Internal and External Hemorrhoids

Have you ever felt pain or itching near your bottom and wondered what’s going on? You’re not alone. Millions of people face this uncomfortable problem every year. We’re talking about internal and external hemorrhoids — a topic many are too shy to discuss but should definitely know about. These swollen veins in and around your rectum can lead to pain, bleeding, or discomfort that can affect daily life. But here’s the good news: they’re treatable.

In this blog, we will explain what internal and external hemorrhoids are, why they happen, how to tell the difference, and, most importantly, how to treat and prevent them.

What are Hemorrhoids and Why Do They Happen?

Hemorrhoids are swollen veins around the anus or inside the rectum. Think of them like varicose veins, but in your bottom area. They become a problem when they swell up due to pressure.

According to the National Institutes of Health (NIH), about 1 in 20 Americans has hemorrhoids, and almost half of people over age 50 have them. That’s a lot of people silently dealing with this issue.

So what causes hemorrhoids?

• Straining during bowel movements
• Sitting on the toilet for too long
• Chronic constipation or diarrhea
• Pregnancy (due to pressure on veins)
• Obesity
• Low-fiber diet

Bowel habits matter too. If you don’t go regularly or push too hard, it adds pressure to the veins, causing them to swell.

What is the Difference Between Internal and External Hemorrhoids?

To truly manage internal and external hemorrhoids, it helps to know how they differ.

Internal hemorrhoids form inside the rectum. They usually don’t hurt because that area has few pain-sensing nerves. But they may cause anal bleeding during bowel movements.

External hemorrhoids are under the skin around the anus. These are the ones that itch, burn, or hurt, especially when you sit or clean the area.

Yes, it’s possible to have both types at the same time. Many people do.

Type	Location	Symptoms	Common Treatments	Surgical Options
Internal	Inside rectum	Painless bleeding, prolapse	Rubber band ligation, fiber intake	Rarely needed
External	Around anus	Pain, itching, swelling, rectal pain	Sitz bath, over-the-counter hemorrhoid treatments	Hemorrhoidectomy or excision

What are the Symptoms of Internal and External Hemorrhoids?

Let’s break down the symptoms of both types:

Internal Hemorrhoids Symptoms

Internal hemorrhoids usually cause less pain because fewer pain-sensing nerves are present in that area. Common symptoms include:

• Painless bleeding during bowel movements.
• Prolapse, where tissue bulges out from the anus, causing mild discomfort.
• Itching and irritation around the anus.
• Burning sensation after bowel movements.

External Hemorrhoids Symptoms

External hemorrhoids are more painful due to the presence of numerous pain-sensing nerves. Symptoms include:

• Pain during activities such as sitting or passing stools.
• Itching around the anus.
• Bleeding after bowel movements.
• Swelling near the anus, sometimes visible as lumps.

Some signs shouldn’t be ignored. If you see ongoing bleeding, lumps that don’t go away, or intense pain, it’s time to get checked.

How are Internal Hemorrhoids Diagnosed and Staged?

Doctors classify internal hemorrhoids into stages or grades. This helps decide the best treatment for internal hemorrhoids.

Internal hemorrhoids stages:

• Grade I: No prolapse, just bleeding
• Grade II: Prolapse during bowel movement but go back on their own
• Grade III: Prolapse and need to be pushed back manually
• Grade IV: Always outside, can’t be pushed back in

To diagnose, doctors may do:

• A digital rectal exam
• Anoscopy (small tube to look inside)
• Sigmoidoscopy (to check the lower colon)

Usually, internal and external hemorrhoids are visible during an exam, but some internal ones are hidden deeper and need tools to be found.

Causes of Hemorrhoids

Several factors can cause or worsen hemorrhoids, including:

• Pregnancy: The expanding uterus puts pressure on the colon, leading to hemorrhoids.
• Obesity: Extra body weight increases pressure on the veins in the rectal area.
• Constipation: Straining during bowel movements due to hard stools adds pressure to the colon.
• Heavy lifting: Regular lifting of heavy objects can strain the muscles and contribute to hemorrhoids.
• Aging: People aged 45-65 are at higher risk of developing hemorrhoids.
• Genetics: A family history of hemorrhoids increases the likelihood of developing them.
• Liver cirrhosis: This condition can increase the risk of hemorrhoids. If you have liver disorders, consult a liver specialist in Delhi NCR or Patna for appropriate treatment.

What are the Available Treatment of Hemorrhoids?

Treatment depends on the severity of the symptoms. Most hemorrhoids resolve within 14-15 days with proper care. Here are some treatment options:

Home Remedies for Internal and External Hemorrhoids

Good news: you can manage many hemorrhoids at home.

Home remedies for hemorrhoids include:

• Sitz bath: Soak your bottom in warm water for 15-20 minutes, 2-3 times a day
• Over-the-counter hemorrhoid treatments like creams or pads with witch hazel or hydrocortisone
• Fiber intake: Eat fruits, vegetables, whole grains, or take fiber supplements
• Stool softeners to avoid straining
• Stay active and drink plenty of water

These simple habits reduce pressure on veins and promote smoother bowel movements.

Medical Treatments for Internal Hemorrhoids

When home care isn’t enough, medical help is the next step. Doctors have many tools for treatment for internal hemorrhoids.

Rubber band ligation is the most common. A small band is placed at the base of the hemorrhoid to cut off blood supply. It shrinks and falls off in a few days.

