By Zahra Barnes– Self
Straining to poop is an essential part of the human experience. Everybody poops—no matter your location, socioeconomic status, or delicate sensibilities. And unfortunately, even the simplest things are harder than they should be sometimes. So, yes, straining to poop is just a fact of life.
But when you’re bearing down on the porcelain throne, hoping you don’t pass out before you pass anything, you might wonder what all that pushing is actually doing to your butt.
The truth is that straining to poop (especially if you do so consistently) can have a couple of different results. Luckily, none of them are too worrisome, but they can be clues that you might want to change anything from your fiber intake to your toilet paper so you can finally go in peace.
First, let’s talk about why you’re straining to poop.
If it feels impossible to poop—and then nothing comes out or it’s just hard little lumps—you’re dealing with constipation. Eating habits are often to blame, gastroenterologist Shilpa Ravella, M.D., an assistant professor of medicine at Columbia Medical Center, tells SELF. “I see a lot of patients coming in who have way too little fiber in their diets. They’re not eating a lot of fruits, vegetables, and whole grains, and they’re not drinking a lot of fluids like water,” she says. “That can lead to hard stools and constipation that can cause people to strain a lot when they go to the bathroom.”
Women 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. That number goes down to 25 grams between the ages of 31 and 50. There are two forms of fiber, according to the American Heart Association: soluble and insoluble. While soluble fiber, found in foods like oats, lentils, and beans, is important—it can potentially help lower your “bad” cholesterol—when it comes to pooping, insoluble fiber is especially important. It soaks up water as it works its way through your digestive system, which helps keep things chugging smoothly along. Good sources of insoluble fiber include wheat, nuts, cauliflower, and potatoes.
As you increase your fiber intake, be sure to stay hydrated, David Poppers, M.D., Ph.D., gastroenterologist and clinical associate professor of medicine at NYU Langone Health, tells SELF. 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. Beyond eating and hydration, exercise also plays a role in bowel health, Dr. Poppers says, though the exact mechanism behind this connection still isn’t clear. Some medications can also lead to constipation, Dr. Ravella says, including things like blood pressure drugs, opioids, antacids, and antidepressants. So if you’ve tried the dietary changes and you’re still constipated, it’s worth asking your doctor if you could switch medications, she says.
Constipation can also happen if you have health issues like irritable bowel syndrome, thyroid conditions, and celiac disease, Dr. Poppers says. So if you suspect an underlying condition is at the root of your constipation, make an appointment with your doctor for testing.
Not only is straining to poop super uncomfortable, but it’s one of the prime causes of hemorrhoids, which are essentially varicose veins in your butt.
Hemorrhoids are piles of bulging veins that can be internal (nestled inside the rectum) or external (under the skin around your anus), according to Mayo Clinic. When you bear down to use the bathroom, that force applies pressure to your anus, which can result in swollen anal veins and tissue, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Although pretty much no one ever says the word “hemorrhoid” out loud, they can be surprisingly common. While exact numbers are hard to pin down, Mayo Clinic estimates that almost three out of four adults will get a hemorrhoid at some point, and the National Institutes of Health says this condition affects around 1 in 20 Americans, along with half of adults over the age of 50.
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.
You may not even realize you have hemorrhoids, which sounds like something out of a horror movie—very What Lies Beneath. But sometimes hemorrhoids really do just exist without bothering you at all. You might stumble upon an external one if you happen to be feeling around down there when you’re, say, making use of a sex toy. Or a doctor might alert you to the presence of any internal hemorrhoids they discover while administering a colonoscopy. In any case, if your hemorrhoids are asymptomatic, you can keep living your life without trying to get rid of them.
Other times, hemorrhoids can cause symptoms like itching, discomfort, anal swelling, and bleeding, according to the Mayo Clinic. This is much more likely if you have an external hemorrhoid, since they’re more prone to getting irritated as you strain to use the bathroom or as you wipe after you go. (Sometimes excess straining can cause an internal hemorrhoid to push through the anus and become external, which is known as a protruding or prolapsed hemorrhoid, according to Mayo Clinic.)
