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By Hemorrhoid.com | November 24, 2025
Most people don’t realize that straining on the toilet for just five minutes can be the start of years of hemorrhoid pain. This one common habit is often the trigger that separates a comfortable day from a week of agony, but the type of pain you feel reveals everything about what's happening inside… or outside… your body.
I once spoke with a customer who had been using the wrong treatment for weeks. He was applying a cream meant for external pain to an internal issue that only caused bleeding. He felt frustrated and defeated, thinking nothing would ever work. It wasn’t until he understood the simple difference between internal and external hemorrhoids that he found the right path to relief. He just needed to know where the problem was located.
Understanding your hemorrhoid type is the first step to finding the right relief.
The biggest distinction between internal and external hemorrhoids boils down to just one thing… location. Internal hemorrhoids are tucked away inside the rectum and usually cause painless bleeding. External hemorrhoids form under the skin around the anus and are notorious for causing pain and itching. This guide will break down what that means for you, so you can stop guessing and start healing.
Here are the concrete steps to figure out what you’re dealing with and what to do next:
That customer I mentioned? Once he switched to the right approach, his symptoms started to improve in days. The key wasn’t a miracle cure… it was clarity. Knowing the difference empowered him to take the right action and finally get relief.
It often starts with a vague sense of discomfort or a moment of alarm after using the restroom. Maybe you feel a strange lump, notice bright red blood on the toilet paper, or deal with persistent itching that just won't quit.
This uncertainty can be stressful. The good news? Pinpointing the type of hemorrhoid you have is simpler than you might think. The heart of the issue is where the swollen vein is located. This single factor determines everything you feel… or don't feel.
Think of it this way: the tissue deep inside your rectum has very few pain-sensing nerves. This is why internal hemorrhoids can grow without causing any pain at all. Their most common calling card is painless bleeding during a bowel movement.
In contrast, the skin around the anus is packed with sensitive nerves. When external hemorrhoids form here, they can trigger a whole range of uncomfortable sensations, including:
This quick comparison table breaks down the main differences to help you figure out what you might be experiencing.
| Feature | Internal Hemorrhoids | External Hemorrhoids |
|---|---|---|
| Location | Inside the rectum, above the dentate line. | Under the skin around the anus. |
| Primary Symptom | Painless, bright red bleeding. | Pain, itching, and swelling. |
| Visibility | Not visible unless they prolapse (protrude). | Visible as a lump near the anal opening. |
| Sensation | Usually painless due to fewer nerve endings. | Often painful due to numerous nerve endings. |
To get a real handle on the difference between internal and external hemorrhoids, we need to zoom in on one critical anatomical landmark: the dentate line. It sounds a bit technical, but the idea is actually pretty simple.
The dentate line is basically an invisible boundary inside your anal canal. It separates the nerve-packed skin on the outside from the much less sensitive tissue on the inside of your rectum.
Think of it this way… a papercut on your finger hurts like crazy because your skin is loaded with nerves. But a tiny scratch inside your cheek? You might not even feel it. The exact same principle is at play here.
This anatomical divide is the single biggest reason your symptoms are what they are. Where a hemorrhoid forms… either above or below this line… is what determines whether you feel sharp pain or mostly just see blood.
Internal hemorrhoids show up inside the rectum, which is above the dentate line. This area is lined with the same kind of tissue as your intestines, and it has very few nerves that register pain.
This is exactly why the classic sign of an internal hemorrhoid isn't pain. Instead, it’s often bright red, painless bleeding when you have a bowel movement. Since you can’t feel them, they can hang around for a while without causing any real discomfort. You might only realize one is there when you spot blood on the toilet paper or in the bowl.
The defining feature of the dentate line is the dramatic shift in nerve supply. Below it, the area is highly sensitive to pain, touch, and temperature. Above it, the area is relatively numb.
Now, sometimes an internal hemorrhoid can cause other feelings. You might notice a sense of fullness or pressure, almost like you haven’t quite finished your business. Getting familiar with these subtle signs is helpful, and you can learn more about them in our guide on if hemorrhoids feel like something is stuck.
