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Internal hemorrhoids lie under the lining of the lower rectum. They become problems when they fall down into the anus (prolapse), where they get rubbed and squeezed by poop. This rubbing causes them to bleed. Sometimes internal hemorrhoids prolapse right out of the anus and may need to be pushed back inside. Internal hemorrhoids prolapse like this because we strain at stool (so avoid straining when pooping by eating enough roughage and not postponing going to the toilet). Delivering a baby also can cause prolapsing hemorrhoids. External hemorrhoids are a system of veins that lie just under the skin at the anal margin. They cause problems when they clot, or thrombose. This often happens with straining, and produces a very painful purple lump (a pile). This will gradually go away by itself, leaving a tag of stretched skin. Alternatively, the clot can be removed through a small incision.
External hemorrhoids are on the outside of the anus, while internal ones are further inside the anal canal. In this video, Jill E. Waldron, MD, colorectal surgeon at St. Mark's Hospital describes the different symptoms of these hemorrhoids.
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