Are you having issues with rectal bleeding, itching, pain, or other common hemorrhoid symptoms? If so, you might wonder if those symptoms are a sign of internal or external hemorrhoids.
Hemorrhoids are swollen blood vessels in the rectum or under the skin surrounding the anus. Where they form determines whether they are external or internal hemorrhoids.
Although both types of hemorrhoids have the same cause, they can produce different symptoms. There are also varying treatments for internal vs. external hemorrhoids.
Understanding the differences can help you determine what to do next and when to see a hemorrhoid specialist. This guide will answer all your questions about how internal and external hemorrhoids differ, including symptoms and treatment options.
What Are Hemorrhoids?
Hemorrhoids are swollen clusters or ‘piles’ of blood vessels, smooth muscle, and connective tissue. They can be very painful and physically uncomfortable—and even a little embarrassing to talk about.
However, the reality is that most people have hemorrhoids at some point in their lives. One study found that roughly 11% of the adult population suffers from hemorrhoids at any point in time. (1) It’s estimated that by age 50, one in two adults in the US has dealt with hemorrhoid symptoms, such as anal itching, bleeding during bowel movements, or pain. (2)
Hemorrhoids develop because of excess pressure from straining during bowel movements, often due to constipation. A lack of blood flow from prolonged sitting can also cause hemorrhoids, as clusters of blood vessels and connective tissue become swollen and enlarged. Additionally, lifestyle factors, such as diet, weight, and exercise, can also lead to hemorrhoids. It’s important to consult a hemorrhoid specialist to ensure an accurate diagnosis for the cause, type, and management plan for hemorrhoids.
Depending on whether the hemorrhoids are external or internal, you might experience different symptoms. Regardless, it’s important not to leave hemorrhoids untreated.
Internal Hemorrhoids
Internal hemorrhoids occur in the lower rectum, inside the anal cavity, making them invisible from the outside.
A person with an internal hemorrhoid might notice bright red blood on their toilet paper or in their stool. They may not experience pain as there are fewer sensory nerves in the rectal area.
However, an internal hemorrhoid can cause pain or irritation if it pushes through the anal opening, a condition known as prolapse. A prolapsed hemorrhoid occurs when the connective tissue holding the blood vessels in place can no longer support them, causing a small lump to form at the anus.
External Hemorrhoids
External hemorrhoids develop around the anus. Compared to internal hemorrhoids, external ones are more likely to cause pain and discomfort because there are more pain-sensing nerves under the skin near the anus.
Other possible symptoms include:
- Swelling around the anus
- Itching
- Bleeding
- Lumps
- Pain or discomfort
External hemorrhoids can cause severe pain if a clot develops A hemorrhoid with a blood clot is called a thrombosed hemorrhoid. This can also occur with internal hemorrhoids but is not as common. It looks like a hard lump near the anus and can cause swelling and inflammation that makes sitting extremely uncomfortable.
Diagnosing External vs. Internal Hemorrhoids
A hemorrhoid doctor will review your medical history to determine whether external or internal hemorrhoids are causing symptoms. They will ask about your eating and toilet habits and any existing medical conditions.
An interventional radiologist, also known as a hemorrhoid doctor, will also perform an exam:
- To diagnose external hemorrhoids, the doctor will examine the area around the anus, assessing any existing lumps to make a diagnosis.
- Diagnosing internal hemorrhoids is more complex because they occur inside the rectum and are not visible. The doctor will perform a digital rectal exam using ultrasound imaging technology.
Treating External vs. Internal Hemorrhoids
Treatment for internal hemorrhoids differs from the treatment for external hemorrhoids.
External hemorrhoids are often easier to treat. Home treatments can often provide temporary relief from hemorrhoids within a couple of weeks, such as:
- Sitting in a warm bath can relieve pain and discomfort.
- Eating more fiber and drinking more water can help loosen your stool, preventing further straining.
- Topical creams or ointments for hemorrhoids can ease itching and swelling.
Internal hemorrhoids are more likely to require medical treatment. Some mild hemorrhoids can be temporarily relieved through home remedies, but a medical diagnosis and treatment plan from a hemorrhoid specialist are recommended. If you still notice symptoms after a few days, it’s important to see a hemorrhoid doctor.
There are several treatments for internal hemorrhoids, including surgical removal and non-surgical procedures that can effectively relieve symptoms.
- Hemorrhoid artery embolization (HAE) is a non-surgical procedure that shrinks existing hemorrhoids by stopping blood flow to the pile. It’s a good option for people who want to avoid the pain and discomfort associated with other treatments.
- Hemorrhoidectomy is surgical hemorrhoid removal. This procedure does come with some risks, including bleeding post-treatment, so it’s usually only recommended for severe cases.
- Rubber band ligation involves tying rubber bands around internal hemorrhoids, which causes them to fall off. This procedure can be painful, and some may experience post-treatment discomfort.
- Sclerotherapy involves injecting a medical solution into the hemorrhoids, which stops blood from reaching the hemorrhoid, causing it to shrink.
When to See a Doctor for Hemorrhoids
If hemorrhoid symptoms persist for more than one week or if you have severe pain or bleeding, you should see a doctor for a diagnosis and to learn about your treatment options.
USA Hemorrhoid Centers is a leading network of outpatient hemorrhoid treatment centers. We offer non-surgical hemorrhoid treatment and personalized treatment plans. Schedule a consultation at a location near you today and find out how we can help you get back to living hemorrhoid-free.
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FAQs
How do you know if you have an internal or external hemorrhoid?
If a hemorrhoid is under the skin around your anus and is painful, it’s likely an external hemorrhoid.
An internal hemorrhoid is more difficult to identify. You can’t see or feel the lump. Also, blood in the stool could be caused by a more serious health condition, such as inflammatory bowel disease or colon cancer. It’s not always clear whether bleeding is related to hemorrhoids.
To find out for certain if you have internal hemorrhoids, external hemorrhoids, or both, schedule a consultation with a hemorrhoid specialist near you.
Can external hemorrhoids become internal?
External hemorrhoids can’t become internal hemorrhoids. However, a prolapsed hemorrhoid, which is an internal hemorrhoid that bulges outside of the anus, may go back inside on its own.
Can you have both internal and external hemorrhoids at the same time?
Yes, you can have internal and external hemorrhoids at the same time. That can make it more difficult to figure out if your symptoms are caused by one type of hemorrhoid or another. A hemorrhoid doctor can give you an accurate diagnosis and recommend a treatment plan for the specific types of hemorrhoids you have.
Internal vs. external hemorrhoids: which are worse?
External hemorrhoids can cause more discomfort. They can lead to itching, swelling, and pain, as well as bleeding. Internal hemorrhoids aren’t always painful. However, they can be harder to get rid of. People with moderate to severe internal hemorrhoids may require medical treatment to help alleviate their symptoms.
Are external or internal hemorrhoids more common?
External hemorrhoids are more common than internal hemorrhoids.
References:
- Sheikh, Parvez et al. The prevalence, characteristics and treatment of hemorrhoidal disease: results of an international web-based survey.Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2020-0159
- LeWine, Howard E. MD. Hemorrhoids and what to do about them. Harvard Health Publishing. www.health.harvard.edu/diseases-and-conditions
