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Common contributing factors include: Chronic constipation and straining during bowel movements Prolonged sitting on the toilet Diarrhea and frequent bowel movements Increased intra-abdominal pressure Given that Zepbound commonly causes both constipation (in approximately 16-17% of patients) and diarrhea (in about 18-24% of patients), these gastrointestinal effects could theoretically contribute to hemorrhoid development or worsening in susceptible individuals