Causes of hard-to-pass stool and what to try

But some conditions that make pooping an uncomfortable chore are more serious and may require a visit to the doctor. Read on to learn what conditions may need medical treatment and what you can do to help relieve and prevent symptoms.

10 Reasons It Hurts When You Poop

Feeling some pain when you poop isn’t uncommon. Your diet, daily activities, and emotional state can all affect what it feels like to go number two, and the pain may only be temporary.

But some conditions that make pooping an uncomfortable chore are more serious and may require a visit to the doctor. Read on to learn what conditions may need medical treatment and what you can do to help relieve and prevent symptoms.

Anal fissures are tiny cuts that happen when anus skin cracks and often bleeds.

• an area near your anus that looks torn
• skin outgrowth near the tear
• stinging or intense pain near your anus when you poop
• blood in your poop or on toilet paper when you wipe
• anal itchiness
• burning sensation around your anus

They’re not too serious and usually go away without medical treatment in a little over a month.

Some treatments for anal fissures include:

The last 20 years have seen the cost of medical care increase about 70% faster than the rate of general inflation as measured by the Consumer Price Index (CPI), the Research Division of the Federal Reserve Bank of St. Louis Healthcare inflation dropped to a historical low after 2010 but is again on the rise as of 2018, according to Bloomberg.

• taking stool softeners
• hydrating with water and water-rich foods
• eating about 20 to 35 grams of fiber per day
• taking a sitz bath to improve blood flow and help muscles relax
• applying hydrocortisone cream or ointment to reduce inflammation
• using pain relief ointments, such as lidocaine, to reduce pain

Hemorrhoids, sometimes called piles, happen when the anus or rectum veins become swollen.

You may not notice an internal hemorrhoid in your anus, but external hemorrhoids can cause pain and make it hard to sit without discomfort.

• pain when you poop
• intense anal itching and pain
• lumps near the anus that hurt or feel itchy
• anal leakage
• blood on toilet paper when you poop

Try the following treatments and prevention tips for hemorrhoids:

• Take a warm bath for 10 minutes each day to relieve pain.
• Apply topical hemorrhoid cream for itching or burning.
• Eat more fiber or take fiber supplements, such as psyllium.
• Use a sitz bath.
• Wash your anus every time you bathe or shower with warm water and a gentle, unscented soap.
• Use soft toilet paper when you wipe. Consider using a bidet for gentler cleansing.
• Apply a cold compress to help with swelling.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain, including ibuprofen (Advil) or naproxen (Aleve).

More serious hemorrhoids may need to be surgically removed.

Constipation happens when you poop less than three times a week, and when you do, the poop comes out hard and with more trouble than usual. Pain is usually less sharp and may accompany pain in your lower gut from backup.

Common symptoms include:

• hard, dry stool that comes out in small chunks
• anus or gut pain while you poop
• still feeling like you need to poop even after you go
• bloating or cramping in your lower gut or back
• feeling like something’s blocking your intestines

Follow these treatments and prevention tips for constipation:

• Drink plenty of water — at least 64 ounces a day — to stay hydrated.
• Reduce your caffeine and alcohol intake.
• Eat plenty of fiber or take fiber supplements.
• Eat foods with probiotics, such as Greek yogurt.
• Reduce your intake of foods that can cause constipation, such as meat and dairy.
• Get about 30 minutes of light exercise, such as walking or swimming, every day to keep your bowels moving.
• Go to the bathroom as you feel it coming to keep stool from getting hard or stuck.
• Try laxatives for severe cases but talk to your doctor before you take them.

Proctitis happens when the lining of your rectum, the tube where bowel movements comes out, becomes inflamed. It’s a common symptom of sexually transmitted infections (STIs), radiation treatments for cancer, or inflammatory bowel conditions such as ulcerative colitis.

