your starting point. Research published in the World Journal of Gastroenterology found that patients with normal sphincter function before surgery experienced no change in continence afterward, meaning the removal of hemorrhoidal tissue didn’t cause new leakage. However, patients who already had some degree of compromised continence or subclinical incontinence before surgery saw their symptoms worsen after the procedure. Their continence scores increased significantly in the two months following surgery, indicating more leakage, not less.
This is an important distinction. If you already have weakened sphincter function, whether from nerve damage, aging, or childbirth, surgical removal of hemorrhoids carries a higher risk of making incontinence worse. The hemorrhoidal tissue, even in its swollen state, may still be providing some of that 15 to 20% contribution to anal canal closure. Removing it in someone whose sphincter is already compromised can tip the balance. Less invasive treatment options, such as rubber band ligation or office-based procedures, may be safer choices in those cases.