Hemorrhoids are swollen veins in the rectal area that make our lives uncomfortable. To start treatment it is important to understand the different types and cause behind them to apply correct treatment.
In general, hemorrhoids can be separated into two types – internal and external. Internal hemorrhoids are invisible, being formed inside the rectum. And external hemorrhoids are easily visible and touchable as they are formed outside the rectum.
Besides the two main types, the Internal and external hemorrhoids have both also one additional and a more severe type. So in total, we have four different types. It is possible to distinguish one from the other based on the symptoms they produce and the location where they are found. Different types of hemorrhoids also result in different types of effects, including itching, bleeding, and different painful sensations.
Before starting hemorrhoids treatment, it is important to know the different hemorrhoid types and stages to apply the most suitable treatment. In the following sections, we will cover the four types in dept.
The four types—internal, prolapsed (a progression of internal), external, and thrombosed external—reflect varying degrees of severity and anatomical involvement. Recognizing these distinctions is crucial because treatment efficacy depends on addressing the specific pathology, whether it’s venous swelling, protrusion, or clot formation. Misdiagnosis can delay relief, so understanding symptoms and stages is a foundational step.
Internal hemorrhoids
As the name clearly states, internal hemorrhoids develop inside of the rectal area. The anal canal is divided into three regions. The two upper regions are separated from the third region by a line called pectinate line. Internal hemorrhoids are present on this line and are also present in the mucosa. It`s an overlying layer of loose connective tissue that is continuous with the skin at various body openings – at our case inside the anus.
Internal hemorrhoids are usually painless and become apparent because they cause bleeding during bowel movement.
The reason why there is almost no pain related to internal hemorrhoids is that the mucus does not have pain-sensitive nerves and therefore is not affected by the pain causing factors like: temperature changes, stretching, straining or touching or even irritations and damages.
Internal hemorrhoids arise from the hemorrhoidal cushions—normal vascular structures that aid continence—becoming engorged due to pressure. Their location above the pectinate (dentate) line means they’re covered by mucosa, not skin, which lacks somatic nerve endings. This explains their painless nature unless they prolapse. Chronic straining or poor venous drainage can exacerbate their development, making them a silent but common issue.
Internal hemorrhoids symptoms are as follows
The most common way for you to identify internal hemorrhoids is if you find blood on toilet paper or you see blood in the stool. The bleeding starts because the hemorrhoids tissue gets damaged during the bowel movement.
Internal hemorrhoids can also swell, but this does not generally affect the sufferer. This is because the pectinate line and the mucus do not have sensory nerves associated with the sensation of pain. Despite that, it is possible for the person to experience muscle spasms in muscles close to the anal region.
Sometimes, the situation may progress and a lump may be present on the verge of the anal opening. Therefore by internal hemorrhoids, it is possible that mucus may leak from the lump and this fluid causes inflammation. As a response to this inflammation, you may start to suffer from excessive anal itching.
In the case where the internal hemorrhoids do not get proper attention and treatment, they may develop further and prolapse or protrude outside the anus. This is already a more painful stage that includes all the previously mentioned symptoms, but worse.
The bright red blood associated with internal hemorrhoids results from their arterial supply, distinguishing it from darker blood that might indicate upper GI issues. Mucus discharge can irritate perianal skin, leading to secondary infections if hygiene is neglected. Persistent symptoms may signal progression, so monitoring changes is key to preventing complications.
Prolapsed hemorrhoids
If the Internal hemorrhoids protrude out of the anal region, they are called prolapsed hemorrhoids. In that case, you will be able to see and feel them in the rectal area.
The overall symptoms are very similar to internal hemorrhoids and you may see blood on your toilet paper as well.
The major symptom of this type of hemorrhoids is anal itching which is accompanied by a feeling of incomplete bowel movement. This means you have a feeling that you are not completely done with passing stool.
Prolapsed hemorrhoids, due to the protrusion come in contact with areas that have sensory nerves associated with them. For this reason, prolapsed hemorrhoids can be painful. Also, there can occur edema – this refers to the swelling of the concerned area, which can be painful and can cause discomfort when passing stool.
Blood clots may also form in prolapsed hemorrhoids. This is known as thrombosis and is quite pronounced by prolapsed hemorrhoids. Blood clots are likely to make the hemorrhoids more painful and can increase the extent of bleeding.
