Hemorrhoids: Internal vs. External Symptoms and Effective Treatments

Hemorrhoids: Internal vs. External Symptoms and Effective Treatments Sep, 1 2026

You’re sitting on the toilet, scrolling through your phone, and suddenly you notice bright red blood on the paper. Panic sets in. Is it serious? Do you need surgery? Most people assume it’s just a flare-up of hemorrhoids, which is likely correct. About 75% of adults will deal with this issue at some point. But here’s the thing: not all hemorrhoids are created equal. Knowing whether you have internal or external hemorrhoids changes everything about how you treat them and what to expect.

What Are Hemorrhoids Really?

Before we get into the types, let’s clear up a misconception. Hemorrhoids aren’t always "bad." Everyone has hemorrhoidal tissue-it’s a set of vascular cushions in the anal canal that help you control stool and gas. Problems start when these veins swell due to increased pressure. Think of them like varicose veins, but in your backside. The American Society of Colon and Rectal Surgeons notes that while they’ve been documented since ancient Egypt (the Ebers Papyrus from 1550 BCE mentions them), modern medicine classifies them based on location relative to the dentate line.

Hemorrhoid Types Comparison
Feature Internal Hemorrhoids External Hemorrhoids
Location Above the dentate line, inside the rectum Below the dentate line, under the skin around the anus
Pain Sensitivity Low (mucosa lacks pain receptors) High (rich nerve endings)
Primary Symptom Bright red bleeding, prolapse Itching, swelling, visible lumps, pain
Visibility Invisible unless prolapsed Visible as soft or firm lumps

Spotting Internal Hemorrhoids

Internal hemorrhoids form inside the rectum. Because this area doesn’t have many pain sensors, you often won’t feel them until they cause trouble. The classic sign is painless, bright red blood on your toilet paper or in the bowl. You might also feel a sense of fullness or like you haven’t fully emptied your bowels. Doctors grade internal hemorrhoids from I to IV based on how much they prolapse (slip out):

  • Grade I: Bleeding only, no prolapse.
  • Grade II: They pop out during straining but go back in on their own.
  • Grade III: They pop out and you have to push them back in with a finger.
  • Grade IV: They stay out permanently and can’t be pushed back.
If you’re seeing blood but feeling little pain, it’s likely an internal issue. However, don’t ignore it. Persistent bleeding needs checking to rule out other conditions like polyps or colorectal cancer.

The Painful Reality of External Hemorrhoids

External hemorrhoids develop under the sensitive skin around the anus. This area is packed with nerve endings, so even minor swelling hurts. You’ll likely feel itching, irritation, and tender lumps that make sitting uncomfortable. These lumps are usually skin-colored and soft, but if a clot forms inside, they become thrombosed. Thrombosed external hemorrhoids are nasty. A blood clot forms quickly, turning the lump purple or blue and causing sudden, severe pain. It feels like a hard pea under the skin. Unlike internal ones, you can see and feel these easily. If you have both types simultaneously-which is common-symptoms can blend, making self-diagnosis tricky.

Illustrated cross-section showing internal and external hemorrhoid locations.

Why Do They Happen?

Pressure is the enemy. Anything that strains the pelvic floor contributes. Common culprits include:

  • Chronic Constipation: Straining to pass hard stools puts massive pressure on rectal veins.
  • Toilet Habits: Sitting on the toilet for 20 minutes reading news lets gravity pool blood in those veins.
  • Pregnancy: Up to 35% of pregnant women develop hemorrhoids due to uterine pressure on pelvic veins.
  • Lifting: Heavy weightlifting without proper breathing techniques spikes abdominal pressure.
In Calgary, where winters keep us indoors and sometimes less active, constipation rates can climb. Dehydration from dry indoor heating also hardens stool, creating a perfect storm for flare-ups.

Treating Mild Cases at Home

For Grade I or mild external hemorrhoids, home care works wonders. The goal is to reduce inflammation and soften stools.

  • Fiber is King: Aim for 25-30 grams daily. Add oats, beans, or psyllium husk supplements. Fiber absorbs water, keeping stools soft and easy to pass.
  • Hydration: Drink at least 8 glasses of water. Fiber without water creates concrete-like stool, worsening the problem.
  • Sitz Baths: Soak your bottom in warm water for 15-20 minutes, two or three times a day. This relaxes the sphincter muscle and improves blood flow.
  • Topical Relief: Over-the-counter creams with hydrocortisone or witch hazel pads can soothe itching and shrink swollen tissue temporarily.
Pro tip: Use a small footstool to elevate your knees above your hips while pooping. This mimics a squatting position, straightening the rectum and reducing strain by about 30%.

Person using a footstool for posture with healthy food nearby.

When to See a Doctor

Home remedies fail when hemorrhoids are advanced or complicated. Seek professional help if:

  • Bleeding persists for more than a week.
  • You experience dizziness or fatigue (signs of significant blood loss).
  • Pain becomes unmanageable despite OTC meds.
  • You suspect a thrombosed hemorrhoid (severe sudden pain).
Don’t wait months. Studies show nearly 70% of patients delay seeking care due to embarrassment, but early intervention prevents invasive procedures later.

Medical Procedures That Actually Work

If lifestyle changes don’t cut it, doctors offer minimally invasive options for internal hemorrhoids. Rubber band ligation is the gold standard for Grades I-III. A tiny rubber band cuts off blood supply, causing the hemorrhoid to fall off within days. It’s highly effective (90% success rate) and done in-office. Other options include sclerotherapy (injecting a chemical to shrink tissue) or infrared coagulation (using heat). For thrombosed external hemorrhoids, a doctor might perform a simple incision to remove the clot. Doing this within 72 hours of onset provides immediate pain relief. Severe cases might require a hemorrhoidectomy-surgical removal. It’s painful, requiring 2-4 weeks of recovery, but has a 95% success rate. Recurrence rates drop to 5-10% if you stick to preventive habits post-surgery, compared to 50% if you revert to old habits.

Prevention Is Better Than Cure

Once you’ve dealt with hemorrhoids, you want to avoid round two. Consistency matters more than intensity.

  • Movement: Walk regularly to stimulate bowel function.
  • Listen to Your Body: Go when you need to. Holding it in lets water reabsorb from the stool, making it harder.
  • Avoid Straining: If nothing happens after 5 minutes, get up and try later.
Remember, hemorrhoids are mechanical issues caused by pressure. Reduce the pressure, and you solve the problem.

Can internal hemorrhoids hurt?

Generally, no. Internal hemorrhoids lack pain receptors. However, if they prolapse significantly and become trapped outside the anus (incarcerated), they can become painful due to swelling and reduced blood flow.

How long does it take for hemorrhoids to heal?

Mild symptoms often improve within a few days to a week with home care like sitz baths and fiber. Thrombosed external hemorrhoids may take 2-3 weeks to resolve fully, though pain decreases significantly after the first few days.

Is rectal bleeding always hemorrhoids?

No. While hemorrhoids are a common cause, rectal bleeding can signal anal fissures, inflammatory bowel disease, polyps, or colorectal cancer. Always consult a doctor for new or persistent bleeding to rule out serious conditions.

Do spicy foods cause hemorrhoids?

Spicy food doesn’t cause hemorrhoids, but capsaicin can irritate existing ones, causing burning sensations during bowel movements. If you’re experiencing a flare-up, avoiding spicy foods might provide temporary comfort.

Can pregnancy cause permanent hemorrhoids?

Many pregnancy-related hemorrhoids shrink after delivery as pressure on pelvic veins decreases. However, some may persist or worsen with subsequent pregnancies. Proper postpartum care and fiber intake help manage residual symptoms.

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