You get it from the different forms of straining, from all of the above that others have said, even consistent coughing. I've had it before, dumps were terrible coming every few days (probably my very low veggie consumption). I've had it for years and it I recently started going once or twice a day because of the intake of more veggies, starches, and cultured foods. You just have to stimulate your system with not only fiber but good bacteria and water. You can only remove it surgically or it can burst accidentally but the best step is to just improve your eating habits, also if you can't get it brown stuff out just give up and try again when you really need to go. One important thing to remember is, when you go poop, get a box and put your feet on it to simulate squatting, this is a very natural form for bowel movements and will put less strain.