Internal Versus External Hemorrhoids: How to Tell the Difference

Hemorrhoids are a painful medical problem for millions of Americans, and they become more common with age. In fact, after you reach age 50, you have a 50% chance of having at least one painful hemorrhoid.

Hemorrhoids can happen for different reasons and cause a variety of symptoms, but in general, all hemorrhoids fall into one of two groups: internal hemorrhoids and external hemorrhoids. This key difference affects treatment, including both at-home, DIY options and medical treatments that offer a more permanent solution.

Our top-ranked colorectal surgeon in Deerfield Beach, Florida, Michael H. Tarlowe, MD, is skilled in diagnosing hemorrhoids and providing advanced hemorrhoid treatment options to relieve symptoms and improve your overall health. 

In this post, we explain all you need to know about internal and external hemorrhoids, including their symptoms and how they’re treated.

Internal vs. external hemorrhoids: Signs and symptoms

Both internal hemorrhoids and external hemorrhoids are swollen veins that form in or near the rectum and anus. While they may have similar underlying causes, the symptoms they cause can vary significantly, and taking note of those symptoms can help you determine which type of hemorrhoid you have.

External hemorrhoids

An external hemorrhoid affects the blood vessels outside the anus. These hemorrhoids feel like lumps near the anal opening. 

External hemorrhoids can become sore and painful, particularly after a bowel movement. They also tend to bleed frequently, particularly when wiping after a bowel movement. External hemorrhoids can become irritated easily, causing persistent itching or burning sensations following a bowel movement or even when sitting for a long time. 

Internal hemorrhoids

Internal hemorrhoids form inside the rectum near the anus. Because they’re located inside, you won’t be able to feel them like you can touch an external hemorrhoid. 

Unlike external hemorrhoids, internal hemorrhoids rarely cause pain unless they become very swollen. However, internal hemorrhoids can still cause bleeding, particularly when you move your bowels. 

If an internal hemorrhoid becomes extremely swollen, it may “prolapse” or extend outside the anus when you move your bowels. Prolapsed hemorrhoids can be extremely painful, and like external hemorrhoids, they can cause itching and burning sensations, too. Unlike an external hemorrhoid that remains outside your anus, prolapsed hemorrhoids often retract (go back inside) your rectum shortly after you have a bowel movement.

Treating hemorrhoids

Hemorrhoids are associated with risk factors like chronic constipation, straining to move your bowels, being overweight or obese, and spending a lot of time sitting or standing. Some people find relief for mild hemorrhoids by incorporating lifestyle changes, like:

• Eating more fiber
• Using stool softeners
• Losing weight
• Taking breaks from sitting or standing at work
• Being more physically active
• Drinking more fluids
• Taking fiber supplements

Using an ice pack, taking a sitz bath, or applying topical creams and ointments may provide relief for mild symptoms, but more severe or chronic symptoms typically require medical intervention.

Dr. Tarlowe offers several treatments based on the type of hemorrhoid you have, its symptoms, and other factors. These treatments include rubber band ligation, clot removal, injections, and hemorrhoidectomy.

Rubber band ligation

In this approach, Dr. Tarlowe places a special surgical rubber band around the hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off on its own over time, leaving behind a scar that helps prevent future hemorrhoids.

Clot removal

Sometimes, an internal or external hemorrhoid develops a blood clot (thrombosis). These thrombosed hemorrhoids can be extremely painful. In these instances, Dr. Tarlowe uses special techniques to remove the clot and relieve the painful symptoms it’s causing.

Injections

For internal hemorrhoids that cause significant bleeding, Dr. Tarlowe may recommend injections to block the vessels associated with bleeding. Injections can be a good solution for patients on blood thinners, since there’s no bleeding afterward.

Hemorrhoidectomy (hemorrhoid removal)

Hemorrhoidectomy is performed using sedation and a local anesthetic to keep you comfortable. During the procedure, Dr. Tarlowe surgically removes the hemorrhoid to relieve symptoms permanently. 

Find relief for your hemorrhoid symptoms

It’s important to note that while bleeding and lumps are common hemorrhoid symptoms, they can also be caused by cancer. If you have any type of persistent rectal bleeding, pain, or other symptoms, you should schedule an evaluation as soon as possible to determine the cause.

To learn more about hemorrhoids and the treatments that can provide you with relief, call 954-210-7127 or request an appointment online with Dr. Tarlowe in Deerfield Beach, Florida.