One reason for prolapsed hemorrhoids can be increased pressure in anal sphincter. This is a ring of muscles that surrounds the anal opening. They serve to control the end of the gastrointestinal tract, preventing uncontrolled access from any direction – basically, they hold the poo in. When for some reason the pressure is constantly too high or blood flow is disrupted, it can result in an increased chance of forming prolapsed hemorrhoids.
In simple words, prolapsed hemorrhoids are worse developed internal hemorrhoids, that reach out of the anal area. You can feel them as moist pads of skin that are pinker than the surrounding area. If irritation is reduced and treatment applied they can usually recede into the rectum on their own. It is also possible to push them gently back into place by yourself.
Prolapse occurs when supportive tissues weaken, often due to chronic straining or aging. The pink color reflects mucosal tissue, unlike the skin-covered external hemorrhoids. Thrombosis in prolapsed hemorrhoids is less common than in external ones but can occur, especially if strangulation cuts off blood flow. Gentle manual reduction works best when the tissue is lubricated and relaxed—e.g., after a warm bath—but persistent prolapse requires medical evaluation.
External hemorrhoids
These hemorrhoids form under the piece of skin present in the external region of the anus. External hemorrhoids are also called perianal hemorrhoids and they can have the following symptoms:
External hemorrhoids also cause pain because these are present close to those regions with pain sensing nerve fibers. The major difference between prolapsed hemorrhoids and external hemorrhoids is that the external ones are covered with skin. The sufferer can feel this skin very close to the anal opening.
When a blood clot forms in the area, the skin above it tends to get stretched. As the clot grows over time, the skin also gets stretched further. However, even when the blood clot gets absorbed back into the body, the skin continues to stretch. One outcome of this persistent skin stretching in the affected area is the formation of skin tags.
The same stretched and swollen skin can also become the precursor for many skin infections that can be a source of discomfort for the suffering individual.
Located below the pectinate line, external hemorrhoids are covered by squamous epithelium rich in nerve endings, explaining their painful nature. Skin tags from resolved external hemorrhoids are benign but can complicate hygiene. Infections may arise from microtears or moisture buildup, emphasizing the need for gentle cleansing and drying.
Thrombosed external hemorrhoids
Thrombosed external hemorrhoids are a progressed form of external hemorrhoids. They are detected by the presence of a hard lump in the anal region. The lump gets hardened because the vein present in the hemorrhoids clots. When the hemorrhoids split up, the blood flow to the area is obstructed.
It is due to this reason that a person feels pain. The clot also causes stretching of the overlying skin and this further increases the sensation of pain.
Thrombosis occurs when blood pools and clots within the hemorrhoidal vein, often triggered by trauma (e.g., straining) or prolonged pressure. The resulting lump can turn purple or blue, and pain peaks within 48-72 hours before gradually subsiding as the clot resolves. If untreated, ulceration or bleeding may occur, though most cases self-resolve within weeks with supportive care.
There are four different stages of internal hemorrhoids. These stages are detected differently and are also treated differently. In every stage, the extent of pain and location of the hemorrhoid varies. A basic overview of these stages is given below.
In this stage, the patient experiences bleeding from the rectal region, especially when they pass stool. If the patient tends to push a lot during excretion, this bleeding can increase due to extensive pressure on the rectal region. At this stage, a person will see blood in their stool and on the toilet paper. They may also feel some pain but at this point, the hemorrhoid is still inside the body and has not protruded out of the anal region.
Stage 1 is the mildest form, often unnoticed beyond minor bleeding. The lack of prolapse keeps it painless, but repeated irritation can push it to the next stage. Early intervention with diet and hydration can halt progression.
At this stage, the prolapsing of the hemorrhoid begins. Bleeding can also occur at this stage. Sometimes, hemorrhoids that have protruded out of the body go back inside and is not something you have to be worried about. Stage 2 hemorrhoids are not very painful and are not considered something to be alarmed about.
However, spotting blood in stool or on toilet paper can be worrisome for the individual. In addition, patients may also find it somewhat uncomfortable to eliminate feces from their body.
Spontaneous reduction distinguishes Stage 2 from later stages. The prolapse is temporary, often triggered by straining, and resolves post-bowel movement. Discomfort arises from mild irritation rather than nerve involvement, making it manageable with conservative measures.