• pain when you poop
• diarrhea
• bleeding when you poop or wipe
• mucuslike discharge from your anus
• feeling like you have to poop even if you’ve just gone

Here are some treatment and prevention tips:

• Use condoms or other protection when you have sex.
• Avoid sexual contact with someone who has visible bumps or sores in their genital area.
• Take any prescribed antibiotics or antiviral medications for infections, such as doxycycline (Vibramycin) or acyclovir (Zovirax).
• Take any prescribed medications for radiation side effects, such as mesalamine (Canasa) or metronidazole (Flagyl).
• Take over-the-counter stool softeners to help soften stool.
• Take prescribed medications for inflammatory bowel diseases, such as mesalamine (Canasa) or prednisone (Rayos), or immunosuppressants such as infliximab (Remicade).
• Get surgery to remove any damaged areas of your colon.
• Get treatments like argon plasma coagulation (APC) or electrocoagulation.

Inflammatory bowel disease (IBD) refers to any condition that involves inflammation in your digestive tract. This includes Crohn’s disease, ulcerative colitis, and irritable bowel syndrome. Many of these conditions result in a lot of pain when you poop.

Common symptoms include:

• diarrhea
• feeling exhausted
• pain or discomfort in your belly
• blood in your poop
• losing weight for no reason
• not feeling hungry, even when you haven’t eaten for a while

Some treatments and prevention tips for IBD include:

• anti-inflammatory medications, such as mesalamine (Delzicol) or olsalazine (Dipentum)
• immunosuppressants, such as azathioprine or methotrexate (Trexall)
• medications to control your immune system, such as adalimumab (Humira) or natalizumab (Tysabri)
• antibiotics for infections, such as metronidazole (Flagyl)
• diarrhea medications, such as methylcellulose (Citrucel) or loperamide (Imodium A-D)
• pain medications, such as acetaminophen (Tylenol)
• iron supplements to limit anemia from intestinal bleeding
• calcium or vitamin D supplements to lower your risk of osteoporosis from Crohn’s disease
• removal of parts of your colon or rectum, leaving a small pouch from your small intestine to your anus or to the outside of your body for collection
• a low-meat, low-dairy, moderate-fiber diet with small amounts of caffeine and alcohol

Diarrhea happens when your bowel movements are thin and watery.

Diarrhea doesn’t always make pooping hurt. But wiping a lot and passing a lot of stool can irritate skin and make your anus feel raw and sore.

• nausea
• stomach pain or cramps
• feeling bloated
• losing too much fluid
• blood in your poop
• needing to poop often
• fever
• a large volume of stools

Treatment for diarrhea usually consists of rehydration, inserting an intravenous line if necessary, or antibiotics. Here are some prevention tips for diarrhea:

• Wash your hands for at least 20 seconds with soap and water before and after you eat.
• Wash and cook food properly, eat it right away, and put leftovers in the fridge quickly.
• Ask your doctor about antibiotics before you visit a new country.
• Don’t drink tap water when you travel or eat food that’s been washed with tap water. Only use bottled water.

Endometriosis happens when the tissues that make up the lining of the uterus, known as the endometrium, grow outside the uterus. They can attach to your colon and cause pain from irritation or scar tissue formation.

Other symptoms include:

• pain during your period
• lower abdominal or back pain and cramps before your period starts
• heavy menstrual flow
• pain during or after sex
• infertility

Some treatments include:

• pain medications, such as ibuprofen (Advil)
• hormone therapy to regulate growth of tissues
• birth control, such as medroxyprogesterone (Depo-Provera) injections, to mitigate tissue growth and symptoms
• gonadotropin-releasing hormone (GRNH) to reduce estrogen that causes tissue growth
• minimally invasive laser surgery to remove tissue
• last resort surgical removal of the uterus, cervix, and ovaries to stop menstruation and tissue growth

STIs such as chlamydia or syphilis spread through anal sex can result in bacterial infections that cause your rectum to swell and make it painful to poop.

Both STIs are spread through unprotected sexual contact with someone who’s infected, and painful rectal swelling can also accompany symptoms like burning when you pee, discharge from your genitals, and pain during sex.

Some treatment and prevention tips for these STIs include:

• antibiotics, such as azithromycin (Zithromax) or doxycycline (Oracea)
• penicillin injections for severe syphilis
• abstaining from sex while you’re being treated for either STI
• using protection whenever you have sex, including oral or anal sex
• getting tested for STIs regularly if you’re sexually active

Human papillomavirus (HPV) is a viral infection that can cause warts to form near your anus, genitals, mouth, or throat. Anal warts can get irritated when you poop, making you feel a rawness or stinging pain.

