Internal vs External Hemorrhoids

Internal or external hemorrhoids? Hemorrhoids are a pain in the you know what. Literally.

But there are several ways to treat this common condition. Before you decide how to treat the problem, it’s important to understand the signs and symptoms of hemorrhoids to be sure you have properly self-diagnosed.

In some cases, it may be necessary to seek medical attention.

When it comes to hemorrhoids, it’s also important to understand the causes. This will help you reduce your risk and prevent future recurrence once your hemorrhoids have healed.

Let’s take a closer look at everything you need to know about hemorrhoids.

How Do You Know If You Have Internal or External Hemorrhoids?

Hemorrhoids fall into one of two categories. They can be internal or external. The two types of hemorrhoids present themselves differently, so it’s easy to tell whether you have internal or external hemorrhoids.

Internal hemorrhoids are located far enough inside the rectum that they can go without notice.

In fact, most cases of internal hemorrhoids go undetected because they present no symptoms at all. Internal hemorrhoids cannot be seen or felt unless they become prolapsed.

They don’t usually hurt because they are located in an area of the rectum that is void of pain-sensing nerves. The most common sign of internal hemorrhoids is painless bleeding.

External hemorrhoids are very different from internal. They are commonly associated with the bothersome symptoms you hear about with hemorrhoids. External hemorrhoids are located under the skin around the opening of the anus.

They appear as pillow-like lumps.

They may cause symptoms such as pain, bleeding, itching, and discomfort.

Do Internal Hemorrhoids Hurt More Than External Hemorrhoids?

Internal hemorrhoids do not generally hurt more than external hemorrhoids. Since they are located deeper inside the anus, internal hemorrhoids are located in an area that is free from pain-sensing nerves.

In most cases, internal hemorrhoids may come and go without a patient even realizing they are there.

The only symptom patients frequently report are painless bleeding.

External hemorrhoids, on the other hand, are often associated with pain. In some cases, they are associated with severe pain. Bowel movements can be particularly painful as you try to pass stool through this sensitive area of the anus.

Because they are commonly associated with pain, there are a variety of products available that work to treat the symptoms of external hemorrhoids.

Internal vs. External Hemorrhoids Symptoms

Common internal hemorrhoid symptoms are:

• Painless bleeding
• Itching in the anal area
• Leaking feces
• A large lump protruding from the anus that can either simultaneously retract inside on its own, be pushed back in manually, or require surgery

Common external hemorrhoid symptoms are:

• Bleeding
• Itching
• Burning
• Discomfort
• Swelling around the anus
• Irritation
• A lump near your anus

Internal vs. External Hemorrhoids Anatomy

Hemorrhoids are clusters of vascular tissue, smooth muscle, and connective tissue lined by the normal epithelium of the anal canal.

Everyone has hemorrhoids, they develop at birth, but symptomatic hemorrhoids are those whose veins become swollen.

The bleeding commonly associated with hemorrhoids is not generally dangerous because it is arterial.

In terms of anatomy, external hemorrhoids develop from ectoderm and are covered by the squamous epithelium. They are associated with highly sensitive nerves that lead to the symptoms of pain. 

Internal hemorrhoids come from embryonic endoderm and are lined with the columnar epithelium of anal mucosa. Internal hemorrhoids have three main cushions in the left lateral, right posterior, and right anterior areas of the anal canal.

Internal vs. External Hemorrhoids Pictures

Internal hemorrhoids can progress in severity to the point where they become prolapsed. They are classified by one of four grades of severity.

The following graphic represented the different stages of progression for internal hemorrhoids.

External hemorrhoids appear at the opening of the anus, as shown in the graphic below.

Internal vs. External Hemorrhoids Surgery

When it comes to hemorrhoid surgery, there are several options. The most common surgical procedures for external hemorrhoids are:

Banding- This non-invasive procedure is often used to treat internal hemorrhoids. It is also referred to as a rubber band ligation. This procedure involves the use of a tight band placed around the based of the hemorrhoid to cut off its blood supply. In some cases, this procedure requires two or more office visits for effectiveness.

Sclerotherapy- This non-invasive procedure involves the injection of a chemical into the hemorrhoid. The chemical causes the hemorrhoid to shrink and resolve.

Hemorrhoidectomy- This surgical procedure is done under anesthesia at a hospital or surgical center. It is often used for large external hemorrhoids or prolapsed internal hemorrhoids. Once under anesthesia, the surgeon places an incision in the hemorrhoid and cuts it out. The incision is then stitched and you are sent home.

Hemorrhoidopexy- This is also referred to as surgical stapling. It is also done under anesthesia. Stapling is most commonly used to treat prolapsed hemorrhoids. During the surgery, a surgical staple is used to fix the prolapsed hemorrhoid back into place inside the rectum. This cuts off the blood supply to the hemorrhoid so that the tissue shrinks and is reabsorbed.