External hemorrhoids form under the skin around the anus, placing them squarely below the dentate line. This whole area is packed with pain receptors, which is what makes these hemorrhoids so notoriously uncomfortable.
Because they’re located in such a sensitive spot, external hemorrhoids are behind the symptoms most people think of when they hear the word "hemorrhoids":
Understanding this core difference is crucial. It explains why treatments like topical creams are designed for the pain of external hemorrhoids, while something like a suppository is meant to work on internal issues.
Pinpointing the exact difference between internal and external hemorrhoids really comes down to listening to your body. While both are just swollen veins, where they are located makes them feel worlds apart.
Internal hemorrhoids, for instance, are famous for their “silent” symptom: painless, bright red blood on the toilet paper. You might also feel a sense of fullness, like you haven’t completely finished a bowel movement, or even notice a bit of mucus discharge. To learn more about this specific sign, check out our guide to bleeding hemorrhoids.
Because they’re tucked away inside the rectum where there are very few pain-sensing nerves, internal hemorrhoids often show up without causing any real pain.
External hemorrhoids are a different story. They form under the skin around the anus, an area loaded with sensitive nerves, which is why they tend to be much more noticeable. You’ll often find them as small, tender lumps that can make sitting a real chore.
When a blood clot forms inside one, it’s called a thrombosed hemorrhoid, and that’s when you get a sudden, sharp pain along with significant swelling.
A key distinction is the acute onset of pain with external hemorrhoids. While internal ones might only reveal themselves with bleeding, you will almost certainly feel an external hemorrhoid.
So, what are the typical signs of an external issue?
Getting a clear picture of these distinct symptoms is the first step toward relief. This simple side-by-side table can help you figure out what you’re likely dealing with.
| Symptom | Internal Hemorrhoids | External Hemorrhoids |
|---|---|---|
| Primary Sensation | Usually painless; may feel like pressure or fullness. | Often painful, itchy, or sore. |
| Bleeding | Bright red, typically painless, on tissue or in bowl. | Can occur, but it’s often accompanied by pain. |
| What You Feel | Usually nothing, unless it has prolapsed. | A noticeable lump or swelling. |
| Most Severe Symptom | A prolapsed hemorrhoid that becomes painful. | A thrombosed hemorrhoid causing sudden, severe pain. |
Knowing which type you have is crucial, as it guides you toward the right treatments and helps you understand when it’s time to see a doctor.
Knowing what to expect during a doctor's visit can make the process much less stressful. When it comes to the difference between internal and external hemorrhoids, the way a doctor diagnoses them is usually straightforward and depends entirely on where the problem is located.
For an external hemorrhoid, the diagnosis is often just a simple visual inspection. Since these lumps are on the outside, a doctor can typically identify them just by looking at the area. They’ll check for the classic signs of swelling and irritation to confirm it’s a hemorrhoid and not another skin condition. It’s a very quick and simple process.
Because internal hemorrhoids are tucked away inside the rectum, a doctor needs to do a gentle internal exam to find them. This is not nearly as intimidating as it might sound.
This simple visual breaks down the key symptoms for each type, which is often what guides a doctor's diagnostic approach in the first place.
You can see the clear split between the painless bleeding common with internal hemorrhoids and the sharp pain often linked to external ones.
Sometimes, rectal bleeding needs a more thorough investigation to rule out anything more serious. If it’s not obvious where the bleeding is coming from, or if you have other risk factors, your doctor might suggest a colonoscopy. This procedure gives a complete view of the entire colon and is the gold standard for ruling out other conditions.
The distinction between internal and external types is crucial because it shapes everything from diagnosis to treatment. As a rule of thumb, external hemorrhoids are diagnosed based on what can be seen and felt, while internal ones are often found during routine checkups or more in-depth exams. You can learn more about these diagnostic implications.
Understanding this process helps you walk into your appointment with confidence, knowing exactly what to expect.
