Women get recurring hemorrhoids because of a combination of anatomy, hormones, and life stages that repeatedly put pressure on the veins around the rectum. Pregnancy is the most common trigger, but it’s far from the only one. Chronic constipation, prolonged sitting, hormonal fluctuations, and even toilet habits can keep hemorrhoids coming back long after a first episode.
Why Women Are Especially Prone
Hemorrhoids develop when extra pressure builds up in the pelvic area and lower digestive tract, causing the veins around the anus and rectum to stretch and swell. Several factors make this more likely to happen repeatedly in women.
Pregnancy is the biggest one. The growing uterus presses directly on the veins that drain blood from the rectum, making it harder for blood to flow freely. That blood pools and the veins swell. On top of that, blood volume increases significantly during pregnancy, forcing veins throughout the body to handle more fluid than usual. The added weight of the baby compounds the pressure further. Hemorrhoids that develop during pregnancy often resolve after delivery, but they tend to return with subsequent pregnancies, and each episode can weaken the vein walls a little more.
Hormonal shifts also play a role outside of pregnancy. Progesterone, which rises during the second half of the menstrual cycle, relaxes the walls of blood vessels. This makes veins more prone to swelling under pressure. Some women notice hemorrhoid flare-ups around their period for exactly this reason. The same mechanism applies during perimenopause, when hormone levels fluctuate unpredictably.
Childbirth itself is a separate risk factor. The prolonged, intense pushing of vaginal delivery puts enormous strain on the pelvic floor and rectal veins. Women who had hemorrhoids during pregnancy frequently see them worsen during labor, and the tissue damage from delivery can make future episodes more likely.
Constipation: The Cycle That Keeps Them Coming Back
Chronic constipation is the single most common driver of recurring hemorrhoids in both sexes, but women experience constipation at roughly twice the rate men do. Straining to pass hard stools forces blood into the rectal veins and holds it there. Do this regularly and the veins stay stretched, making each subsequent episode easier to trigger.
Iron supplements during pregnancy, hormonal birth control, and the hormonal changes of menopause all slow gut motility and contribute to constipation. So does not eating enough fiber. Current dietary guidelines recommend 14 grams of fiber for every 1,000 calories you eat daily, which works out to roughly 22 to 28 grams for most women. The average American gets about half that. Without adequate fiber, stools are harder, drier, and require more straining to pass.
Low fluid intake makes this worse. Fiber works by absorbing water and adding bulk to stool, so increasing fiber without increasing water can actually backfire and make constipation worse.
Habits That Add Pressure
Sitting on the toilet for long stretches is a surprisingly common contributor. Scrolling your phone on the toilet for 10 or 15 minutes keeps constant downward pressure on the rectal veins. The unsupported position of the standard toilet seat also plays a role. Sitting upright on a toilet creates a kink in the rectum that requires more effort to push stool through. A squatting position, which you can approximate by placing your feet on a low stool, straightens the rectal angle and reduces the abdominal pressure needed to empty the bowel. Less straining means less stress on those veins.
Sedentary jobs and long periods of sitting throughout the day also increase pelvic pressure. If you sit for most of the workday, the weight of your upper body compresses the veins in your pelvis for hours at a time. Regular movement, even brief walks every hour, helps blood circulate out of the pelvic region.
Heavy lifting, whether at the gym or picking up small children, forces you to brace your core and bear down. This temporarily spikes pressure in the abdominal cavity and pushes blood into the rectal veins. If you lift regularly without exhaling through the effort, the repeated pressure spikes can trigger flare-ups.
How Hemorrhoids Progress Over Time
One reason hemorrhoids keep returning is that the vein tissue weakens with each episode. Internal hemorrhoids are classified into four degrees based on severity. A first-degree hemorrhoid bulges into the anal canal during bowel movements but stays inside. A second-degree hemorrhoid pushes out during straining, then slides back in on its own. A third-degree hemorrhoid comes out and has to be manually pushed back in. A fourth-degree hemorrhoid protrudes permanently and can’t be repositioned.
Each recurrence stretches the supporting tissue a little more, which is why hemorrhoids that started as occasional bleeding can gradually progress to tissue that protrudes regularly. This doesn’t happen to everyone, but it’s the pattern when the underlying causes go unaddressed. The earlier you break the cycle of pressure and straining, the less likely the tissue is to progress.
What Actually Stops the Cycle
The first-line treatment for recurrent hemorrhoids, per current clinical guidelines from the American Society of Colon and Rectal Surgeons, is addressing the underlying constipation. Increasing fiber and fluid intake is strongly recommended as the most effective way to reduce both prolapse and bleeding. This means building toward that 25-gram daily fiber target through whole grains, fruits, vegetables, and legumes, or using a fiber supplement if dietary changes aren’t enough. Increase fiber gradually over a couple of weeks to avoid bloating and gas.
Over-the-counter topical treatments containing hydrocortisone or other anti-inflammatory ingredients can help with pain, itching, and swelling during a flare-up. However, hydrocortisone products should not be used for more than seven consecutive days. Longer use can thin the delicate skin around the anus and actually make symptoms worse over time.
Flavonoid supplements, derived from plant compounds, appear to reduce itching, bleeding, and discharge from hemorrhoids. These are available over the counter and are considered safe for most people.
When lifestyle changes and topical treatments don’t control symptoms, the next step is typically rubber band ligation, a quick office procedure where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply. It’s effective for first- through third-degree hemorrhoids and doesn’t require anesthesia.
Practical Changes That Reduce Flare-Ups
- Time your bathroom trips. Go when you feel the urge rather than waiting, and limit toilet time to five minutes or less. Put the phone down.
- Use a footstool. A six- to eight-inch stool under your feet while sitting on the toilet mimics a squat, straightening the rectal angle so stool passes with less effort.
- Stay hydrated. Aim for at least eight cups of water daily, more if you’re pregnant, breastfeeding, or increasing your fiber intake.
- Move throughout the day. If you sit for work, stand or walk for a few minutes every hour. Regular exercise also promotes healthy bowel motility.
- Manage postpartum recovery carefully. If hemorrhoids developed during pregnancy, using stool softeners, sitz baths, and gentle fiber supplementation in the weeks after delivery can prevent them from becoming a chronic problem.
- Breathe through lifting. Exhale during the exertion phase of any heavy lift, whether it’s a barbell or a toddler. Holding your breath while straining drives pressure straight to the pelvic floor.
Recurring hemorrhoids are frustrating, but in most cases they’re a signal that something about your daily habits, diet, or life stage is creating repeated pressure on the same vulnerable veins. Addressing the root cause, rather than just treating each flare-up, is what breaks the cycle.