Hemorrhoids: Internal vs External Types and Treatment Options

Did you know that 75% of people will experience hemorrhoids at some point in their lives? Despite how common they are, many people don't know the difference between internal and external hemorrhoids. This confusion can delay proper treatment. Let's break it down simply.

Internal Hemorrhoids: What You Need to Know

Internal hemorrhoids form above the dentate linethe anatomical boundary between the rectum and anus where internal and external hemorrhoids form inside the rectum. Because they're covered by tissue without pain receptors, they usually don't hurt. But they can cause bright red bleeding during bowel movements. You might notice blood on toilet paper, in the toilet bowl, or on your stool.

Doctors grade internal hemorrhoids based on how much they prolapse (protrude). Grade I hemorrhoids bleed but don't prolapse. Grade II prolapse during straining but pop back in on their own. Grade III need to be pushed back in manually. Grade IV are permanently prolapsed and can't be pushed back. Most people with internal hemorrhoids have Grade I or II issues.

External Hemorrhoids: Symptoms and Causes

External hemorrhoids develop below the dentate line around the anus. They're covered by sensitive skin with lots of pain receptors. This makes them much more likely to cause discomfort. Common symptoms include itching, swelling, pain, and visible lumps. If a blood clot forms inside, it becomes a thrombosed hemorrhoida blood clot within an external hemorrhoid causing severe pain and a firm lump. Thrombosed hemorrhoids often appear as purple or blue lumps and hurt intensely, especially when sitting.

Unlike internal hemorrhoids, external ones rarely bleed. They're more about pain and irritation. Many people mistake them for skin tags or other growths, which is why proper diagnosis matters.

Key Differences Between Internal and External Hemorrhoids

Treatment Options Based on Type and Severity

Treatment depends on whether you have internal or external hemorrhoids and how severe they are.

For mild cases, home care often works. Try sitz bathsa warm water bath for the anal area to reduce swelling and pain for 15-20 minutes a few times daily. Over-the-counter creams with hydrocortisone can ease itching. Witch hazel pads help reduce inflammation. Increasing fiber intakedietary fiber that softens stool and prevents straining to 25-35 grams daily and drinking plenty of water also helps.

For moderate internal hemorrhoids (Grade I-III), doctors often recommend minimally invasive procedures. rubber band ligationa procedure where a small rubber band is placed around the base of the hemorrhoid to cut off blood supply is the most common. It's 90% effective and done in the doctor's office. Sclerotherapy (injecting a solution to shrink the hemorrhoid) and infrared coagulation (using heat to seal the vein) are other options.

For severe cases, surgery might be needed. hemorrhoidectomysurgical removal of hemorrhoids, often for Grade IV or recurrent cases is the gold standard. It's 95% effective but requires 2-4 weeks recovery. Stapled hemorrhoidopexy repositions prolapsed tissue and is less painful than traditional surgery. For thrombosed external hemorrhoids, doctors may make a small incision to remove the clot within 72 hours of onset for quick pain relief.

When to See a Doctor

Don't ignore these warning signs:

• Bleeding that lasts more than a week or keeps coming back
• Severe pain that doesn't improve with home care
• Changes in bowel habits like diarrhea or constipation lasting over two weeks
• Dizziness or weakness from blood loss
• Any lump that doesn't go away after a few days

Rectal bleeding can also signal more serious issues like colorectal cancer or anal fissuresa small tear in the anal lining causing sharp pain during bowel movements. Always get checked if you're unsure.

Preventing Hemorrhoids: Practical Tips

Prevention is easier than treatment. Here's how to keep them at bay:

• Eat high-fiber foods like oats, beans, and berries. Aim for 25-35 grams of fiber daily.
• Drink at least 64 ounces of water every day to stay hydrated.
• Avoid sitting on the toilet for more than five minutes. Use a footstool to position your knees above your hips while pooping.
• Exercise regularly. Even a 30-minute walk daily helps keep things moving.
• Don't strain during bowel movements. If you feel the need to push, take a break and try again later.

Studies show people who maintain these habits have a 5-10% recurrence rate after treatment. Skip them, and recurrence jumps to 50%.

Frequently Asked Questions