What’s the Difference Between External and Internal Hemorrhoids?

Hemorrhoids can be an embarrassing and uncomfortable condition. Luckily, there are effective treatments for hemorrhoids, so it’s easier than you think to get rid of this fairly common problem. 

Michael Tarlowe, MD, PC is a proctologist and general surgeon at our offices in White Plains, New York, and Manhattan in New York City. He offers safe and effective treatment for all types of hemorrhoids along with compassionate care and advice. 

Here, he describes the different types of hemorrhoids and explains what treatments are available to reduce your discomfort.

What causes hemorrhoids? 

Hemorrhoids are caused when blood vessels in your rectum or around your anus get swollen. They’re also incredibly common: Up to 75% of people may experience them at some point in their life. 

Your first sign of hemorrhoids might be noticing red blood on the toilet tissue or in the bowl during a bowel movement, or you may have pain and itching. If you suspect you may have hemorrhoids, it’s important to come in to see Dr. Tarlowe quickly so you can get the treatment you need. 

The difference between internal and external hemorrhoids

Internal hemorrhoids occur within the rectum and aren’t usually visible or uncomfortable. They may bleed, which can cause bright red blood when you pass stool, and can eventually interfere with normal bowel movements if they get bigger. 

On occasion, internal hemorrhoids can get pushed outside of the anus due to straining when passing stool, giving birth, or heavy lifting. This causes a prolapsed hemorrhoid, which can bleed frequently and cause greater discomfort. 

External hemorrhoids are found outside of the rectum and can cause bleeding and pain when you pass stool. Due to their exposure to fiction, normal activities such as walking or sitting can cause them to get irritated and painful.

Additionally, external hemorrhoids can sometimes pool blood, causing a clot called a thrombus. Thrombosed hemorrhoids can cause a tender, hard lump near the anal opening. These can become extremely painful and inflamed. 

Preventing hemorrhoids

As with many health conditions, prevention is much easier than treatment. One easy way you can prevent hemorrhoids from developing, or recurring after treatment, is to consume a high-fiber diet. Having soft, regular stools can reduce unnecessary straining.

If you’ve already been diagnosed with hemorrhoids, it can be good to add extra fiber to your diet during your treatment. Start adding fiber slowly as too much fiber can cause diarrhea and irritate your hemorrhoids. 

Hemorrhoid treatments

If you’re concerned you may have hemorrhoids, Dr. Tarlowe conducts a thorough exam to confirm your diagnosis. Your treatment plan is based on the type of hemorrhoid and your symptoms. 

Possible treatments for hemorrhoids include:

Rubber band ligation

Ligation is used for severe internal hemorrhoids, especially those that are prolapsed or bleeding. Dr. Tarlowe places a small rubber band around your hemorrhoid to cut off its blood supply, so it shrinks or falls off. 

Injection sclerotherapy

Injection sclerotherapy is appropriate for bleeding internal hemorrhoids and is recommended for those on blood thinners. Dr. Tarlowe injects a sclerosing solution into your hemorrhoid which causes it to shrivel up and scar. 


This is a hemorrhoid removal surgery that’s best suited for serious internal or external hemorrhoids, and the procedure requires general anesthesia and a few weeks of recovery time. 

Clot removal

This procedure offers immediate relief from a thrombosed external hemorrhoid. Using local anesthesia, Dr. Tarlowe drains the clot through a small incision. This should be done within 72 hours after onset of symptoms. 

No matter what type of hemorrhoid you have, Dr. Tarlowe can help you find relief. If you’re suffering from hemorrhoids, call the nearest office or make an appointment using our online booking portal. 

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