Why It Hurts: Common Causes and the Pain Cycle

Short answer: most hemorrhoids and anal fissures start with hard stools and straining. They stick around because of a pain-tension loop: it hurts, so you clench and put off going, which makes stools harder, which hurts more. Soften the stool and break the loop, and most cases heal.

Working out why it hurts was a turning point for me. Once you know the cause, you basically have your to-do list for getting better.

What causes hemorrhoids and fissures in the first place?

Most of the time the root cause is simple plumbing. Hard or infrequent stools are tough to pass. Passing them means straining and pushing. That pressure either swells the blood vessels (hemorrhoids) or tears the lining (a fissure).

So a big chunk of recovery is just making stools softer and easier to pass: more water, more fiber, and not forcing it. For scale, the recommended fiber intake is about 25 grams a day for women and 38 for men, and survey data suggests only around 1 in 20 people gets there. I certainly wasn’t. During my worst stretch I was barely eating at all, which made the constipation worse, which made the pain worse. The routine guide goes into the how.

The pain cycle nobody warns you about

This is the part that kept me stuck for weeks. With fissures especially, you get a nasty loop:

The tear hurts → the muscle around it clenches → that tightness cuts blood flow and pulls the tear open again → which hurts → which makes you clench…

And there’s a mental version layered on top. It hurt so much that I started putting it off, held it in, got more backed up, and made the whole thing worse. If that’s you, you’re not weak. That’s just how this works. Noticing the loop is the first step to breaking it.

Which everyday habits make it worse?

On top of hard stools, a few habits quietly make things worse:

• Sitting for long stretches, especially on the toilet with your phone.
• Pushing or “powering through” instead of letting things happen on their own.
• Days where there isn’t much fiber or much water.
• Pregnancy and the postpartum weeks (very common, and usually temporary).
• Lifting something heavy while holding your breath and bearing down.
• Stress. This one deserves its own line, because it was my personal trigger. Every exam period and every stressful project, the flare-ups came back harder. Stress changes your digestion and your bathroom habits, and the anxiety makes you clench. Four years in, I could predict a flare-up from my calendar.

The good news hidden in the causes

Go back through that list and you’ll notice almost every item has an easy fix:

• Hard stools? Soften them with fiber and water.
• Straining? Change your position and stop forcing it.
• Long toilet sits? Get in, go, get out.
• The pain-spasm cycle? Warm soaks to relax, and a prescribed ointment if your doctor thinks you need one.

Two small changes did a surprising amount of the work for me, and they’re below. The full routine lives in what actually helped me.

And if you’ve put in a couple of honest weeks with no real change, take that as your cue to read when to see a doctor. A stubborn fissure sometimes needs a bit of prescription help before it’ll finally close up.