Untreated HPV can cause anal and cervical cancer. HPV can’t be fully cured. Warts may come and go, and your doctor may use laser or cryotherapy to remove warts. Make sure you get tested for STIs and for cancer regularly if you have an HPV diagnosis.

Prevention tips for HPV include:

• getting the HPV vaccine if you’re under age 45
• using condoms every time you have sex
• getting Pap smears and regular health and STI screenings

It’s highly unlikely that anal cancer or rectal cancer is the culprit for painful pooping, but it’s a small possibility. Some symptoms that may indicate cancer include:

• sudden, abnormal changes in poop color or shape
• small, thin stool
• blood in your poop or on toilet paper when you wipe
• new or unusual lumps near your anus that hurt when you apply pressure to them
• itchiness around your anus
• unusual discharge
• frequent constipation or diarrhea
• feeling unusually exhausted
• having a lot of gas or bloating
• losing abnormal amounts of weight
• constant pain or cramps in your abdomen

See your doctor right away if you notice any of these symptoms. Early treatment can help stop the spread of cancer and limit complications.

Treatment for these cancers may include:

• chemotherapy injections or pills to kill cancer cells
• surgery to remove anal or rectal tumors and prevent cancerous tissue from spreading, possibly removing the entire rectum, anus, and parts of your colon if cancer has spread
• radiation treatment to kill cancer cells
• regorafenib (Stivarga) for advanced rectal cancer to stop cancer cell growth

Seek immediate medical attention if you have:

• pain or bleeding lasting for a week or more
• fever or unusual fatigue
• unusual bleeding or discharge when you poop
• pain or other symptoms after sex, especially with a new partner
• intense abdominal or back pain and cramps
• newly formed lumps near your anus

Causes of hard-to-pass stool and what to try

Many people occasionally find that their poop is large and difficult to pass. This symptom is usually temporary and not a cause for concern. However, in some cases, uncomfortable bowel movements may be a sign of an underlying medical issue.

Various treatments and lifestyle adjustments may help a person pass the stool and prevent the issue from happening again.

In this article, we look at possible causes of large stools that are difficult to pass. We also discuss the treatment options and explain when to see a doctor.

There are many possible causes of large, painful, and hard-to-pass stools. They include:

Constipation

Constipation can cause stools that are hard to pass. The National Institute of Diabetes and Digestive and Kidney Diseases note that constipation is a common condition, affecting about 16 out of 100 adults in the United States. Among those aged 60 years and over, it affects 33 out of 100 people.

Possible causes of constipation include :

• older age
• lack of fiber in the diet
• travel
• ignoring the need to have a bowel movement
• dehydration
• lack of physical activity
• changes in diet or eating habits

The symptoms of constipation may include :

• fewer than three bowel movements in a week
• hard, dry, or lumpy stools
• difficulty passing a stool or pain on doing so
• the feeling of an incomplete bowel movement

Fecal impaction

Fecal impaction is a condition in which the body is unable to move a large, dry, hard stool through the colon or rectum.

Causes of fecal impaction can include:

• overuse of laxatives
• some types of pain medication
• lack of physical activity over an extended period
• dietary changes
• untreated constipation

The symptoms can include :

• inability to pass a stool
• stomach or back pain
• difficulty urinating
• nausea
• vomiting
• diarrhea that leaks out
• changes in breathing or heartbeat

Fecal impaction can be dangerous without treatment, so a person should seek medical help straight away if they have symptoms of fecal impaction.

Bowel obstruction

A bowel obstruction is a severe condition in which an obstruction in the intestines blocks the normal digestion process. As a result, it can be difficult or impossible to move stools through to the rectum.

Possible causes of a bowel obstruction include:

• foreign objects in the intestines
• abnormal twists or growths of the intestines
• inflammatory bowel disease
• a tumor
• scarring after surgery or infection
• a hernia

The symptoms can include :

• severe stomach pain or cramping
• vomiting
• a swollen or full-feeling stomach
• constipation
• inability to pass gas
• loud sounds coming from the stomach

A bowel obstruction is an emergency, and a person will need medical help immediately.

Hypothyroidism

In people with hypothyroidism, the thyroid is unable to produce enough of the thyroid hormones, which affects many bodily functions.

