Hemorrhoids: Internal vs. External and How to Treat Them

Most people think hemorrhoids are just an embarrassing nuisance - something you get if you sit too long or eat too little fiber. But here’s the truth: hemorrhoids are a common, normal part of human anatomy that only become a problem when they swell. About 75% of us will deal with them at least once in our lives. And while they’re not dangerous, they can be painfully disruptive - especially when you can’t sit comfortably or see blood on the toilet paper.

What’s the Difference Between Internal and External Hemorrhoids?

It all comes down to location. Hemorrhoids are swollen veins, but where they form makes all the difference.

Internal hemorrhoids sit inside the rectum, above a line called the dentate line. This area has no pain receptors, so even when they’re swollen, you often won’t feel pain. That’s why many people don’t even know they have them - until they notice bright red blood on the toilet paper, in the bowl, or on their stool. These are graded from I to IV:

• Grade I: Bleeds but doesn’t prolapse (protrude)
• Grade II: Prolapses when you strain but pops back in on its own
• Grade III: Prolapses and needs to be pushed back in manually
• Grade IV: Stays outside permanently and can’t be pushed back

External hemorrhoids form under the skin around the anus. This area is packed with nerves, so even a small swelling can feel like a tender, itchy lump. You can see and feel them. They often cause discomfort when sitting, and if a blood clot forms inside (called a thrombosed hemorrhoid), the pain can be sudden and intense. These look like firm, purple or blue bumps - like a bruise that won’t go away.

And yes, you can have both at the same time. Many people do. That’s why symptoms can get confusing. Is the burning from external swelling? Is the bleeding from an internal one? Or both?

What Causes Hemorrhoids to Flare Up?

It’s not just about being constipated - though that’s a big one. Hemorrhoids happen when pressure builds up on the veins in your rectum and anus. Common triggers include:

• Straining during bowel movements (especially if you’re holding it in or pushing too hard)
• Sitting on the toilet for more than 5 minutes - scrolling, reading, or just zoning out
• Chronic diarrhea or constipation
• Pregnancy - up to one in three pregnant women get them
• Obesity
• Lifting heavy weights regularly
• Genetics - if your family has a history, you’re more likely to get them

Here’s something most people don’t realize: your posture matters. Sitting with your knees level with your hips puts extra pressure on your rectal veins. But if you put your feet on a small stool while you poop, you angle your pelvis just right - reducing pressure by about 30%. It’s simple, free, and surprisingly effective.

What Else Could It Be? Don’t Assume It’s Hemorrhoids

Rectal bleeding sounds like hemorrhoids - but it’s not always. You could have an anal fissure - a small tear in the lining of the anus. Fissures cause sharp, tearing pain during bowel movements, often followed by a burning sensation that lasts for hours. They don’t usually cause lumps or swelling, just pain and a little blood.

Even worse, bleeding can be a sign of something more serious - like colorectal cancer, inflammatory bowel disease (Crohn’s or ulcerative colitis), or polyps. That’s why if you’re over 45, have a family history of colon cancer, or notice changes in your bowel habits (like new constipation, narrow stools, or unexplained weight loss), you need to see a doctor. Don’t self-diagnose. Hemorrhoids are common, but they’re also a red flag that needs checking.

Home Treatments That Actually Work

For mild cases, you don’t need surgery. Start here:

• Eat more fiber - aim for 25-30 grams daily. Think beans, lentils, oats, apples with skin, broccoli, chia seeds. Most people get less than half that.
• Drink water - 8-10 glasses a day. Fiber without water just makes things worse.
• Sitz baths - sit in warm (not hot) water for 15-20 minutes, 2-3 times a day. It reduces swelling and soothes irritation. No fancy gadgets needed - just a clean tub or a special basin.
• Avoid straining - if you don’t have a bowel movement after 5 minutes on the toilet, get up. Try again later.
• Use over-the-counter creams - hydrocortisone for itching, witch hazel pads for cooling relief. Don’t use them for more than a week without checking with a doctor.

One thing that helps a lot: don’t wipe too hard. Use unscented, alcohol-free wipes or damp cotton cloths. Harsh toilet paper can turn a minor irritation into a raw, painful mess.

When You Need More Than Home Care

If your symptoms don’t improve in a week or two, or if you’re in real pain, it’s time for medical treatment.

For internal hemorrhoids:

• Rubber band ligation - a tiny band is placed around the base of the hemorrhoid, cutting off its blood supply. It 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 to shrink the vein. Less painful than banding, but may need repeat treatments.
• Infrared coagulation - heat is used to seal the blood vessels. Quick, outpatient, minimal downtime.

For thrombosed external hemorrhoids:

• If the clot is fresh (within 72 hours), a doctor can make a tiny cut to drain it. This gives almost instant pain relief.
• After 72 hours, the body usually starts absorbing the clot on its own. Ice, pain relievers, and sitz baths help until then.

For severe or recurring cases:

• Hemorrhoidectomy - surgical removal. It’s the most effective long-term solution (95% success rate) but requires 2-4 weeks of recovery. Pain is significant for the first week, and you’ll need prescription pain meds.
• Stapled hemorrhoidopexy - repositions prolapsed tissue instead of removing it. Less pain than traditional surgery, but higher chance of recurrence.

What Doesn’t Work - and What to Avoid

There’s a flood of online products promising “miracle cures” for hemorrhoids: herbal ointments, detox teas, unregulated supplements. Most are useless. Some are dangerous.

The American Gastroenterological Association and the American Society of Colon and Rectal Surgeons agree: stick to science-backed treatments. Don’t waste money on unproven remedies. If it sounds too good to be true - it is.

Also, avoid these mistakes:

• Delaying care because you’re embarrassed - 68% of people wait over six months before seeing a doctor
• Using steroid creams long-term - they can thin the skin and cause more problems
• Ignoring bleeding - even if you think you know what it is

How to Prevent Them From Coming Back

Treatment helps. Prevention keeps them away. Here’s what works:

• Keep eating fiber - 30 grams a day is the sweet spot. Track it with an app if you need to.
• Stay hydrated - your stool should be soft and easy to pass, not hard or pellet-like.
• Move regularly - even a 20-minute walk daily helps your digestion.
• Don’t delay bowel movements - the longer you hold it, the more pressure builds.
• Use a footstool - it’s not a gimmick. It changes your body position and reduces strain.

People who stick to these habits after treatment have only a 5-10% chance of recurrence. Those who don’t? Up to 50% get them again within a year.

When to See a Doctor

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

• Bleeding lasts more than a week or gets worse
• You feel dizzy, weak, or lightheaded - signs of significant blood loss
• Pain is severe and doesn’t improve with home care
• You notice changes in bowel habits - new constipation, diarrhea, or narrow stools
• You’re over 45 and haven’t had a colon cancer screening

There’s no shame in getting help. Hemorrhoids are a medical condition, not a personal failure. Doctors see them every day. They’re not judging you. They’re here to help you feel better.

Final Thought: It’s Manageable

Hemorrhoids aren’t a life sentence. They’re a signal - your body telling you something’s off. Maybe your diet needs tweaking. Maybe you’re sitting too long. Maybe you need to see a doctor. But whatever the cause, the fix is almost always simpler than you think. Start with fiber. Drink water. Don’t strain. See a professional if it doesn’t improve. You don’t have to live with pain.