Internal and External Hemorrhoids

Hemorrhoids are enlarged veins in the anus and lower parts of the rectum. They are fairly common and affect nearly 75 percent of adults at some point in their lives. Although hemorrhoids are an uncomfortable and occasionally painful condition, they are usually not serious and can be prevented with the right lifestyle choices. Here’s a look at the different types of hemorrhoids, how they’re caused, and how you can treat and prevent them.

Internal vs External Hemorrhoids

There are two types of hemorrhoids: internal and external.

1. Internal hemorrhoids: Internal hemorrhoids are located inside the rectum and typically can’t be seen or felt without specialized examinations. As there aren’t traditional nerves near internal hemorrhoids, most people don’t know they have them and don’t have symptoms from them. Bleeding is the most common, and sometimes only, sign of internal hemorrhoids.
2. External hemorrhoids: External hemorrhoids are located external to the rectum, usually near the anus. External hemorrhoids are located near a high-number of nerves so they often cause pain, itching and other symptoms including bleeding. They are also at a higher risk of thrombosis or developing a blood clot inside the hemorrhoid. Thrombosed hemorrhoids are usually very painful and usually require medical treatment.

Prolapse occurs when a hemorrhoid grows large enough to bulge outside the anus. Most prolapsed hemorrhoids return to normal on their own but sometimes require medical treatment. They can usually be gently pushed back inside the rectum.

Causes

Increased pressure in the rectal area can impact blood flow and cause swelling in the veins of the rectum and anus. There are several factors that can increase this pressure and can lead to the formation of hemorrhoids:

Pushing or heavy straining during bowel movements
Chronic constipation or diarrhea
Anal intercourse
Pregnancy
Obesity
Long periods of sitting on the toilet or standing
Low-fiber diet

Symptoms and Complications

Symptoms may vary depending on whether the hemorrhoids are internal or external, but in general, common symptoms include:

Pain or discomfort
Bleeding—with or without pain
Itching or irritation near the anus
Swelling or sensation of a lump near the anus

In most cases, hemorrhoids are minor and do not require treatment. Rarely, medical problems such as anemia (low blood counts due to bleeding) can result from hemorrhoid-related complications.

Treatment and Prevention

In most cases, hemorrhoids resolve without specialized medical care. Treatment and prevention typically focus on the same measures as below:

High-fiber diet: Fruits, vegetables and whole grains can prevent constipation, soften stools and increase stool bulk, all of which help limit straining that can cause hemorrhoids. Consuming 25-30 grams of dietary fiber daily is a safe way to minimize hemorrhoid problems.
Drink lots of water: This will help avoid hard stools and constipation.
Exercise often: Regular physical activity helps keep the bowels active.
Clean anal area: Keep the anus clean by using non-dry toilet paper and bathing daily.
Topical treatments: If hemorrhoids are causing problems, certain over-the-counter creams containing witch hazel and hydrocortisone can help reduce swelling and pain.
Ice packs or cold compression: These treatments can reduce swelling and pain near the anus.
Procedures: Most hemorrhoids don’t require aggressive medical treatment. However, in rare cases, surgical and non-surgical procedures may be necessary to relieve complications. The necessity of medical intervention, and the procedure used, depends on symptoms and whether the hemorrhoids are internal or external.

If you’re experiencing pain, discomfort or bleeding during bowel movements, or if you are worried you may be developing hemorrhoid-related problems, speak to your doctor about your treatment options.

I grew up in Utah County and graduated from Brigham Young University. I received my medical degree from the University of Virginia, and I finished my residency in internal medicine at the University of Utah where I also served as chief medical resident. As a doctor, I recognize the tremendous trust my patients place in me, and I do my best to help them understand not only their medical issues but also the plan—the how and why—behind helping them feel better. I love the challenge posed by all gastrointestinal disorders but especially enjoy the challenges and intricacies of Crohn’s disease and Ulcerative Colitis.