OK, so what if…hypothetically…you pushed too hard, and now you have a hemorrhoid?
Hey, it happens, so try not to freak out. Sometimes they’ll even disappear on their own—especially if you fix whatever was causing you to strain a lot. “I would advise patients, even if they don’t have symptoms, to see hemorrhoids as a sign that they’re potentially not taking in enough fiber,” Dr. Ravella says.
But other times, they don’t go away. So if they’re bothering you, get to the doctor ASAP. Although hemorrhoids can be pretty responsive to at-home treatment (like over-the-counter creams, an ice pack, soaking in the bath, or using a suppository with corticosteroid creams to alleviate pain and swelling), it’s always smart to see a doctor. In very rare cases, these veins can clot and form lumps called thrombosed hemorrhoids, which may need to get lanced and drained before bothersome symptoms dissipate. And some hemorrhoid symptoms, like anal bleeding, can be a sign of a more serious condition like colorectal cancer, which is on the rise in millennials. Whenever you’re dealing with something sudden and strange in your body (especially your butt) you’re going to want to get that checked out.
Straining to poop can also cause anal fissures, aka little wounds that feel like your butt has papercuts.
Discomfort after straining on the toilet doesn’t automatically mean you have a hemorrhoid. Sometimes excessive straining can lead to anal fissures, or tears in the thin, delicate mucosa (tissue) around the anus. These fissures are another common cause of pain, itching, bleeding, and irritation after straining to poop, according to the Mayo Clinic.
Anal fissures typically arise when you have to work too hard to pass large, hard stools. They can also also happen due to chronic diarrhea or conditions like Crohn’s disease, since spending what feels like your entire life on the toilet can irritate your anal mucosa, especially if you’re using rough toilet paper or one that has a fragrance.
Luckily, anal fissures tend to heal on their own (though you may want to avoid super spicy food in the meantime, because ow). But if your anal discomfort doesn’t dissipate after a few weeks, it’s time to see a doctor. They may prescribe a cream with lidocaine or another anesthetic to relieve the pain. And if you have chronic anal fissures, they’ll likely want to discuss more extreme treatment options like nitroglycerin creams to increase blood flow and speed healing or even surgery.
No matter what, if you’re dealing with rectal bleeding you should always see a doctor.
Yes, even if you know you’ve been straining a lot recently and think it’s because you haven’t been getting enough fiber.
“Although not everything is an emergency, most diagnoses should not be made by the patient,” Dr. Poppers says. “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.”
One more reason to care about straining to poop: There’s a small possibility you could pass out on the pot.
You know those nightmares of coming to with firefighters standing over you, having broken down your bathroom door after you strained yourself into a fainting spell? Not to freak you out, but sometimes that does happen, and both experts we talked to have seen cases of this.
“It is not uncommon to hear stories of patients straining on the toilet bowl or standing immediately after attempting a bowel movement and feeling the sensation they’re about to faint,” Dr. Poppers says. “Some do lose consciousness, and some have the feeling that loss of consciousness is impending.” 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.
Losing consciousness while straining to poop is called defecation syncope, which is a kind of vasovagal syncope, or fainting because your body overreacts to certain stimuli, according to the Mayo Clinic. It happens when a trigger makes your heart rate and blood pressure fall, which lowers blood flow to your brain, which can then result in you passing out.
While 25 percent of healthy young adults will experience an isolated fainting episode, according to the Vanderbilt University Medical Center, defecation syncope is much rarer and typically happens in people who are middle-aged or older with underlying diseases. If it happens to you, you’ll definitely want to see a doctor just in case (especially if you hit your head at all).
Ultimately, if you’re having trouble using the bathroom, you should try to fix it for comfort’s sake, not because you’re endangering your life every time you sit on the toilet.
When adding fiber or changing your medication under a doctor’s supervision doesn’t do the trick, it’s time to see a gastroenterologist. If you’re feeling bashful about it, don’t. 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.