At this stage, the hemorrhoid prolapses. This is when it starts to cause pain because it now touches the part of the anal region which has sensory nerve endings. At this stage, the patient feels pain and discomfort during elimination of feces. However, the hemorrhoid can still be retracted back into the body with consistent massage of the region.
To make sure that the hemorrhoid retracts back into the body, you need to keep the anal area clean at all times. Moreover, if the region is not touched much, hemorrhoids tend to go back into the body on their own. In some extreme cases, the patient may have to take aid from herbal ingredients and over-the-counter ointments that not only sooth the anal region but also help push hemorrhoids back into the body. Home remedies are most commonly used since they are a mild form of treatment.
Stage 3 marks a shift to symptomatic prolapse requiring manual intervention. Pain stems from exposure to the sensitive anoderm. Hygiene is critical to prevent edema or infection, and remedies like witch hazel can reduce swelling to aid retraction.
The last stage of internal hemorrhoids is the most dangerous one. It is not possible for the patient to make these hemorrhoids retract into the body manually. If not treated in time, these hemorrhoids can further progress to form thrombosed external hemorrhoids.
At this stage, a patient is expected to feel the most pain and the treatment methods for this stage includes herbal treatment. Even at this stage, the hemorrhoids can retract back on their own but they take quite long to do so. For this reason, most patients opt for getting treatment instead of having to suffer the discomfort and pain for such a long time.
Stage 4 often involves strangulation or irreducible prolapse, risking complications like necrosis if blood supply is cut off. Pain is severe due to nerve compression and inflammation. Medical intervention is typically advised, as spontaneous resolution is slow and unreliable.
For most people, hemorrhoid flare ups typically disappear within two weeks without treatment. Generally, consuming a high fiber diet and drinking an adequate 8-10 glasses of water daily can help manage symptoms. For mild to moderate cases, individuals may also use stool softeners to minimize straining during bowel movements.
More specifically, treatment methods do vary for all hemorrhoid stages and types. For instance, in milder cases, a massage can do the job. Often, all the patient has to do is to leave the hemorrhoids alone and keep the affected area clean for the hemorrhoid to be retracted. In more severe cases, supplements may be used that are filled with herbal ingredients.
There are also plenty of herbal medicines and home remedies that are used for treating hemorrhoids and getting rid of lumps that form in the anal region. You can treat a hemorrhoid at home but if you see a lot of blood and the pain just does not seem to go away, you need to consult your doctor for medical advice.Read about: NATURAL TREATMENT FOR HEMORRHOIDS
Treatment success hinges on matching the approach to the stage and type. Early stages respond well to lifestyle tweaks, while advanced cases may need procedural intervention. Persistent symptoms despite home care signal the need for professional assessment to rule out complications or alternative diagnoses.
Hemorrhoids stem from increased venous pressure in the rectal area. Key risk factors include:
Less obvious causes include heavy lifting, sedentary jobs, or even anal intercourse, all of which elevate pressure. Understanding these triggers helps tailor prevention and treatment, addressing root causes rather than just symptoms.
Beyond home remedies, severe or persistent hemorrhoids may require:
These procedures vary in invasiveness and recovery time. Minimally invasive options like ligation are outpatient, while surgery may require weeks of healing. Thrombosed hemorrhoids might need urgent incision to relieve pain. Discussing risks (e.g., recurrence, infection) with a doctor ensures informed choices.
Long-term relief relies on sustainable habits:
A footstool during bowel movements mimics squatting, easing strain. Limiting toilet time to 5-10 minutes prevents venous pooling. These adjustments not only treat but also prevent recurrence, offering a holistic approach to hemorrhoid care.
Hemorrhoids, whether internal, external, prolapsed, or thrombosed, vary in impact and management. By understanding their types and stages—from painless Stage 1 bleeding to painful Stage 4 prolapse—you can choose the right treatment, from simple home remedies to advanced procedures. With proactive lifestyle changes and timely medical advice, relief and prevention are within reach, restoring comfort to your daily life.
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Stage 4 hemorrhoids pictures can be found here. And actual pictures of hemorrhoids can be found here. And live pictures of hemorrhoids can be found here.
