External vs Internal Hemorrhoids: What’s the difference?

Illustrated internal view of a healthy anus and one with hemorrhoids

Author’s note: it should be mentioned that hemorrhoids are normal human anatomy. They are problematic when they become inflamed and irritated and cause pain and discomfort. For the sake of this post, when we refer to ‘hemorrhoids,’ know that we are referring to symptomatic hemorrhoids.


Hemorrhoids are a common condition that will affect more than half of American adults over 50. They are inflamed blood vessels in your rectum or anus that can cause pain, itching, swelling, irritation, and general discomfort.

There are two types of hemorrhoids: internal hemorrhoids and external hemorrhoids. This guide will cover the differences between the two types of hemorrhoids. We’ll also take a look at hemorrhoidal symptoms, causes, and treatments for each kind as well as how to prevent future flare-ups.

External vs. Internal Hemorrhoids

If you’re struggling with hemorrhoids, you’ll want to get rid of them as fast as possible. The first step towards healing is determining which hemorrhoid types you have: external vs. internal hemorrhoids. External hemorrhoids are enlarged blood vessels or veins under the skin outside the anus. These are the most common type of hemorrhoids and cause the most discomfort.

Internal hemorrhoids are less common and come with fewer symptoms, but they can cause bleeding. They are blood vessels and veins inside the anus that have become inflamed and engorged. People with internal hemorrhoids don’t often feel them but are alerted to their presence by bleeding during bowel movements. Internal hemorrhoids can get in the way of bowel movements, causing further irritation and complications.

Internal hemorrhoids may cause a feeling of pressure, but most sufferers won’t feel them at all. However, excess strain can sometimes cause an internal hemorrhoid to be pushed outside of the anus, becoming painful, especially during bowel movements. External hemorrhoids can cause a great deal of pain, itching, and burning and make sitting down difficult.

Both internal and external hemorrhoids are enlarged blood vessels, and they have similar causes, but they differ in the symptoms.

What Causes External Hemorrhoids?

External hemorrhoids are typically preceded by internal hemorrhoids. If you are able to catch and treat internal hemorrhoids before they cause external flare ups, you may be able to prevent the associated pain and irritation that comes with external hemorrhoids.

In short, external hemorrhoids are caused by pressure. This pressure can result from constipation, diarrhea, pregnancy, exercise, and other factors, including age, dehydration, and diet.

Constipation puts a great deal of strain on your body during bowel movements causing blood to engorge hemorrhoidal blood vessels around your anus. Pressure can also come from diarrhea, which makes the diet a critical factor in the causes of hemorrhoids. A diet rich in fats and carbs can cause irregular bowel movements, constipation, and diarrhea.

Additionally, any other factors that cause changes to your digestive system mean you are at risk for external hemorrhoids. Factors such as age, obesity, and pregnancy.

What Causes Internal Hemorrhoids?

Internal hemorrhoids have similar causes to external hemorrhoids. They are a result of pressure and strain on the body. The pressure is often caused by constipation but can also be caused by sitting for long periods and pregnancy. Diets low in fiber can risk internal hemorrhoidal blood vessels, as can dehydration and age.

How to Know if Your Hemorrhoids are Internal or External

To know if you have internal hemorrhoids or external hemorrhoids, there are a few key signs. Internal hemorrhoids are not likely to cause internal hemorrhoid pain, but they can cause itching, pressure and bleeding. External hemorrhoids can be painful and itchy and present as lumps or bumps that you can feel outside your anus.

If, while determining which kinds of hemorrhoids you have, you notice bleeding or extreme pain, it’s essential to see your doctor to rule out more severe conditions.

Let’s jump into the differences between external vs. internal hemorrhoids symptoms and look at them more closely.

How to Know if Your Hemorrhoids are Internal or External

External hemorrhoids are enlarged blood vessels on the outside of your anus and are characterized by the following symptoms.

• Pain
• Itching
• Swelling
• Burning
• Lumps or bumps around the anus

External hemorrhoids can make sitting down and bowel movements cause pain and discomfort.

Internal Hemorrhoid Symptoms

Internal hemorrhoids are veins of blood vessels inside your anus that have become enlarged and irritated. This type of hemorrhoid presents fewer symptoms, but the symptoms can be more alarming. Internal hemorrhoid symptoms are

• Blood during or after a bowel movement
• Itching
• Soft tissue protruding from the anal opening. When this happens, it’s referred to as prolapsed hemorrhoids.
• Prolapsed hemorrhoids can also cause pain.
• Anal fissures – fissures are small tears in the lining of the anus that can cause irritation and discomfort.

While internal hemorrhoids tend to remain painless, prolapsed hemorrhoids can become painful and may require medical attention.

Treatment for Internal or External Hemorrhoids

Whenever you feel you may be suffering from internal or external hemorrhoids, it’s always the best choice to consult with your doctor and get a diagnosis first before beginning any external hemorrhoids treatment.

An official diagnosis can help direct your treatment and make it more effective. It’s essential to see your doctor if you’re suffering from chronic flare-ups or your hemorrhoids are getting in the way of living everyday life. Internal hemorrhoids bleeding also causes for a doctor’s visit to prevent any severe side effects.

