Understanding the Differences Between Internal and External Hemorrhoids

Did you know that almost three in four adults suffer from hemorrhoids? This common problem has a reputation for causing severe pain, swelling, and inflammation. But you can also have hemorrhoids you can’t see or feel. 

Dr. Laureen Forgione-Rubino offers numerous solutions for treating hemorrhoids at her practice in Manchester, Connecticut. In this blog post, she explains the difference between internal and external hemorrhoids and how to spot the signs of an issue.

Hemorrhoid basics

It’s no secret that you have veins all over your body. These blood vessels are part of your circulatory system, and their job is to send oxygen-depleted blood back to your heart. Believe it or not, veins hold nearly 75% of the blood in your body.

What’s often overlooked is that you also have veins in your rectum and outside your anus. When these veins become enlarged or swollen, you have a hemorrhoid called piles.

Anyone can experience hemorrhoids, even teenagers. However, they become increasingly common with age and plague over half of people 50 and older. Other factors that put you at higher risk of hemorrhoids include:

• Being pregnant, overweight, or obese
• Consuming a low-fiber diet
• Spending a long time on the toilet
• Straining during bowel movements
• Struggling with chronic constipation or diarrhea
• Lifting heavy objects on a regular basis
• Having a family history of the condition

While hemorrhoids are very common, you can have them without knowing. That’s because symptoms vary based on their location.

Internal vs. external hemorrhoids

As you might suspect, an internal hemorrhoid forms inside your rectum. This part of your digestive system holds waste from your colon until you’re ready to have a bowel movement, and it exits your body through your anus.

When you have internal hemorrhoids, they usually don’t cause pain. However, strain or irritation from a bowel movement can cause bleeding, leaving bright red blood on your toilet tissue. Sometimes, an internal hemorrhoid can also push through the opening of your anus, leading to pain and irritation. If this occurs, you have a prolapsed or protruding hemorrhoid.

Unlike internal hemorrhoids, an external hemorrhoid develops outside your rectum. These veins develop under the skin surrounding your anus, resulting in the telltale signs of a hemorrhoid, such as:

• Discomfort or pain
• Swelling
• Irritation or itching
• Occasional bleeding

While rectal bleeding is a common sign of a hemorrhoid, never assume that’s the problem — especially if you have other symptoms, like changes in your bowel habits or stools. Bleeding can also be a sign of other diseases, including ulcerative colitis, Crohn’s disease, and colorectal cancer.

Treating hemorrhoids

Dr. Forgione-Rubino diagnoses hemorrhoids by discussing your symptoms and performing a physical exam. She may also recommend a digital rectal exam or additional testing, like an anoscopy, sigmoidoscopy, or colonoscopy.

After diagnosing hemorrhoids, Dr. Forgione-Rubino may suggest a variety of treatments. In some cases, hemorrhoids respond to conservative approaches, like adding more fiber to your diet, soaking in a warm bath, or using topical creams, pads, or suppositories.

However, surgery could be your best option if your hemorrhoids cause persistent bleeding or significant pain. Dr. Forgione-Rubino uses minimally invasive techniques to treat hemorrhoids whenever possible. This approach, known as rubber band ligation, involves placing a small rubber band around the base of the hemorrhoid, cutting off the blood supply so the hemorrhoid dries out and falls off.

For more persistent or large hemorrhoids, Dr. Forgione-Rubino could recommend removing the problem vein entirely during a hemorrhoidectomy. 

Do you have hemorrhoids? Contact our office by phone or online to schedule a consultation with Dr. Forgione-Rubino today.