Internal vs External Hemorrhoids: Key Differences Explained

Internal vs External Hemorrhoids: Key Differences

Understanding whether you have internal or external hemorrhoids is crucial for choosing the right treatment. Here's everything you need to know about each type.

The Anatomy

Hemorrhoids develop in one of two locations, divided by an anatomical landmark called the dentate line:

• Internal hemorrhoids: Above the dentate line, inside the rectum
• External hemorrhoids: Below the dentate line, under the skin around the anus

Internal Hemorrhoids

Symptoms

• Painless bleeding during bowel movements (bright red blood)
• No visible external lump
• May protrude during straining (prolapsed hemorrhoid)
• Mucus discharge
• Feeling of incomplete evacuation

Grading System

Internal hemorrhoids are classified by severity:

• Grade 1: Small swelling inside, no prolapse
• Grade 2: Prolapse during straining, retract on their own
• Grade 3: Prolapse requiring manual pushing back
• Grade 4: Permanently prolapsed, cannot be pushed back

Treatment

• Fiber supplements and dietary changes
• Stool softeners
• Sitz baths
• Over-the-counter suppositories
• Medical procedures for Grade 3-4 (banding, sclerotherapy)

External Hemorrhoids

Symptoms

• Visible or feelable lump near the anus
• Pain, especially when sitting
• Itching and irritation
• Swelling around the anus
• Bleeding when irritated

When They Become Thrombosed

External hemorrhoids can develop blood clots, becoming thrombosed hemorrhoids. Signs include:

• Sudden, severe pain
• Hard, bluish lump
• Swelling that peaks within 48-72 hours

Treatment

• Topical creams and ointments
• Witch hazel pads
• Sitz baths
• Ice packs
• Donut cushions for sitting
• Incision for thrombosed hemorrhoids (if within 72 hours)

Key Differences

Feature	Internal	External
Location	Inside rectum	Around anus
Pain	Usually painless	Often painful
Visibility	Not visible unless prolapsed	Usually visible
Main symptom	Bleeding	Lump and discomfort
Treatment	Often dietary, may need procedures	Usually topical treatments

Recovery time differs significantly between the two types — see our full guide on hemorrhoid duration and healing timeline for what to expect.

Which Do You Have?

Take our hemorrhoid assessment quiz to help identify your type. If you're unsure about your symptoms, our guide on what hemorrhoids look like visually can help with identification. Remember, many people have both internal and external hemorrhoids simultaneously.

When to See a Doctor

Consult a healthcare provider if:

• Bleeding persists or is heavy
• Pain is severe
• Home treatments aren't working after 2 weeks
• You're unsure about your diagnosis

Learn about when to see a doctor for hemorrhoids for more guidance. Understanding what causes hemorrhoids can also help with prevention, and our guide on how to shrink hemorrhoids fast covers treatment for both types. For external hemorrhoid relief, see our best hemorrhoid cream and sitz bath recommendations.