Hypothyroidism can cause constipation. Other symptoms may include :

• fatigue
• dry skin and hair
• being unable to tolerate the cold
• depression
• unexplained weight gain

Hypothyroidism is more common in females and those over the age of 60 years.

Irritable bowel syndrome (IBS)

IBS is a digestive issue that causes abdominal discomfort and frequent changes in bowel movements.

The symptoms may include :

• stomach pain
• constipation
• diarrhea
• bloating
• gas
• mucus in the stool
• headaches
• nausea
• fatigue

There is no clear cause of IBS, but triggers can include:

• stress
• certain foods or drinks
• bacterial infection or overgrowth in the gut
• mental health disorders

Encopresis

Encopresis refers to children over 4 years of age being unable to control their bowel movements. Long-term constipation usually causes encopresis. The symptoms include:

• soiling of clothing or defecating on the floor
• painful, hard-to-pass stools
• large stools that may clog the toilet
• leaking of liquid stools

Pregnancy

Constipation can be a common symptom in pregnancy, when it can be due to:

• changing hormones affecting the digestive system
• the developing baby pressing down on the intestines
• reduced physical activity
• dietary changes

People may experience:

• hard, lumpy stools
• the feeling of an incomplete bowel movement
• straining
• infrequent bowel movements

Medications

Certain medications and supplements can cause hard-to-pass stools, including :

• antiacids with aluminum and calcium
• antiseizure medications
• calcium channel blockers
• diuretics
• iron supplements
• Parkinson’s disease medications
• narcotics
• medications to treat muscle spasms
• some antidepressants

People may be able to treat large, hard-to-pass stools by making adjustments to their daily routine, such as :

• increasing fiber intake by eating more fruits, vegetables, whole grains, legumes, and nuts
• increasing water intake
• avoiding low fiber foods, such as processed and fast foods
• doing more physical activity
• allowing time to have a bowel movement at a regular time of the day
• eating meals at regular times and chewing thoroughly
• responding to any urge to go to the toilet
• avoiding straining or sitting on the toilet for too long

If people do not find these changes effective, or they have severe or additional symptoms, they may need medical treatment. Depending on the underlying cause, treatment may involve:

• laxatives, stool softeners, or fiber supplements
• prescription medication to encourage bowel movements
• biofeedback therapy to retrain the muscles responsible for bowel movements
• an enema, which is an injection of fluid or gas into the rectum to release stools
• changing an existing medication if this is a potential cause
• the manual removal of stools, if necessary
• surgery, for example, to repair the colon or treat a rectal prolapse
• therapy and positive toilet training techniques for children with encopresis
• following a specific treatment plan, for conditions such as IBS

If dietary changes are not effective during pregnancy, a person can talk with their healthcare team about which treatment options are safe.

People should see their doctor if they have symptoms of fecal impaction. Treatments may include :

• enemas or suppositories to soften the stool
• the manual removal of the stool from the rectum
• laxatives and increased water and fiber intake for prevention

It is advisable to see a doctor if at-home treatments are not effective or a person has any of the following symptoms:

• constant stomach pain
• inability to make a bowel movement, but there is leaking of liquid stool
• being unable to control bowel movements
• oily or greasy stools that are difficult to flush
• hard, black stools
• blood in stools
• bleeding from the rectum
• being unable to pass gas
• vomiting
• fever
• unintentional weight loss
• lower back pain

People should seek immediate medical attention if they have symptoms of fecal impaction or intestinal obstruction.

People may be able to treat large, hard-to-pass stools by making dietary changes and other simple lifestyle adjustments.

In some cases, hard-to-pass stools can cause serious complications if a person does not get treatment. If a medical condition is causing uncomfortable bowel movements, treating or managing the condition may help relieve the symptoms.

Large, hard-to-pass poop can be uncomfortable, but this issue may resolve with simple changes, such as increasing fiber intake, doing more physical activity, and drinking more water.

If home remedies are not effective, it is best to see a doctor for further treatment advice to prevent any complications.

Last medically reviewed on February 9, 2021

• Constipation
• Hypothyroid
• Irritable Bowel Syndrome
• GastroIntestinal / Gastroenterology
• Pregnancy / Obstetrics

How we reviewed this article:

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