The Difference Between Internal vs. External Hemorrhoids
What Are Hemorrhoids?
We are all born with hemorrhoids, which are clusters of veins that can be found just beneath the mucous membranes that line the lowest part of the rectum and the anus.2 Hemorrhoids, also known as piles, do not typically bother us unless they become swollen and enlarged.3 Once they start being painful or produce irritating symptoms, they are called symptomatic hemorrhoids.3 Symptomatic hemorrhoids can affect anyone, especially those over the age of 50.3
What Are Internal Hemorrhoids?
The type of symptomatic hemorrhoids you have depend on where they are located. Internal hemorrhoids are large, swollen veins that lie inside the rectum.1 Some people may not initially notice that they have internal hemorrhoids, as they are usually painless.2
A common symptom of this type of hemorrhoids is bleeding during bowel movements.1 You may notice blood on the toilet paper, in the toilet or even in your stool after going to the bathroom.4 Internal hemorrhoids can sometimes prolapse, in which case they may feel more painful.4 A prolapsed internal hemorrhoid can cause irritation, which will only get worse with itching and constant wiping.2
Should I Get Checked for Internal Hemorrhoids?
Hemorrhoids are rarely dangerous, but they are still worth getting checked out.1,2 Symptoms of internal hemorrhoids like rectal bleeding can overlap with other conditions, making it difficult to know what’s really causing them.
Plus, rectal bleeding shouldn’t always be assumed as a sign of internal hemorrhoids, as they can also be caused by a much more serious condition.1 Colorectal cancer and anal cancer are examples of severe conditions that can make you bleed during bowel movements.1,4
Other conditions that can cause bleeding include anal fissures, inflammatory bowel disease, diverticulosis, ulcers and large polyps.4 Getting evaluated by a doctor is especially important if your bowel habits change or if you notice any differences in the color or consistency of your stools.1
What Are External Hemorrhoids?
External hemorrhoids are swollen veins that form underneath the skin around the anus.3 You may notice hard lumps near the anus that are sore and tender.3
Unlike most cases of internal hemorrhoids, external hemorrhoids can be itchy and painful.3 The overlying skin becomes irritated and starts to erode, which is why this type of hemorrhoids can feel quite uncomfortable.2
Sometimes blood clots can form in external hemorrhoids, causing sudden and severe pain.2 Pain from external hemorrhoids can especially be felt when you sit down.3
Should I Get Checked for External Hemorrhoids?
A good reason to get checked for external hemorrhoids is to find solutions for the pain and itchiness that they may cause. External hemorrhoids are not known to cause serious problems, but some people may develop flaps of tissue that hang off the skin called skin tags.3
Skin tags occur after a blood clot dissolves and cause itching and irritation.2 While skin tags will not affect your health, they can be removed by a doctor if you wish.5
Like with internal hemorrhoids, external hemorrhoids can also cause rectal bleeding.3 If you notice any blood after wiping, it may be a good idea to speak with a doctor to be absolutely sure about the cause.
How to Diagnose Internal and External Hemorrhoids
When getting diagnosed for internal and external hemorrhoids, your doctor will ask you a few questions about your symptoms and perform a physical exam.3 External hemorrhoids are generally apparent, especially if there is a blood clot.2
Internal hemorrhoids require further examination since they are inside the rectum. You may have a digital rectal exam, where your doctor inserts a gloved, lubricated finger into the rectum to feel for swollen hemorrhoids.3
Other possible procedures include an anoscopy, which uses a lighted tube to see the lining of the anus and rectum, and a sigmoidoscopy, which uses a lighted tube with a camera to look into the lower part of the colon and rectum.3 If your doctor decides to check for symptoms of other possible conditions, they may perform a colonoscopy.3
How to Treat Internal and External Hemorrhoids
Internal and external hemorrhoid symptoms can be treated from home.3 Drinking more water and increasing your fiber intake are good lifestyle changes that can help ease symptoms.3
You can also apply over-the-counter products that contain lidocaine, witch hazel or hydrocortisone to your affected areas for relief from pain and discomfort.3 Preparation H Rapid Relief with Lidocaine Cream is a quick way to numb painful hemorrhoid symptoms. For a discreet, on-the-go solution, try Preparation H Soothing Relief Cleansing & Cooling Wipes. Each flushable, biodegradable wipe contains witch hazel to keep your butt feeling cool and clean.
If your internal or external hemorrhoid symptoms interfere with your daily life, your doctor may recommend additional treatment solutions, such as rubber band litigation or electrocoagulation.3 Surgical treatments are also available for those who need it.3
- Hemorrhoids. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268 Accessed 8/10/2022.
- Hemorrhoids and what to do about them. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them Accessed 8/10/2022.
- Hemorrhoids. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15120-hemorrhoids Accessed 8/10/2022.
- Rectal Bleeding. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/14612-rectal-bleeding Accessed 8/11/2022.
- Skin Tags (Acrochordons). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21528-skin-tags-acrochordons Accessed 8/11/2022.