What is the difference between external and internal hemorrhoids?

Jill E. Waldron, MD
Colorectal Surgery
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.
Dr. Michael Roizen, MD
Internal Medicine
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.

Continue Learning about Hemorrhoids

Hemorrhoids

Hemorrhoids are very common, with half of the US population over 50 having at one time consulted a doctor about these painful, itchy, sometimes bleeding bumps along the anus. They are bunches of enlarged veins, external ones that ...

you feel as bumps or internal ones that occasionally protrude through the rectum. If you strain frequently, perhaps due to constipation, or lift heavy weights you may cause them. Typical symptoms include bright red blood drops. They can make it hurt to clean properly after a bowel movement. Increasing fiber and fluid intake can help prevent hemorrhoids. Minor hemorrhoids may be treated with lubrication and use of stool softeners. Doctors may use an instrument to put rubber bands around them to make them clot or fall off, inject them with a clotting agent, use infrared light to heat clot, or surgery for removal.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.