Constipation, Hemorrhoids & Your Pelvic Floor

When Going to the Bathroom Becomes Hard Work

Pelvic health for every body

Read the introduction

Maybe going to the bathroom used to be something you never thought about. You felt the urge, sat down, had a bowel movement, and continued with your day.

Then things started changing.

Perhaps your stool became harder. You started sitting on the toilet longer, pushing harder, or feeling as though something was still left behind even after you finished. Maybe you started skipping days between bowel movements or found yourself returning to the bathroom because you never quite felt empty.

Then you noticed something else—a little blood on the toilet paper, itching or pressure around the anus, or a tender lump that appeared after straining.

You may have thought, “It's probably just hemorrhoids.”

But sometimes the bigger question is not only whether hemorrhoids are present. It is why you are straining so much in the first place.

Constipation, hemorrhoids, bowel habits, and the pelvic floor can be closely connected. Constipation and repeated straining are recognized contributors to symptomatic hemorrhoids, while some people with chronic constipation have difficulty relaxing and coordinating the pelvic floor muscles during a bowel movement.

At Peloraa

At Peloraa, our role is not to treat hemorrhoids themselves or assume every constipation problem comes from the pelvic floor. Instead, we look at how your bowel habits, breathing, abdominal pressure, pelvic floor muscles, toileting position, and overall movement are working together and collaborate with your medical team when another gastrointestinal or colorectal condition needs treatment.

Understand your journey

What You Should Know About Constipation, Hemorrhoids &
Your Pelvic Floor

Find clear, supportive answers to common questions about urinary incontinence, bladder leakage, symptoms, treatment, and pelvic health physiotherapy.

What Is Constipation?

Constipation means more than simply not having a bowel movement every day. You may be constipated if your stools are hard, dry, or difficult to pass, if you have fewer than three…

Constipation means more than simply not having a bowel movement every day. You may be constipated if your stools are hard, dry, or difficult to pass, if you have fewer than three bowel movements per week, or if you regularly feel that you have not emptied completely.

For one person, constipation may mean going several days without a bowel movement. For another, they may go every day but spend fifteen minutes straining and still feel unfinished. Someone else may feel that the stool reaches the rectum but simply will not come out without excessive pushing, changing positions, or even using their fingers to help empty.

These differences matter because constipation can have many causes. Diet, fluid intake, medications, physical activity, medical conditions, bowel motility, anatomical problems, and pelvic floor coordination can all play a role.

That means the answer is not always simply:

‍“Eat more fibre.”

‍Sometimes we need to understand what is happening at the exit.

What Do Hemorrhoids Have to Do With Constipation?

Hemorrhoidal tissue is a normal part of the anal canal, but hemorrhoids become symptomatic when these tissues enlarge, swell, prolapse, bleed, itch, or become painful.…

Hemorrhoidal tissue is a normal part of the anal canal, but hemorrhoids become symptomatic when these tissues enlarge, swell, prolapse, bleed, itch, or become painful.

Constipation and abnormal bowel habits can significantly contribute to symptomatic hemorrhoids. Repeated straining, spending prolonged periods sitting on the toilet, and difficult bowel movements all increase pressure through the anorectal region. The 2024 American Society of Colon and Rectal Surgeons guideline specifically recommends addressing constipation and bowel habits as part of first-line hemorrhoid management.

This can create a frustrating cycle. Your stool is difficult to pass, so you strain harder. Straining increases pressure around the hemorrhoidal tissues, symptoms become worse, and having a bowel movement becomes uncomfortable. Because you expect discomfort, you may delay going to the bathroom, and the stool may become harder and even more difficult to pass.

Over time, the bathroom becomes something you have to work at rather than something your body naturally does.

Constipation, Pelvic Floor Dysfunction and Hemorrhoids: What's the Difference?

ConditionWhat Is Happening?What You May NoticeHow Pelvic Floor Physiotherapy May FitConstipationStool may move slowly, become hard or difficult to pass, or bowel movements may…

Condition

What Is Happening?