Knowing the difference between internal and external hemorrhoids is the first step… but taking action is what really counts. Relief often starts with simple, effective at-home strategies that tackle the root causes of irritation for both types.
Think of these habits as the foundation for your healing. They help soothe current symptoms and prevent future flare-ups, making any treatment you use more effective.
Before zeroing in on specific symptoms, it’s best to weave these gentle habits into your daily routine. They work by easing pressure on rectal veins and calming inflamed tissue, providing a solid base for recovery.
Once you have a good baseline routine, you can add treatments designed for your specific type of hemorrhoid. The location… inside or out… is what guides the best approach.
For the painless bleeding that often signals an internal hemorrhoid, suppositories can be a great choice. They're designed to deliver medication directly inside the rectum to help shrink swollen tissues. To learn more about how they work, check out our guide on what a hemorrhoid suppository does.
The rule is simple: topical treatments for external symptoms you can see and feel, and internal treatments like suppositories for issues hidden inside.
For the pain, itching, and swelling of external hemorrhoids, topical treatments are your best friend. Products like Revivol-XR Hemorrhoid & Fissure Cream are formulated for multi-symptom relief. It combines a powerful numbing agent like lidocaine with ingredients that reduce swelling and protect irritated skin, targeting the discomfort right at the source.
If your hemorrhoids are severe, persistent, or just don't respond to at-home care, your doctor might suggest a medical procedure. These are usually quick, in-office treatments that can offer a more permanent fix.
Starting with gentle at-home care and choosing targeted treatments like Revivol-XR gives you a powerful, practical plan for managing symptoms and getting back to feeling comfortable.
While understanding the difference between internal and external hemorrhoids is a great first step, it’s just as important to know when to stop self-treating and call a professional. Most hemorrhoids are not dangerous, but some symptoms can overlap with more serious conditions.
Ignoring certain red flags can do more harm than good. A quick trip to the doctor can give you peace of mind and confirm you're on the right track.
If you experience any of the following, it’s time to schedule an appointment with your healthcare provider right away. Don’t wait.
Seeking a proper diagnosis is never an overreaction. It's a crucial step in taking control of your health and getting the right treatment from the start.
Sometimes, these symptoms can mimic those of more serious gastrointestinal issues. A quick consultation provides a definitive diagnosis and ensures you’re on the fastest path to recovery.
When you're trying to figure out the difference between internal and external hemorrhoids, a few common questions always seem to pop up. Let's clear up some of the confusion so you can get on the right path to relief.
Absolutely. It’s actually quite common to have both internal and external hemorrhoids at once, a condition sometimes called mixed hemorrhoids.
Since both types share the same root causes… like chronic constipation or too much straining… it’s easy for the conditions that create one to also create the other. You might notice a confusing mix of symptoms, like painless bleeding (a classic sign of an internal hemorrhoid) along with a painful, sensitive lump on the outside.
This really depends on the type of hemorrhoid and how severe it is. A small, mild external hemorrhoid might clear up within a few days, especially if you’re diligent with at-home care like sitz baths and topical creams.
Larger, more irritated ones can stick around for a week or longer. Chronic cases, especially internal ones that have prolapsed (slipped out), may not go away until you get them treated by a doctor. The key to making them go away faster… and keeping them from coming back… is consistency with your diet and habits.
Extremely common. Up to 40% of women develop hemorrhoids during pregnancy and in the postpartum period. The combination of the growing uterus putting pressure on pelvic veins and pregnancy-induced constipation creates a perfect storm.
For expecting or new moms, gentle but effective care is a must. Safe options that can bring a lot of relief include:
Managing symptoms well during this time can make a world of difference for your comfort and postpartum recovery.
For fast, multi-symptom relief from the pain, itching, and swelling of hemorrhoids, trust Revivol-XR. Our doctor-trusted formulas are designed to provide powerful yet gentle care when you need it most. Find the right solution for your needs at https://hemorrhoid.com.