Other treatments:

• Sclerotherapy: Injecting a solution to shrink the vein
• Infrared or laser therapy to burn off the tissue

And yes, internal hemorrhoids are curable, especially in early stages.

Medical Treatments for External Hemorrhoids

When pain and swelling don’t go away, medical care becomes necessary for treatment for external hemorrhoids.

External hemorrhoids surgery options include:

• Excision: Minor surgery to remove a thrombosed hemorrhoid
• Hemorrhoidectomy: Full removal under anesthesia (for large or repeated cases)

Surgery is done when:

• There’s ongoing pain
• Bleeding doesn’t stop
• There’s frequent recurrence

Recovery from surgery takes about 1-2 weeks, and pain relief is usually quick afterward.

Hemorrhoidectomy (Internal-External Hemorrhoid Surgery)

In severe cases, hemorrhoids can lead to complications like blood clots, infections, or prolapse. When hemorrhoids become too large, surgery may be required to remove them. Hemorrhoidectomy is a surgical procedure to treat serious hemorrhoids. For expert treatment, consider consulting a top gastroenterologist at Max Saket or a liver specialist in Patna.

When Should You See a Doctor?

Here’s a rule of thumb: when to see a doctor for hemorrhoids includes:

• Bleeding that lasts more than a week
• Severe pain or swelling
• Lumps that don’t shrink

In rare cases, hemorrhoids can lead to swollen blood vessels, infections, or even anemia due to blood loss. That’s why expert advice matters.

If you see signs of prolapsed hemorrhoids or experience sudden pain from thrombosed hemorrhoids, consult a doctor for the best hemorrhoids treatment.

How to Prevent Internal and External Hemorrhoids from Coming Back?

Prevention is always better than cure.

Lifestyle changes can reduce your risk:

• Eat a high-fiber diet
• Stay hydrated
• Don’t delay bathroom visits
• Avoid sitting too long on the toilet
• Get regular physical activity

Good bowel habits matter too. Try not to push hard or hold in stools.

Myths About Internal and External Hemorrhoids

Many people believe myths that only make things worse. Here’s a table to clarify the truth behind these common beliefs:

Myth	Truth
Hemorrhoids mean cancer	No, but anal bleeding should still be checked by a doctor
Spicy food causes hemorrhoids	Not directly, but it can irritate existing hemorrhoids
Only old people get hemorrhoids	Even teens can get them with poor diet or constipation
They’ll always go away on their own	Some may shrink, but many need medical care for lasting relief

Help is Available for Hemorrhoids — You Don’t Have to Suffer

Hemorrhoids may be uncomfortable, but they don’t have to take over your life. Whether you’re dealing with bleeding, itching, or pain, treatments exist, from home remedies to surgery. Knowing the difference between internal and external hemorrhoids is the first step toward relief.

For expert help, book a consultation with Dr. Nivedita Pandey, MBBS, Diplomate, American Board (Internal Med & Gastroenterology). She’s a US-trained, board-certified Senior Gastroenterologist and Hepatologist. As one of South Delhi’s trusted female digestive health experts, she offers private, professional care that makes you feel comfortable.

FAQs

What are hemorrhoids?

Hemorrhoids are swollen veins in the rectum and anus that cause discomfort and bleeding. Learn more about What Are Hemorrhoids?.

What’s the fastest way to shrink internal and external hemorrhoids?

The fastest relief comes from a warm sitz bath, cold compresses, and using over-the-counter hemorrhoid treatments like creams or pads with witch hazel or hydrocortisone. These reduce itching and swelling. For larger or painful cases, procedures like rubber band ligation might be needed. You should avoid straining and stay hydrated.

Can hemorrhoids be a sign of something serious?

Usually not. But anal bleeding could also be caused by polyps, infections, or even colon cancer. If your bleeding is heavy, comes with weight loss, or changes in stool color, it’s best to see a specialist like Dr. Nivedita Pandey for a full evaluation.

Is walking or sitting better for hemorrhoids?

Walking is better. It helps blood flow, keeps pressure off the anal veins, and reduces swelling. Sitting for long hours, especially on hard chairs, can make rectal pain worse. Try standing up every 30 minutes or using a cushion to stay comfortable.

Can hemorrhoids go away on their own?

Yes, many hemorrhoids resolve on their own within a couple of weeks with proper care, like diet changes and over-the-counter treatments.

What causes hemorrhoids?

Common causes include pregnancy, obesity, constipation, heavy lifting, aging, genetics, and liver disorders.

What foods should you avoid if you have hemorrhoids?

Avoid low-fiber, processed foods like white bread, chips, and red meat, as they cause constipation. Spicy food may irritate your bottom but doesn’t cause hemorrhoids. Eat more fiber intake foods like fruits, veggies, and whole grains, and drink water regularly.

Are internal hemorrhoids more dangerous than external ones?

Not really. Internal hemorrhoids may bleed more without pain, while external hemorrhoids are often painful but visible. Both types can become severe if untreated. The best approach is early treatment and regular follow-ups with a specialist if needed.

Can you pop a hemorrhoid at home?

Absolutely not. Trying to pop a hemorrhoid can cause serious anal bleeding, infection, and make the problem worse. If you notice a lump or swelling, leave it alone and book a visit with a doctor. Dr. Nivedita Pandey can recommend safe and sterile treatments.

When should I see a doctor for hemorrhoids?

If you experience severe pain, heavy bleeding, or hemorrhoids that don’t improve with home treatment, consult a healthcare provider.