What You May Notice

How Pelvic Floor Physiotherapy May Fit

Constipation

Stool may move slowly, become hard or difficult to pass, or bowel movements may feel incomplete. Many dietary, medical, medication-related and functional factors can contribute.

Hard stools, fewer bowel movements, straining, bloating, discomfort, or incomplete emptying.

Physiotherapy may help when pelvic floor coordination or bowel mechanics contribute, but not every type of constipation requires pelvic floor treatment.

Pelvic Floor Dyssynergia / Defecatory Disorder

The pelvic floor and anal muscles do not relax and coordinate appropriately when you try to have a bowel movement.

Stool feels “stuck,” excessive straining, incomplete emptying, repeated attempts, or needing to change positions or manually assist evacuation.

Pelvic floor retraining and biofeedback are recommended first-line treatments when pelvic floor dyssynergia is diagnosed.

Hemorrhoids

Hemorrhoidal tissues around the anus or lower rectum become enlarged or symptomatic.

Bright-red bleeding, itching, swelling, prolapse, discomfort, or a tender lump.

Physiotherapy does not remove or directly treat hemorrhoids, but may help address constipation, straining and pelvic floor dysfunction that can contribute to repeated pressure.

What Does the Pelvic Floor Have to Do With Constipation?

Having a bowel movement requires coordination. As stool moves into the rectum, your abdominal wall creates pressure while the pelvic floor and muscles around the anus need to…

Having a bowel movement requires coordination.

As stool moves into the rectum, your abdominal wall creates pressure while the pelvic floor and muscles around the anus need to relax and lengthen so stool can pass.

Think of it like trying to squeeze toothpaste through a tube.

Your abdomen provides the gentle pressure from above, but the opening at the bottom also needs to open.

If you push harder while the pelvic floor is tightening instead of relaxing, you are essentially trying to push through a closed door.

This pattern is commonly called pelvic floor dyssynergia or a defecatory disorder. It involves impaired coordination between the pressure needed to empty the rectum and relaxation of the pelvic floor and anal muscles. Current ASCRS guidance identifies biofeedback therapy as a first-line treatment for symptomatic pelvic floor dyssynergia.

This is why someone can eat fibre, drink water, take laxatives, and still say:

‍“The stool is there. I just can't get it out.”

‍That experience may deserve further assessment rather than simply more pushing.

Why Does Straining Become a Habit?

For many people, straining begins because stool is hard or difficult to pass. But over time, pushing can become the way your body thinks a bowel movement is supposed to happen.…

For many people, straining begins because stool is hard or difficult to pass. But over time, pushing can become the way your body thinks a bowel movement is supposed to happen.

You sit down, hold your breath, tighten your abdomen, push downward as hard as possible, and remain on the toilet until something happens.

If that has been your routine for years, changing it may feel surprisingly unfamiliar.

Repeated straining can increase pressure around hemorrhoidal tissues and may also reinforce poor coordination between the abdominal wall and pelvic floor. ASCRS recommends avoiding excessive straining and limiting prolonged time on the toilet as part of hemorrhoid management.

A successful bowel movement should generally involve pressure with relaxation, not a battle between your abdominal muscles and pelvic floor.

What About the “Just in Case” Toilet Sit?

Sometimes constipation creates another habit: sitting on the toilet even when there is not a strong bowel urge. You may bring your phone, scroll for ten or fifteen minutes, and…

Sometimes constipation creates another habit: sitting on the toilet even when there is not a strong bowel urge.

You may bring your phone, scroll for ten or fifteen minutes, and keep pushing because you feel that you should have a bowel movement.

Long toilet sitting increases time under pressure around the anorectal region. Current colorectal guidance specifically recommends reducing prolonged time on the commode for people with symptomatic hemorrhoids.

The goal is not to rush your body.It is to help it work more efficiently.

Is Fibre Always the Answer?

Fibre can be very helpful for many people with constipation and hemorrhoids. NIDDK recommends adequate dietary fibre and fluid intake as part of constipation management, while the…

Fibre can be very helpful for many people with constipation and hemorrhoids. NIDDK recommends adequate dietary fibre and fluid intake as part of constipation management, while the 2024 ASCRS hemorrhoid guideline strongly supports dietary and behavioural modifications as first-line treatment.

