Hemorrhoids: Understanding Internal vs. External and Effective Treatment Options

Most people think hemorrhoids are just a minor annoyance-something you get from sitting too long or eating too little fiber. But if you’ve had one, you know it’s more than that. It’s the burning after a bowel movement. The lump you can’t ignore. The fear that every streak of blood means something worse. And here’s the truth: hemorrhoids are far more common than you think. About 75% of people will deal with them at some point in their lives. The good news? Most don’t need surgery. The better news? You can tell the difference between internal and external hemorrhoids-and treat them properly-if you know what to look for.

What Exactly Are Hemorrhoids?

Hemorrhoids aren’t a disease. They’re normal blood vessels-like cushions-that help you control bowel movements. Think of them like shock absorbers inside your anus. But when pressure builds up-because of constipation, pregnancy, heavy lifting, or sitting too long-they swell. That’s when they become a problem.

There are two main types: internal and external. They’re not just different in location-they’re different in how they feel, what they do, and how you treat them. And yes, you can have both at the same time. That’s why so many people get confused.

Internal Hemorrhoids: Silent but Not Harmless

Internal hemorrhoids form inside the rectum, above a line called the dentate line. This area has no pain nerves, so even when they’re swollen, you often won’t feel pain. That’s why they’re sneaky.

The main sign? Bright red blood. You might see it on the toilet paper, in the bowl, or on your stool. It’s usually painless. Sometimes, you’ll feel like you haven’t fully emptied your bowels, or you’ll feel pressure deep inside. That’s the internal hemorrhoid pushing down.

Doctors grade them from I to IV:

• Grade I: Bleeds, but doesn’t bulge out.
• Grade II: Pops out when you strain, but goes back in on its own.
• Grade III: Comes out and you have to push it back in.
• Grade IV: Stays out all the time. Can’t be pushed back. This one often needs treatment.

The bigger the grade, the more likely you’ll need more than just cream. But even Grade IV can be treated without major surgery-more on that later.

External Hemorrhoids: Pain You Can’t Ignore

External hemorrhoids form under the skin around your anus. This area is packed with nerves. So when they swell? You feel it.

Symptoms are harder to miss:

• A tender lump you can see or feel
• Itching or irritation around the anus
• Pain that gets worse when you sit
• Swelling that feels like a balloon

Then there’s the worst-case scenario: a thrombosed external hemorrhoid. This happens when a blood clot forms inside the swollen vein. It turns purple or blue, feels hard, and hurts like hell. Sitting is torture. Walking is a chore. You might even wake up at 3 a.m. from the pain.

If you have one of these, you need to act fast. The best time to drain the clot is within 72 hours. After that, the pain fades on its own-but it takes weeks. Don’t wait.

Why You Might Be Mistaking It for Something Else

A lot of people think every itch, bleed, or lump is a hemorrhoid. But that’s dangerous.

An anal fissure-a small tear in the lining of the anus-also causes bleeding and pain. But here’s the difference: fissures cause a sharp, tearing pain during bowel movements. Hemorrhoids cause more of a dull ache, pressure, or burning after. Fissures rarely cause lumps. Hemorrhoids do.

And here’s the big one: rectal bleeding isn’t always hemorrhoids. Colorectal cancer, inflammatory bowel disease, or infections can look the same. If you’re over 50, have a family history of colon cancer, or notice changes in your bowel habits (like new constipation or diarrhea), don’t assume it’s just hemorrhoids. Get checked.

What You Can Do at Home

For mild cases, you don’t need a doctor right away. Start here:

• Eat more fiber. Aim for 25-30 grams a day. That’s 2 cups of beans, 1 cup of oats, 2 apples, and a handful of almonds. Fiber softens stool so you don’t have to strain.
• Drink water. At least 8 glasses a day. Fiber without water makes constipation worse.
• Use a footstool. Put your feet up while you sit on the toilet. This positions your body to push naturally, reducing pressure on your rectal veins by about 30%.
• Take sitz baths. Sit in warm water for 15 minutes, 2-3 times a day. It reduces swelling and soothes irritation.
• Avoid sitting too long. Don’t read or scroll on your phone on the toilet. Five minutes max.
• Use over-the-counter creams. Hydrocortisone helps with itching. Witch hazel pads reduce swelling. Don’t use them for more than a week without checking with a doctor.

These steps work. Studies show that people who stick to them see 80% symptom improvement within a few weeks.

When Home Care Isn’t Enough

If your hemorrhoids keep coming back or won’t go away after a few weeks, it’s time for medical help.

For internal hemorrhoids, doctors have three common office procedures:

• Rubber band ligation: A tiny band is placed around the base of the hemorrhoid. It cuts off blood flow. The hemorrhoid shrivels and falls off in a few days. It’s 90% effective for Grades I-III. You might feel pressure or mild cramping for a day or two.
• Sclerotherapy: A chemical is injected into the hemorrhoid. It causes scarring and shrinkage. Less effective than banding, but good for people who can’t tolerate banding.
• Infrared coagulation: A brief burst of heat seals the blood vessels. You feel a quick zap. No anesthesia needed. Good for smaller hemorrhoids.

For thrombosed external hemorrhoids, the best fix is a simple in-office procedure: the doctor makes a tiny cut, removes the clot, and the pain vanishes almost immediately. Do this within 72 hours, and you’ll avoid weeks of discomfort.

Surgery: The Last Resort

If you have Grade IV hemorrhoids, recurrent problems, or failed other treatments, surgery might be needed.

• Hemorrhoidectomy: The hemorrhoid is completely cut out. It’s the most effective-95% success rate. But recovery takes 2-4 weeks. Pain is real. You’ll need painkillers. It’s not fun, but it’s permanent.
• Stapled hemorrhoidopexy: Instead of removing the hemorrhoid, the doctor staples it back up inside. Less pain than a traditional cut-out, but higher chance of recurrence. Often used for prolapsed hemorrhoids.

Most people avoid surgery because they’re scared of the pain. But the pain of living with untreated hemorrhoids is worse.

Prevention Is the Real Treatment

Hemorrhoids come back if you don’t change your habits. Studies show that people who stick to high-fiber diets, drink enough water, and avoid straining have only a 5-10% chance of recurrence. Those who don’t? Up to 50%.

For pregnant women-who are 25-35% more likely to get hemorrhoids-sleeping on your left side and doing pelvic floor exercises can help reduce pressure.

And skip the miracle cures online. No oil, no herb, no cream sold as a “cure-all” has proven results. Stick to what science backs: fiber, water, movement, and proper toilet habits.

When to See a Doctor

You don’t need to suffer in silence. Call a doctor if:

• Bleeding lasts more than a week
• Pain is severe or getting worse
• You feel dizzy or weak (signs of blood loss)
• You notice changes in bowel habits
• Home treatments haven’t helped after two weeks

It’s not embarrassing. It’s medical. Doctors see this every day. The longer you wait, the harder it gets to treat.

Final Thought

Hemorrhoids aren’t a life sentence. They’re a signal-your body telling you to change how you sit, eat, or strain. The right treatment isn’t always the most expensive or flashy. It’s often the simplest: fiber, water, and time. But if you’re in pain or bleeding, don’t wait. See someone who knows the difference between a hemorrhoid and something more serious. Your body is trying to tell you something. Listen.