Internal vs External Hemorrhoids - What's the Difference?
 |
| Internal vs External Hemorrhoids - What's the Difference? |
Personally Researched | Last Updated: July 2026 | Based on Clinical Studies & Personal Experience.
Hemorrhoids are one of the most common — and most commonly misunderstood — health complaints around.
They affect a large share of adults at some point in life, yet many people aren't sure what's actually happening in their body when symptoms show up.
Part of the confusion comes down to the fact that "hemorrhoids" isn't just one condition:
There are two distinct types, Internal and External, and they don't always look or feel the same.
Understanding which type you're dealing with matters, because it shapes what Symptoms to expect, how urgently to seek care, and which treatments are likely to help.
This guide breaks down exactly how internal and external hemorrhoids differ, what causes them, and when it's time to see a doctor.
I) Internal Hemorrhoids
Internal hemorrhoids develop inside the rectum, above the point where the anal canal has enough nerve endings to register pain.
Because of this, they usually aren't felt or seen, and many people don't realize they have them at all.
Common signs of internal hemorrhoids include:
1. Bright red blood on toilet paper or in the toilet bowl after a bowel movement2. Little to no pain, since this part of the rectum has limited pain-sensing nerves
3. A feeling of fullness or incomplete emptying after a bowel movement
4. Prolapse — when straining pushes the hemorrhoid through the anal opening, which can cause irritation, itching, and discomfort
Internal hemorrhoids are often graded on a scale from I to IV based on how much they prolapse, ranging from no prolapse at all to hemorrhoids that stay permanently outside the anus and can't be pushed back in.
Not all hemorrhoids are the same severity — see our guide on How to identify and Manage Hemorrhoid Grades, from mild Grade 1 to severe Grade 4.
II) External Hemorrhoids
External hemorrhoids form under the skin directly around the anus, an area rich in pain-sensing nerve endings.
That's the main reason external hemorrhoids tend to be far more uncomfortable than internal ones.
Common signs of external hemorrhoids include:
1. A visible or palpable lump near the anal opening2. Pain or soreness, especially during and after bowel movements or long periods of sitting
3. Itching and irritation, partly because swelling can make the area harder to keep clean
4. Swelling, and in some cases a firm, tender lump if a blood clot forms inside the hemorrhoid — known as a thrombosed hemorrhoid, which can cause sudden, sharp pain
Unlike internal hemorrhoids, external ones can usually be identified with a simple visual check, without the need for an internal exam.
Internal vs External Hemorrhoids: Key Differences at a Glance
|
Feature |
Internal Hemorrhoids |
External Hemorrhoids |
|
Location |
Inside the rectum |
Under the skin around the anus |
|
Pain |
Usually painless unless prolapsed |
Often painful, especially if clotted |
|
Visibility |
Not visible unless prolapsed |
Usually visible or felt as a lump |
|
Bleeding |
Common, often painless |
Possible, especially with irritation |
|
Diagnosis |
Requires an internal exam |
Often diagnosed by visual inspection |
What Causes Hemorrhoids
Both types share similar underlying causes, largely related to increased pressure on the veins in the rectal and anal area. Common contributors include:
1. Chronic constipation or diarrhea3. Prolonged Sitting, including long periods on the toilet
4. Pregnancy and Childbirth, due to increased pressure on pelvic veins
5. Heavy lifting
6. A low-fiber diet
7. Aging, which naturally weakens supporting tissue
Treatment Options
Mild cases of either type often improve with conservative, at-home measures such as increasing dietary fiber, drinking more water, using over-the-counter Creams or Suppositories, and taking warm Sitz Baths to ease irritation.
When symptoms are more severe or don't respond to home care, medical treatments may include rubber band ligation, sclerotherapy, infrared coagulation, or, for more advanced cases, surgical removal.
A thrombosed external hemorrhoid may sometimes need a minor in-office procedure to remove the clot and relieve pain quickly.
When to See a Doctor
While hemorrhoids are common and rarely dangerous, it's worth seeing a healthcare provider if you notice:
1. Persistent or heavy Rectal Bleeding2. A hemorrhoid that doesn't improve after a week or two of Home Treatment
3. Severe pain, especially from a hard, tender lump
4. Any change in bowel habits alongside bleeding, since these symptoms can sometimes point to other conditions that need to be ruled out
A doctor can confirm the diagnosis, rule out other causes of similar symptoms, and recommend a treatment plan suited to your specific situation.
Conclusion
Internal and external hemorrhoids may share a common cause, but they behave quite differently.
Internal hemorrhoids tend to be painless and often go unnoticed until bleeding occurs, while external hemorrhoids are more likely to cause visible swelling, itching, and pain.
Knowing which type you're dealing with — and recognizing when symptoms cross the line from mild to concerning — makes it much easier to find the right relief and know when professional care is needed.
If symptoms persist or worsen, a healthcare provider can offer an accurate diagnosis and a treatment plan tailored to you.
📑 Related Articles
🛒 Hemorrhoids Related Products
📚 Medical sources
- Mayo Clinic. "Hemorrhoids – Symptoms and Causes."
- Cleveland Clinic. "Hemorrhoids."
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Hemorrhoids."
- American Society of Colon and Rectal Surgeons (ASCRS). "Hemorrhoids Expanded Information."
- MedlinePlus (National Library of Medicine). "Hemorrhoids."