But fibre is not a universal solution to every bowel problem.

Someone with a defecatory disorder may have soft stool and still struggle to empty because the pelvic floor is not relaxing appropriately. Someone with IBS may experience significant bloating with certain dietary changes. Other people may have slow-transit constipation, medication-related constipation, or a structural condition.

This is why dietary changes should be individualized. When nutrition is a significant part of the problem, Peloraa may recommend collaboration with your physician, gastroenterologist or registered dietitian rather than simply telling you to keep adding fibre.

What Can Peloraa Do About Hemorrhoids?

It is important to be clear about this: Pelvic floor physiotherapy does not remove or directly treat hemorrhoids. Hemorrhoids are an anorectal condition that may require…

It is important to be clear about this:

Pelvic floor physiotherapy does not remove or directly treat hemorrhoids.

Hemorrhoids are an anorectal condition that may require assessment and treatment from your family physician, gastroenterologist, colorectal specialist, or another appropriate medical provider.Where Peloraa may help is with some of the behaviours and pelvic floor problems surrounding the hemorrhoids. If constipation, excessive straining, poor bowel positioning or pelvic floor dyssynergia is creating repeated pressure during bowel movements, physiotherapy may help address those factors while your medical provider manages the hemorrhoids themselves.This collaborative approach matters because treating hemorrhoids without addressing persistent constipation may leave the same bowel pattern in place.

Constipation and Hemorrhoid Care Often Works Better as a Team
At Peloraa, we do not assume that every constipation problem belongs in physiotherapy.

Depending on your symptoms, we may work alongside or recommend assessment from your family physician, gastroenterologist, colorectal surgeon, registered dietitian, pharmacist or another appropriate healthcare professional.Your physician or gastroenterologist may evaluate medications, bowel motility, IBS, thyroid or metabolic conditions, and whether laxatives or prescription medications are appropriate. A colorectal specialist may assess hemorrhoids, anal fissures, rectal prolapse, rectocele, or other anorectal conditions. A dietitian may help when fibre, food patterns or significant bloating need more individualized attention.

Peloraa focuses on the pelvic floor, bowel mechanics, breathing, pressure management, toileting habits and musculoskeletal factors that may be contributing.

You should not have to choose between medical treatment and pelvic floor rehabilitation.

They can work together.

What If My Hemorrhoids Keep Bleeding?

Bright-red blood during a bowel movement can occur with hemorrhoids, but rectal bleeding should not automatically be assumed to be caused by hemorrhoids. The 2024 ASCRS guideline…

Bright-red blood during a bowel movement can occur with hemorrhoids, but rectal bleeding should not automatically be assumed to be caused by hemorrhoids.

The 2024 ASCRS guideline specifically emphasizes that other colorectal conditions can also cause rectal bleeding and that selected patients require further investigation.

If bleeding is new, persistent, increasing, unexplained, associated with abdominal symptoms or changes in bowel habits, or you are due for colorectal cancer screening, discuss it with your medical provider.

your medical provider.Pelvic floor physiotherapy is not a substitute for investigating rectal bleeding.

We Help You Make the Bathroom Feel Normal Again
For many people with chronic constipation, the goal is not complicated.
You want to feel the urge, sit down, empty comfortably, and continue with your day.
You do not want bowel movements to require twenty minutes of pushing.
You do not want to constantly feel unfinished.
You do not want another hemorrhoid flare every time your stool becomes difficult to pass.

At Peloraa Physiotherapy, our approach to constipation, pelvic floor dyssynergia, difficult bowel movements and pelvic floor physiotherapy in Barrhaven and Ottawa focuses on helping you understand how your bowel and pelvic floor work together, reducing unnecessary straining, improving pelvic floor relaxation and coordination, and collaborating with your healthcare providers when constipation or hemorrhoids require broader medical care.

Listen. Understand. Relax. Coordinate. Empty Better.
That's the Peloraa Way.

