Women develop hemorrhoids the same way anyone does: when too much pressure builds up in the veins around the anus and rectum, causing them to stretch, swell, and bulge. What makes hemorrhoids so common in women specifically is that several major life stages and health conditions unique to or more prevalent in females pile on exactly that kind of pressure. Pregnancy alone accounts for a huge share of cases, but it’s far from the only cause.
How Hemorrhoids Form
The veins around your anus and lower rectum sit in a cushion of tissue that helps with bowel control. When sustained pressure forces extra blood into these veins, they stretch outward, much like varicose veins in the legs. Internal hemorrhoids form inside the rectum, where you may not feel them at all. External hemorrhoids develop under the skin around the anus, where they can itch, swell, and sometimes become painful.
Anything that raises pressure in the pelvic area or forces you to strain repeatedly can trigger this process. For women, the list of triggers is longer than it is for men, largely because of pregnancy, childbirth, hormonal shifts, and a higher rate of certain digestive conditions.
Pregnancy: The Most Common Cause
As the uterus grows, its increasing weight presses directly on the veins that drain the rectum and anus. That compression makes it harder for blood to flow freely back toward the heart, so it pools in those veins and causes them to swell. On top of that, blood volume rises significantly during pregnancy, meaning those same veins are handling a much heavier load than usual.
Hormonal changes add another layer. Progesterone, which rises steadily throughout pregnancy, relaxes the walls of blood vessels. Softer, more flexible vein walls are easier to stretch out of shape when pressure climbs. This combination of weight, extra blood, and relaxed vein walls explains why hemorrhoids are one of the most frequently reported discomforts of pregnancy, particularly in the second and third trimesters.
Constipation during pregnancy makes things worse. Iron supplements, prenatal vitamins, and slower gut movement (another effect of progesterone) all contribute to harder stools and more straining on the toilet.
Childbirth and the Postpartum Period
Vaginal delivery can cause hemorrhoids even in women who avoided them during pregnancy. The second stage of labor, when you’re actively pushing, creates enormous intra-abdominal pressure directed straight at the pelvic floor. Prolonged straining during this phase, particularly pushing for more than 20 minutes, is a significant risk factor. The weight of the baby passing through the birth canal also compresses the rectal veins from the inside.
Research on delivery techniques suggests that slower, more controlled pushing reduces the stress placed on the pelvic floor and lowers hemorrhoid rates in the weeks after birth. Women who delivered using spontaneous pushing in positions that kept the pelvis flexible reported fewer hemorrhoid symptoms at three weeks postpartum compared to those who used directed, forceful pushing.
Postpartum hemorrhoids often appear within the first few days after delivery. They can be especially uncomfortable because you’re also recovering from perineal soreness, and the first bowel movements after birth tend to require straining.
Pelvic Floor Weakness
Your pelvic floor is a hammock of muscles that supports the bladder, uterus, and rectum. When these muscles weaken, whether from childbirth, aging, or chronic straining, the organs they hold up can shift downward. This condition, called pelvic organ prolapse, is far more common in women and creates a cycle that promotes hemorrhoids.
One specific form, called a rectocele, happens when the wall between the vagina and rectum thins and bulges. This makes it difficult to fully empty the rectum during a bowel movement, which leads to more straining and more time spent on the toilet. Both of those habits are direct causes of hemorrhoid development. A weakened pelvic floor can also contribute to an overactive bladder, so women dealing with both urinary symptoms and rectal discomfort may be experiencing effects of the same underlying problem.
Constipation and Digestive Conditions
Chronic constipation is the single biggest non-pregnancy cause of hemorrhoids in women. Hard, dry stools force you to bear down, and that straining transmits pressure straight to the rectal veins. Sitting on the toilet for extended periods, even without actively pushing, keeps those veins under sustained pressure.
Irritable bowel syndrome with constipation (IBS-C) is diagnosed roughly twice as often in women as in men, and it significantly raises hemorrhoid risk. The repeated straining from difficult bowel movements causes the rectal and anal veins to bulge under pressure over and over again. Women with IBS who alternate between constipation and diarrhea face a double problem: straining from constipation combined with frequent, urgent bowel movements that irritate existing hemorrhoids.
The daily fiber recommendation for women 50 and younger is 25 grams. Most women fall well short of this, averaging closer to 15 grams. That gap translates directly into harder stools and more straining.
Other Contributing Factors
Hormonal fluctuations throughout the menstrual cycle can influence bowel habits. Many women experience constipation in the days before their period, when progesterone peaks. While a few days of constipation per month won’t cause hemorrhoids on their own, they can aggravate existing ones or contribute to the problem over years.
Prolonged sitting, whether at a desk job or during long commutes, keeps steady pressure on the veins around the anus. Obesity adds to that pressure by increasing the weight the pelvic floor has to support. Heavy lifting, particularly with breath-holding, spikes intra-abdominal pressure in the same way straining on the toilet does.
Age also plays a role. The connective tissue supporting the rectal veins gradually weakens over time, making them more prone to bulging. Hemorrhoid rates climb steadily after age 30 and peak between 45 and 65.
What Hemorrhoids Feel Like
Internal hemorrhoids usually announce themselves with bright red blood on the toilet paper or in the bowl. They rarely hurt because the tissue inside the rectum has few pain-sensing nerves. You might not know they’re there until you see blood.
External hemorrhoids are harder to ignore. You may feel a firm, tender lump near the anus, along with itching, swelling, or a dull ache that gets worse when sitting. If a blood clot forms inside an external hemorrhoid (a thrombosed hemorrhoid), the pain can become sudden and intense.
These symptoms overlap with anal fissures, which are small tears in the skin of the anus. The key difference: fissures tend to cause sharp, stinging pain during and after a bowel movement, while most hemorrhoids cause pressure or itching rather than sharp pain. Hemorrhoids often produce a noticeable lump; fissures do not. If you’re unsure which you’re dealing with, a physical exam can usually tell the difference quickly.
Managing and Preventing Flare-Ups
Most hemorrhoids respond to basic changes at home. Increasing your fiber intake to that 25-gram daily target softens stools enough to reduce straining. Good sources include beans, lentils, berries, oats, and broccoli. Drinking plenty of water alongside the fiber keeps things moving. If dietary changes aren’t enough, a fiber supplement can help, though during pregnancy you should check with your provider on which type is appropriate.
Warm sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes, reduce swelling and ease discomfort. Witch hazel pads applied to the area have a mild astringent effect that can relieve itching. Over-the-counter hemorrhoid creams containing a topical numbing agent can take the edge off pain. During pregnancy, ask your provider to recommend a specific product, since not all active ingredients are considered safe.
Stool softeners can make bowel movements less of an ordeal, especially in the postpartum period when the combination of soreness and medication side effects tends to cause constipation. Limiting time on the toilet to under five minutes and avoiding reading or scrolling while sitting reduces the passive pressure on rectal veins.
For long-term prevention, regular physical activity helps keep bowel movements consistent, and pelvic floor exercises strengthen the muscles that support the rectum. Women who’ve had multiple pregnancies or difficult deliveries benefit particularly from targeted pelvic floor rehabilitation, which addresses the underlying weakness that makes hemorrhoids more likely to recur.