The location makes the difference
The names tell you everything. Internal hemorrhoids form inside the rectum, above the dentate line, a natural boundary about two centimetres inside the anal opening. External hemorrhoids form under the skin around the outside of the anus. This simple fact of anatomy drives every symptom you experience and every treatment that works.
Most people have one or the other, though both can occur together. Knowing which you have before you walk in for your first visit to Hamilton Hemorrhoids means you will not be surprised by what the examination finds, and that alone settles the nerves.
What internal hemorrhoids feel like
Internal hemorrhoids usually announce themselves through bleeding. You see bright red blood on the toilet paper, in the bowl, or streaked on stool. The bleeding is typically uncomfortable rather than painful because the tissue lining the rectum has no pain receptors. You might feel a bulge or fullness during or after passing stool, especially if the hemorrhoid has prolapsed, that is, slipped down toward the opening.
Itching can happen, though it is less common with internal hemorrhoids than external ones. Some people report a sensation of incomplete emptying, as though something is still there after they finish. Internal hemorrhoids rarely cause the sharp pain that makes external ones so miserable.
Grade matters here. A grade 1 internal hemorrhoid bleeds but stays inside. Grade 2 prolapses during straining but slips back in on its own. Grade 3 prolapses and needs a finger to push it back. Grade 4 stays out. Knowing your grade helps you understand what your options are.
What external hemorrhoids feel like
External hemorrhoids announce themselves through pain and a lump. You feel a tender swelling around the anus, often described as a grape-sized or marble-sized bulge. The skin over it may itch intensely. Some people notice blood on the toilet paper or in the bowl, but the pain is usually the dominant complaint.
The lump is often visible and you may be able to feel it with a finger. Sitting, straining, or wiping can make the pain worse. External hemorrhoids are particularly uncomfortable because the skin covering them is sensitive and they are prone to irritation from moisture, friction, and stool contact.
If the blood inside an external hemorrhoid clots, the pain can become severe and sudden. This is called a thrombosed hemorrhoid. It feels like a hard, very tender lump and the discomfort can last for days. The good news is that thrombosed hemorrhoids often improve on their own, though some people choose treatment to speed relief.
Bleeding tells a different story
Bleeding is the most common symptom of internal hemorrhoids and often the only one. It is bright red, typically appears on the paper or in the bowl rather than mixed into stool, and stops on its own. The amount varies from a few spots to more noticeable streaking.
External hemorrhoids bleed less often and usually only if they are scratched or if the skin cracks. When they do bleed, it is usually a small amount. If you are seeing significant bleeding, internal hemorrhoids are the more likely source, though bleeding hemorrhoids can come from other causes too.
Any bleeding that worries you, whether it is heavy, persistent, or mixed into stool rather than on the surface, deserves a proper examination. Hamilton Hemorrhoids examines before treating, so you will know exactly what is causing it.
What you can actually see
Internal hemorrhoids sit too far inside to see without an instrument. You cannot look in a mirror and spot them. What you see is blood. External hemorrhoids, by contrast, are visible. You may see a purplish or reddish lump, swelling, or skin tags around the opening.
Some external hemorrhoids look like small bumps. Others look like loose folds of skin. The appearance varies depending on whether the hemorrhoid is active or has settled, whether it is thrombosed, and how long it has been there. Skin tags, leftover folds of skin from a previous hemorrhoid, are also external and visible, though they cause no pain or bleeding.
If you are uncertain what you are seeing, take a mental note of the color, size, and whether it is painful or itchy. This information helps the clinician at your first visit. You do not need to describe it perfectly; the examination will show exactly what is there.
What happens at your first visit
Knowing whether you have internal or external hemorrhoids helps you feel less anxious, but the examination itself is straightforward. The clinician will ask about your symptoms, look at the external area, and perform an anoscopy if needed to see inside. An anoscopy is a short, thin tube that lets the clinician see the internal tissue without pain.
You will not be rushed and you will not be judged. Hemorrhoids are common and the clinician has examined hundreds of cases. Your job is to describe what you have noticed, the bleeding, the lump, the itching, when it started, and answer questions honestly. The clinician's job is to see what is there and explain it to you.
Once the examination is done, you will know your diagnosis and your options. Your first visit is a consultation, not a procedure, unless you choose otherwise. Many people find that understanding what is happening takes away much of the worry.
Treatment depends on what you have
Internal and external hemorrhoids are treated differently because they sit in different tissue. Internal hemorrhoids often respond well to rubber band ligation, infrared coagulation, or sclerotherapy. These are office procedures that work because the tissue inside has no pain nerves.
External hemorrhoids are more challenging because the skin is sensitive. Conservative care, creams, sitz baths, fiber, and time, helps many people. If treatment is needed, options include conservative care or, for severe cases, surgical removal.
The good news is that you do not have to decide on treatment at your first visit. You will have time to ask questions, understand your options, and think it over. Hamilton Hemorrhoids will give you all the information you need to make a choice that fits your situation.
Take the next step with confidence
If you have been putting off a visit because you were not sure what you had or what to expect, this is your sign to call. Internal hemorrhoids cause bleeding that stops on its own but deserves attention. External hemorrhoids cause pain and a visible lump that often improves with care. Either way, an examination tells you what is happening and what your options are.
You do not need a referral to book an appointment. You can call Hamilton Hemorrhoids directly to schedule your first visit. The clinician will examine you, explain what they find, and discuss treatment only if you want it. Many people find that the visit itself, knowing what is there and why it is happening, brings relief.
Hemorrhoids are treatable. The first step is knowing what you have.