How we support you

The Peloraa Way

The Peloraa Way: We Look Beyond “Just Push Harder”

At Peloraa, we understand that bowel problems can feel embarrassing to talk about. You may have spent years assuming that everyone sits on the toilet for fifteen minutes or that needing to strain is simply normal for you.

Our approach begins by making bowel health something we can actually talk about.

We want to understand what happens from the moment you feel the urge to the moment you leave the bathroom.

First, We Listen to Your Bowel Story

Your Peloraa assessment may include questions about how often you have bowel movements, stool consistency, whether you strain, how long you spend on the toilet, whether you feel completely empty afterward, and whether you experience pain, bleeding, bloating, or hemorrhoid symptoms.

We may also discuss medications, pregnancy and childbirth, previous abdominal or pelvic surgery, bladder symptoms, pelvic pain, diet and fluids, physical activity, and whether you ever need to change positions or manually assist bowel emptying.

Sometimes the most important information is something as simple as:
‍“I go every day, but it never feels finished.”
‍That tells us far more than bowel frequency alone.

We Assess the Whole Bowel–Pelvic Floor Connection

When pelvic floor involvement is suspected, your physiotherapist may assess your breathing, abdominal pressure, pelvic mobility, pelvic floor relaxation, coordination, toileting mechanics, and how you generate pressure during a bowel movement.

An internal rectal pelvic floor examination may sometimes provide useful information about muscle tension and coordination, but it is never mandatory. Your physiotherapist will explain your options, and assessment can begin externally and progress only with your consent.

When constipation does not respond to typical conservative treatment and a defecatory disorder is suspected, medical providers may use tests such as anorectal manometry and balloon expulsion testing to evaluate pelvic floor and anorectal coordination. Recent AGA guidance recommends anorectal testing and pelvic floor biofeedback when indicated before difficult constipation is labelled refractory.

We Teach You How to Push Less and Empty Better

If your pelvic floor is tightening when it should be relaxing, simply pushing harder may reinforce the problem.

Pelvic floor rehabilitation may help you learn how to coordinate breathing, abdominal pressure, rectal emptying and pelvic floor relaxation more effectively. Treatment may also include toileting position, body awareness, relaxation strategies and bowel routine education.

For diagnosed pelvic floor dyssynergia, biofeedback therapy has strong evidence and is recommended as a first-line treatment. Biofeedback provides information about how the muscles are behaving so you can learn to change the pattern rather than guessing whether you are relaxing correctly.

The goal is not to make you stronger at pushing.

It is to help your body become better coordinated at emptying.

We Look at Toileting Position and Breathing

Position can influence how easily stool passes. Your physiotherapist may help you explore foot support, hip position, trunk position and breathing so that your pelvic floor can relax more effectively.

We may also look at breath-holding. When you repeatedly hold your breath and bear down forcefully, pressure can increase significantly through the pelvic floor and hemorrhoidal tissues.

Learning how to create appropriate abdominal pressure while allowing the pelvic floor to lengthen can make bowel movements feel less like hard physical work.

A little more clarity

Constipation, Hemorrhoids & the Pelvic Floor FAQs

Can a tight pelvic floor cause constipation?

Yes. Some people have a defecatory disorder in which the pelvic floor does not relax or coordinate properly when they try to have a bowel movement. This can contribute to straining, incomplete emptying and the feeling that stool is stuck.

Can constipation cause hemorrhoids?

Constipation and repeated straining are associated with symptomatic hemorrhoids. Treating constipation, increasing fibre and fluid when appropriate, avoiding excessive straining and reducing prolonged toilet sitting are important parts of hemorrhoid management.

Can pelvic floor physiotherapy treat hemorrhoids?

Physiotherapy does not remove or directly treat hemorrhoids. It may help address pelvic floor dysfunction, poor bowel mechanics and excessive straining that can contribute to repeated pressure during bowel movements.

Why do I feel like I haven't completely emptied?

Incomplete emptying can occur for several reasons, including stool consistency, bowel motility, structural problems or pelvic floor dyssynergia. Persistent symptoms may require medical and pelvic floor assessment.

