What causes hemorrhoids

Experts don't fully agree, but several mechanisms are probably at work. Large, prolapsing hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which can cause blood to pool and enlarge the vessels. Inadequate fiber intake may also contribute.

People with hemorrhoids tend to have a higher than average resting anal canal tone — that is, the smooth muscle of the anal canal is tighter than average, even when they're not straining. Constipation adds to the trouble, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter muscle. Finally, hemorrhoids may bulge and prolapse because the connective tissues that support and hold them in place become weaker with age.

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