Probiotics for hemorrhoids: do they help?

Probiotics for hemorrhoids get recommended because constipation and straining are among the main causes of hemorrhoids, and probiotics are sold for gut health. The catch is that nobody has tested them on hemorrhoids. A PubMed search we ran in October 2026 for probiotics and hemorrhoids turned up no randomized trial.

What does exist is a fair amount of constipation research. It shows that some probiotics speed things up a little and add roughly one bowel movement a week, while others do nothing. That can matter if hard stools keep setting off your flares. This page walks through those trials, compares them with fiber, and explains how to try a probiotic sensibly. The rest of the natural options are graded in natural remedies for hemorrhoids.

Do probiotics help hemorrhoids?

Only indirectly, if at all. The logic runs like this: hard stools and straining make hemorrhoids swell and bleed, so anything that softens stools or makes them more regular could help. Probiotics have modest evidence for that first step. They have none for the hemorrhoid itself.

What the constipation trials found

The 2022 review

The largest, a 2022 review of probiotics for chronic constipation, pooled 30 randomized trials of probiotics in adults with chronic constipation ¹. Overall, 57 percent of people responded to probiotics and 44 percent responded to a control ¹. Probiotics increased how often people had bowel movements and improved overall symptom scores, but they did not change stool consistency ¹.

Strain mattered. Bifidobacterium lactis helped, while mixtures of probiotics, Bacillus coagulans Unique IS2 and Lactobacillus casei Shirota did not, in that analysis ¹. Synbiotics, products that pair a probiotic with a fiber-like food for the bacteria, did not help ¹. The authors called this “cautious optimism” and warned that the trials varied a lot and had a high risk of bias ¹.

The earlier reviews

A 2014 review of 14 probiotic trials in 1,182 adults found probiotics shortened gut transit time by about 12.4 hours and added about 1.3 bowel movements a week ². They also softened stools ². Again, B. lactis drove the benefit and L. casei Shirota did not ². No serious side effects were reported, and bias in the trials was high ².

A 2020 review of 15 trials came to a slightly different answer. Probiotics shortened transit time by about 13.75 hours and added about one bowel movement a week, but in that analysis the benefit came from products with two or more strains, and B. lactis alone did not reach significance ³. Multi-strain products also eased bloating ³.

The British Dietetic Association drew on these kinds of reviews for its 2025 constipation guideline, which made 20 recommendation statements about probiotics alongside statements on fiber, kiwifruit, prunes and other foods ⁴. Most of its statements rested on low or very low quality evidence ⁴.

Probiotics or fiber?

Fiber wins on evidence. A review of 16 fiber trials in chronic constipation found 66 percent of people responded to fiber against 41 percent on control, with psyllium among the fibers that worked ⁶. Higher doses, more than 10 grams a day, and at least 4 weeks of use gave the clearest results, and gas was the main downside ⁶.

More to the point, fiber has trials in people with hemorrhoids. In seven of them, fiber halved the risk of bleeding and lowered the chance of symptoms persisting by 47 percent ⁷. Probiotics have nothing comparable.

Food-based options also beat probiotics for evidence. In a trial of US adults with chronic constipation, two kiwifruits a day, 100 grams of prunes a day and 12 grams of psyllium a day all improved straining over 4 weeks ⁹. Water matters too: with fiber intake held steady, drinking about 2 liters a day raised stool frequency more than about 1 liter ⁸.

How fiber, stool softeners and laxatives compare is in stool softener, fiber or laxative. Fiber powders and capsules are compared on the best fiber supplements for hemorrhoids.

How to try a probiotic for constipation

If fiber and water have not fully fixed your constipation, a probiotic is a reasonable experiment.

1. Keep fiber and water steady, so you can tell what the probiotic adds.
2. Pick a product that lists its strains and dose. B. lactis or a multi-strain product matches the trials that worked best ^1,2,3.
3. Take it daily at the labeled dose for about 4 weeks.
4. Keep a simple log: bowel movements per week, straining, and any flare.
5. Stop if it gives you bloating that does not settle or loose stools.
6. If nothing has changed after 4 weeks, stop paying for it.

Are probiotics safe?

The NIH center for complementary health says probiotics have an extensive history of apparently safe use, particularly in healthy people ⁵. It also notes that few studies have looked at safety in detail, that the risk of harm is greater in people with severe illness or weakened immune systems, and that some products have been found to contain microorganisms other than those on the label ⁵. Probiotic supplements do not need FDA approval before they are sold ⁵.

Ask your doctor before taking probiotics if you are seriously ill or have a weakened immune system.

When constipation and hemorrhoids need a doctor

MedlinePlus advises seeing a clinician when home care has not helped a hemorrhoid after a week, and says rectal bleeding should be checked because hemorrhoids are only one cause ¹⁰. Colon cancer screening is recommended from age 45 for adults at average risk ¹¹. Daily habits that stop constipation coming back are in how to prevent hemorrhoids and the hemorrhoid diet.