Should I push harder if stool feels stuck?

Usually, repeatedly increasing force is not the ideal solution. Excessive straining can contribute to hemorrhoid symptoms, and if your pelvic floor is not relaxing properly, pushing harder may not correct the underlying coordination problem.

Does everyone with constipation need more fibre?

No. Fibre helps many people, but constipation has different causes. Some people with pelvic floor dyssynergia, slow-transit constipation or other gastrointestinal conditions may require additional or different treatment.

Can pelvic floor physiotherapy help chronic constipation?

It can be particularly helpful when pelvic floor dyssynergia or another defecatory disorder is contributing. Biofeedback-based pelvic floor retraining is considered first-line treatment for symptomatic pelvic floor dyssynergia.

Do I need an internal rectal examination?

No. An internal rectal pelvic floor assessment may provide useful information about muscle function and coordination in some cases, but it is not mandatory. Assessment and treatment can progress according to your comfort and consent.

Going to the Bathroom Shouldn't Feel Like a Workout

You do not need to know whether your constipation comes from your diet, bowel motility, pelvic floor, medications or another condition before asking for help.

And you do not need to assume that years of straining are simply normal.

If bowel movements regularly feel difficult, incomplete or require excessive pushing, understanding why is an important first step.

Book a pelvic floor physiotherapy assessment with Peloraa for constipation, pelvic floor dyssynergia, difficult bowel emptying, excessive straining or related pelvic floor concerns in Barrhaven, Ottawa.

References & Clinical Credits
American Society of Colon and Rectal Surgeons (ASCRS). Clinical Practice Guidelines for the Management of Hemorrhoids. Diseases of the Colon & Rectum. 2024. Provides current clinical guidance regarding constipation, straining, bowel habits, dietary fibre, rectal bleeding, medical management and procedures for symptomatic hemorrhoids.
‍American Society of Colon and Rectal Surgeons (ASCRS). Evaluation and Management of Chronic Constipation. 2024. Provides evidence-based guidance regarding constipation assessment, outlet dysfunction, anorectal testing and biofeedback as first-line treatment for pelvic floor dyssynergia.
‍
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Constipation. Provides patient education regarding constipation symptoms, causes, diagnosis, dietary management, medications and additional treatment options.

American Gastroenterological Association (AGA). Clinical Practice Update on Evaluation and Management of Refractory Constipation. 2025/2026. Recommends evaluation with anorectal manometry and balloon expulsion testing and pelvic floor biofeedback when appropriate before chronic constipation is considered refractory.

American Neurogastroenterology and Motility Society / European Society of Neurogastroenterology and Motility. Consensus Guidelines on Biofeedback Therapy for Anorectal Disorders. Supports biofeedback therapy for short- and long-term treatment of constipation associated with dyssynergic defecation.

Medical Disclaimer
This information is intended for general educational purposes only and does not replace medical diagnosis, individualized medical advice or treatment from a physician or another qualified healthcare professional. Constipation can have dietary, medication-related, gastrointestinal, neurological, metabolic, structural and pelvic floor causes. Hemorrhoids are an anorectal condition and are not directly treated or removed through pelvic floor physiotherapy.

Pelvic floor physiotherapy may help when pelvic floor dyssynergia, muscle tension, poor bowel coordination, toileting mechanics or excessive straining contribute to difficult bowel movements. Medical, dietary, pharmacological or colorectal treatment may also be required depending on the underlying cause.

Rectal bleeding should not automatically be assumed to come from hemorrhoids. Seek medical assessment for persistent or unexplained rectal bleeding, blood mixed with the stool, black or tarry stool, unexplained weight loss, anemia, significant or persistent abdominal pain, fever, vomiting, a new or progressive change in bowel habits, severe rectal pain or swelling, inability to pass stool or gas, or other new or concerning symptoms.

Peloraa works collaboratively with appropriate healthcare providers when gastrointestinal investigation, medication, nutrition support, colorectal assessment, imaging or other specialist care may be required.