Internal hemorrhoids treatment and treatment for external hemorrhoids range from natural remedies and over-the-counter products to surgical options, which your doctor can arrange. These procedures can include:

• Surgery such as a hemorrhoidectomy, usually reserved for people with chronic pain or bleeding in which your hemorrhoidal tissue is surgically removed.
Thrombectomy, or removal of a hemorrhoidal thrombosis. This treatment is usually performed in the office rather than a surgery center, and is most effective for thrombosed external hemorrhoids or hemorrhoids that contain a clot blocking blood flow. Thrombosed hemorrhoids can be either external or internal but are most often external hemorrhoids.
• An option to get rid of prolapsing internal hemorrhoids is an office-based procedure called rubber band ligation, during which a physician will use a small device that wraps a rubber band around the swollen vein or blood vessel, blocking the flow of blood.
• Another in-office procedure for internal hemorrhoids is coagulation or cauterization which involves applying heat or light to the hemorrhoid to close off the hemorrhoid to blood flow.
Hemorrhoidopexy is also an option. A ​​hemorrhoidopexy is a procedure in which a surgeon will use a medical stapler to attach the hemorrhoids to the inner wall of the anus. The hemorrhoidopexy gets your hemorrhoids out of the way of bowel movements and reduces pain and discomfort. The hemorrhoidopexy procedure is best used on internal hemorrhoids that have prolapsed. A hemorrhoidopexy is less painful than some other surgical solutions to hemorrhoids.

These out of the home procedures are usually reserved for stubborn and recurring hemorrhoids. At-home options for treating hemorrhoids are plentiful and very effective in reducing the symptoms in most cases. These treatments are affordable and accessible just about anywhere medication is sold and are powerful in their ability to bring you relief. However, if you notice that your symptoms aren’t going away after a week or two of using the following treatments, please consult your doctor.

Let’s take a look at your at-home treatment options:

Creams and Ointments

Hemorrhoid creams and ointments provide instant relief from itching, burning, pain and swelling. These over-the-counter hemorrhoidal products are easy to find, affordable, and act fast. Hemorrhoid ointment can be used to relieve the symptoms of both internal and external hemorrhoids. Doctor Butler’s hemorrhoid creams have been developed by a proctologist and contain both medical and natural ingredients that promote healing and symptom relief. Shop Doctor Butler’s hemorrhoid cream today.

Sitz Bath

A sitz bath is a soothing way to cleanse and soothe your hemorrhoids and kick-start the healing process. These plastic baths fit over your toilet seat and, when filled with warm water and Epsom salts, can effectively soothe. You may also find relief if you are itchy. Using up to three times per day for around fifteen minutes each time, sitz baths are calming and cleansing.

Oral Pain Relievers

Oral pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil) can bring pain relief and reduce swelling. Still, they will not help heal your hemorrhoids and won’t help if you are itchy. Tylenol is excellent at reducing pain, while Advil is an anti-inflammatory, which can bring down any swelling you are experiencing. Be aware that anti-inflammatories such as Advil can increase the potential for bleeding so avoid use with bleeding hemorrhoids or bleeding which occurs with use.

Hemorrhoid Prevention

Treatment is a great way to get rid of your hemorrhoids, but now you have to make sure to avoid any future flare-ups. The good news is that prevention is easy.

Since hemorrhoids are often the result of difficult bowel movements, it’s imperative to ensure regular, easy bowel movements going forward. That means that a lot of prevention will lie in your diet, hydration, and exercise. Let’s take a look at these more closely:

Eat a high-fiber diet: Fiber is the best way to ensure regular bowel movements that don’t cause strain. It’s easy to increase this ingredient in your hemorrhoids high fiber diet by eating several servings of fruits each day. Apples, pears, bananas, and strawberries are all packed with fiber and easy to enjoy, especially in a morning smoothie.

Take fiber supplements: Fiber supplements are another great way to get your daily fiber intake and keep your digestive system functioning efficiently. Women should aim for 20-25 grams of fiber per day, while men should shoot for around 30-38 grams. It’s much easier to get this amount of fiber with supplements.

Stay hydrated: Water is crucial for ensuring a healthy digestive system and consistently easy bowel movements, and studies suggest you need at least 10-15 cups per day. Make it easier to enjoy your daily water intake with sparkling water or water infused with your favorite fruits like lemon or strawberry.

Exercise: Exercise is an essential part of a normally functioning digestive system. Water-based exercises provide a low-impact option if you’re suffering from a flare-up, while daily walks either outdoors or on a treadmill are perfect for preventing future hemorrhoids.

• Avoid sitting for long periods: Sitting for long periods can increase pressure on hemorrhoid-prone areas. If you work at a desk or have a sedentary lifestyle, make sure you get up and move around at least once per hour, or you may cause or exacerbate hemorrhoids.

• Go as soon as you feel the need to go: Listening to your body is essential. When you feel the urge for a bowel movement, get to the toilet as soon as possible. Delaying bowel movements can create dryer, harder stools that are more challenging to pass.

• Don’t strain on the toilet: Avoid sitting on the toilet for too long as this can encourage you to strain more. Internal hemorrhoids may feel like the bowels have not been completely evacuated, and you may feel the urge to strain as you push to resolve this feeling. It’s better to spend shorter periods on the toilet instead to avoid any pressure from excess straining.

Doctor Butler’s is Here to Help You Leave Hemorrhoid Pain Behind

It’s vital to know the difference between external hemorrhoids and internal hemorrhoids so that you understand which route to take for treatment. After reviewing this page, if you’re still unsure if you’re struggling with internal or external hemorrhoids, it’s essential to see your doctor for a proper diagnosis.

In the meantime, we hope you find some relief with the treatment options we’ve listed. Be sure to find rapid relief from the brand developed by a proctologist and expert in treating hemorrhoids, Doctor Butler’s.

Browse our products and find multiple solutions for relieving pain, swelling, burning, itching, and general discomfort of hemorrhoids. Our hemorrhoid cream includes fast-acting medicinal ingredients to calm the pain and itching while also boasting herbal components that encourage quick healing. Our memory foam seat cushion will comfortably keep the pressure off the affected area while you sit.

We have soothing sprays and flushable wipes as well as Epsom bath salts for your sitz bath. We want you to find relief fast, so shop for Doctor Butler’s hemorrhoid treatments today.

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