At a glance
Straining during bowel movements is one of the most common risk factors for anal fissures, haemorrhoids, and other colorectal conditions. It is also one of the most modifiable — meaning it is something you can change. Understanding why straining is harmful and what to do instead is one of the most practical steps you can take for colorectal health.
Why straining is harmful
When you strain on the toilet, you are creating high pressure in the abdomen and directing it downward into the pelvic area. This pressure affects:
The anal canal lining
The delicate lining of the anal canal is designed for the gentle passage of formed stool. Straining forces stool through with excessive pressure, which can:
- Tear the lining — causing anal fissures
- Aggravate existing fissures by preventing healing
- Damage the tissue over time with repeated force
The blood vessels
The blood vessels around the anal canal (haemorrhoidal cushions) are subjected to increased pressure during straining:
- They can become engorged and swollen — haemorrhoids
- Repeated straining makes existing haemorrhoids worse
- Thrombosis (clotting) can occur in these pressurised vessels
The pelvic floor
The muscles of the pelvic floor bear the brunt of the downward pressure:
- Chronic straining can weaken these muscles over time
- Weakened pelvic floor muscles can contribute to prolapse
- The muscles can also go into chronic spasm from repeated straining
The rectum
In severe or prolonged cases, the combination of pressure and weakened support can contribute to:
- Rectal prolapse — where part of the rectum protrudes through the anus
- Rectal intussusception — where the rectal wall folds in on itself
Why people strain
Understanding the cause is key to fixing it:
Hard stools
The most common reason. When stools are hard and difficult to pass, straining is almost involuntary — the body is trying to expel something that does not want to move. Solutions: more fibre, more water, stool softeners if needed.
Poor toilet habits
- Delaying bowel movements when the urge occurs — the stool continues to dry out in the rectum
- Spending too long on the toilet — sitting and pushing past the productive window
- Distraction — reading or using phones on the toilet extends sitting time
Incorrect posture
Sitting upright on a standard toilet does not put the body in the optimal position for bowel movements. The anorectal angle remains kinked, requiring more effort to push stool through.
Habit
Some people have strained for years and consider it normal. They do not realise that bowel movements should be relatively effortless.
How to stop straining
Get the stools right
This is the most important step:
- Fibre: 25 to 35 grams per day from food and supplements
- Water: Two to three litres daily
- Stool softeners: If dietary changes alone are not enough
- The goal: soft, formed stools (Bristol type 3 or 4) that pass with minimal effort
Fix the posture
- Raise your feet: Use a footstool or toilet stool to bring the knees above the hips
- Lean slightly forward: Rest your elbows on your thighs
- Relax the abdomen: Rather than tightening and pushing, let the abdominal muscles relax
- Breathe normally: Holding the breath increases intra-abdominal pressure
Respect the timing
- Go when you feel the urge: Do not delay — the longer stool sits in the rectum, the harder it gets
- Limit toilet time: Five minutes is enough. If it is not happening, get up and try again later
- Do not force it: If the stool is not ready, pushing will not help and will cause harm
Build good habits
- Establish a routine: Many people find that going at the same time each day (often after breakfast) trains the bowel
- Avoid distraction: Leave the phone outside the bathroom
- Respond to signals: Your body sends cues — respond to them promptly
The payoff
People who successfully reduce straining describe:
- Less pain during bowel movements
- Reduced symptoms from existing conditions
- Fewer flare-ups of haemorrhoids or fissures
- More comfortable and shorter time on the toilet
- Better long-term colorectal health
The changes are not dramatic on any single day, but over weeks and months, the difference is significant.
When to seek care
Contact your clinician if:
- Severe abdominal pain
- Heavy rectal bleeding
- Inability to have a bowel movement for several days despite self-care
- Rectal pain that is severe or worsening
- You are straining despite dietary and lifestyle changes — further assessment may be needed