External Vs. Internal Hemorrhoids

What Are Internal and External Hemorrhoids?

Hemorrhoids are swollen blood vessels in the lower rectum and around the anus. Everyone has this tissue. It only causes problems when it swells and stretches. Doctors call a hemorrhoid “internal” or “external” based on where it sits.

The anal canal has a boundary called the dentate line. Internal hemorrhoids form above this line, inside the rectum. This area has fewer nerves, so pain is less common. External hemorrhoids form below the line, under the skin near the anus. This area has more nerves, so these hemorrhoids are more likely to hurt. Some people have both types at once. This is called a mixed hemorrhoid.¹

Internal Hemorrhoid Symptoms vs. External Hemorrhoid Symptoms

Location determines how hemorrhoids feel and behave. Symptoms can be very different. It depends on whether a hemorrhoid is inside the rectum or under the skin outside it.

Internal Hemorrhoid Symptoms

Internal hemorrhoids usually do not hurt. This is because the rectum has fewer nerve endings. The most common sign is bright red blood. You may see it on toilet paper or in the toilet after a bowel movement. As internal hemorrhoids grow, they can push through the anus. This is called a prolapse. A prolapsed hemorrhoid can cause irritation, mucus, or a feeling that you still need to go.

External Hemorrhoid Symptoms

External hemorrhoids sit in skin with many more nerves. This makes them more likely to itch, swell, and hurt, especially when you sit. Sometimes a blood clot forms inside an external hemorrhoid. This is called a thrombosed hemorrhoid. It can cause sudden, sharp pain and a hard lump near the anus.

What Causes Hemorrhoids to Develop?

Internal and external hemorrhoids usually have the same causes. Extra pressure on the veins can make them swell over time. Common causes include:

• Straining on the toilet: often tied to hard or loose stools
• Pregnancy and childbirth: these add pressure to veins near the pelvis
• Sitting too long: at work, or on the toilet
• Low fiber intake: this can make stool harder to pass
• Getting older: tissue in this area weakens over time
• Family history: this may raise your own risk²

How Are Internal Hemorrhoids Diagnosed and Treated?

A hemorrhoid specialist will ask about your symptoms first. They will also ask about your bowel habits and health history. External hemorrhoids are easy to see on a simple exam. Internal hemorrhoids are harder to find. Your doctor may use a rectal exam or a small scope to get a clear view.

Mild symptoms of either type may get better with more fiber, more fluids, and less straining. If internal hemorrhoid symptoms do not improve, like ongoing bleeding or prolapse, it may be time to talk with a specialist.

USA Hemorrhoid Centers offers Hemorrhoid Artery Embolization for internal hemorrhoids. HAE is a minimally invasive, outpatient procedure. It lowers blood flow to the hemorrhoid so it can shrink over time. An experienced interventional radiologist performs HAE. It does not need general anesthesia or an overnight stay. External hemorrhoids form in different tissue, so they are treated on their own. A colorectal specialist can help if external symptoms do not improve.

Learn About HAE

When to See a Hemorrhoid Specialist

Mild symptoms often settle down on their own. Simple changes at home can help. See a hemorrhoid specialist if you notice:

• Bleeding that lasts more than a week, or keeps coming back
• A hemorrhoid that will not go back in on its own
• Pain that gets in the way of sitting or daily life
• A lump that is new or growing, or has a different look than before

Do not assume bleeding is from hemorrhoids without a checkup. Other issues can look similar. Knowing which type you have helps you and your doctor pick the right next step. That might mean HAE for internal hemorrhoids, or a referral for external hemorrhoid care.