What Are Internal Hemorrhoids?

Internal hemorrhoids are swollen blood vessels inside your lower rectum. They develop when pressure builds up in the veins of that area, causing them to enlarge and become irritated. Unlike external hemorrhoids, which form under the skin around your anus and are visible, internal hemorrhoids are located deep inside your rectum, where you cannot see them directly.

Many people with internal hemorrhoids don’t realize they have them because they may cause no symptoms at all. When symptoms do appear, they can include bright red bleeding, itching, or a sensation of pressure. The challenge is that these symptoms alone cannot tell you how severe your hemorrhoids are or whether they need treatment.

Signs You Might Have Internal Hemorrhoids

If you’re experiencing certain symptoms, internal hemorrhoids could be the cause. But remember: these same symptoms can come from other conditions, so professional evaluation is important for accurate diagnosis.

Bright Red Bleeding

One of the most recognizable signs is bright red blood. You might notice it on toilet paper after wiping, in the toilet bowl, or occasionally in your stool. This bleeding can happen when you strain during a bowel movement or when hemorrhoidal tissue becomes irritated.

Important: While bright red bleeding suggests hemorrhoids, rectal bleeding also occurs with colon polyps, anal fissures, inflammatory bowel disease, and colorectal cancer. Never assume bleeding is from hemorrhoids without professional evaluation.

Anal Itching or Irritation

Many people with internal hemorrhoids experience itching in the anal area. This can happen because enlarged hemorrhoids produce mucus that irritates the surrounding skin. The itching may get worse at night or after bowel movements.

Feeling of Fullness or Pressure

Some patients report a sensation of fullness, pressure, or incompleteness after having a bowel movement, even though they’ve gone to the bathroom. This feeling may suggest internal hemorrhoids but can also indicate other rectal conditions.

Mucus Discharge

Enlarged internal hemorrhoids can leak mucus, which sometimes causes discomfort or moisture around the anus. This mucus discharge is a real symptom but isn’t unique to hemorrhoids and can have other causes.

What You Can See vs What You Can’t

Understanding the difference between what you can observe and what requires professional examination helps explain why self-diagnosis is unreliable for internal hemorrhoids.

External Hemorrhoids (Visible)

External hemorrhoids develop under the skin around your anus and are technically visible or palpable if they’re present. You might notice a small lump, swelling, or feel tenderness when wiping or sitting. External hemorrhoids are easier to self-identify because you can actually see or feel them. However, even with external hemorrhoids, professional evaluation helps determine severity and whether treatment is needed.

Internal Hemorrhoids (Invisible)

Here’s the fundamental limitation: internal hemorrhoids are inside your rectum, where you cannot see them. You can observe symptoms they cause (bleeding, itching, pressure), but you cannot see the hemorrhoids themselves. This means you cannot assess:

• Size — whether they’re small, moderate, or large
• Prolapse status — whether they’re protruding
• Severity grade — doctors use a 4-grade classification system
• Treatment appropriateness — whether they require professional intervention

When Prolapsed Hemorrhoids Might Show Symptoms

The one exception: if an internal hemorrhoid prolapses (stretches and pushes through the anal opening), you might feel it or see it. Prolapsed hemorrhoids may feel like tissue protruding outside your anus. Even in this case, you cannot determine how severe the prolapse is or what treatment is best without professional examination.

Limitations of Self-Checking

Why Internal Hemorrhoids Are Difficult to Self-Diagnose

Professional doctors use specialized instruments like anoscopes (lighted tubes inserted into the anal canal) to see internal hemorrhoids directly. These tools let doctors assess size, location, and severity. At home, you cannot replicate this examination, no matter how carefully you try. The anatomy simply doesn’t allow self-visualization of internal structures.

Severity vs Symptoms Don’t Always Match

Here’s a fact that surprises many patients: symptom intensity doesn’t always match hemorrhoid size. A small internal hemorrhoid might bleed noticeably, while a larger one might cause minimal symptoms. Conversely, a small external hemorrhoid that becomes thrombosed (clotted) can be extremely painful despite being relatively small. This means you cannot estimate how serious your hemorrhoids are based on how much they hurt or bleed. Professional grading is necessary.

Other Conditions That Mimic Hemorrhoids

Rectal bleeding, itching, pain, and pressure can come from various conditions including anal fissures (tears in the anal lining), inflammatory bowel disease (Crohn’s disease or ulcerative colitis), intestinal polyps, colorectal cancer, infections or abscesses, and diverticulitis. While hemorrhoids are common, so are these other conditions. Professional evaluation rules out serious diagnoses that self-assessment cannot.

When to Schedule Professional Evaluation

Red Flags That Warrant Medical Attention

You should see a doctor if you experience:

• Persistent rectal bleeding — bleeding that continues beyond a few days
• Heavy bleeding — or bleeding with multiple bowel movements
• Severe pain — or sudden pain in the anal area
• Worsening symptoms — pain or bleeding that gets worse or changes
• Prolapsing tissue — feeling a lump that won’t go back inside
• Concern about other diagnoses — when you’re unsure what’s causing symptoms

How Long to Wait Before Seeing a Doctor

If you have mild symptoms (slight itching or occasional light bleeding) and suspect hemorrhoids, you can try home remedies like sitz baths, increased fiber, and hydration for about one week. However, if symptoms persist beyond one week, persist despite home care attempts, or are severe, schedule an evaluation. Early diagnosis prevents complications and gives you more treatment options.

What Professional Diagnosis Involves

Professional evaluation is straightforward and quick. Your doctor will:

• Ask about symptoms — discuss when symptoms started and what makes them better or worse
• Review medical history — understand your health background and any relevant conditions
• Perform visual exam — look at your anal area for signs of external hemorrhoids
• Digital rectal exam — gently insert a gloved finger to check for internal abnormalities
• Use anoscope if needed — insert a small lighted tube to visualize internal tissue directly

How USA Hemorrhoid Centers Diagnoses Hemorrhoids

At USA Hemorrhoid Centers, our interventional radiologists specialize in accurate hemorrhoid diagnosis and personalized treatment planning. We use advanced imaging and examination techniques to determine hemorrhoid type (internal or external), severity grade (1-4 scale), whether hemorrhoids are responsive to non-surgical options, and whether you’re a candidate for minimally invasive treatment options like Hemorrhoid Artery Embolization (HAE).

Professional diagnosis is the foundation for effective treatment and lasting symptom relief. With an accurate diagnosis, you’ll understand what you’re dealing with, know whether treatment is appropriate, and be able to make informed decisions about your care.