Internal vs. External Haemorrhoids: Differences Explained

Haemorrhoids affect millions of people worldwide, and it can significantly impact your daily life. Internal haemorrhoids form inside the rectum, and often go unnoticed until they cause bleeding. External haemorrhoids, however, develop under the skin around the anus, leading to pain and swelling. Around 50% of people over the age of 50 develop haemorrhoids, with internal haemorrhoids making up about 60% of these cases, while external haemorrhoids account for the remaining 40%. 

These problems can impact your quality of life and make it harder for you to go through daily life without pain and discomfort. So, to help you understand the differences and accordingly manage them, this blog explains the differences between internal and external haemorrhoids. We will also discuss their causes, symptoms, and the newest treatments like  Piles laser surgery Delhi from healthcare institutions like MASSH. By learning about these types, you can take steps to manage and relieve your symptoms effectively.

Understanding Internal and External Haemorrhoids

Internal Haemorrhoids: Internal haemorrhoids are located inside your rectum, so you usually can't see or feel them. They are generally painless, but they can cause bleeding during bowel movements. This bleeding is often the first sign of internal haemorrhoids. Sometimes, internal haemorrhoids can become so large that they push out of the anus. When this occurs, it can lead to pain and discomfort.

External Haemorrhoids: External haemorrhoids are veins that swell just beneath the skin surrounding the anus. They are more painful than internal haemorrhoids because the skin in this area is more sensitive. Symptoms involve itching, discomfort, and swelling in the anal area. Sometimes, a hard lump may form due to a blood clot in the haemorrhoid. This condition is known as thrombosed haemorrhoid and can be extremely painful.

Before you learn about the key differences between these two conditions, it is crucial to understand that haemorrhoids need to be medically treated in both cases. Not reporting the condition to your doctor and delaying diagnosis can lead to increased pain and the need for more dedicated medical treatment to manage the condition.

Key Differences Between Internal and External Haemorrhoids

It's important to understand haemorrhoid differences to know how to treat them. Here’s a tabulated view of the differences for easier understanding.

Types of Piles

Piles can be categorised based on their location and severity, either as internal haemorrhoids located inside the rectum, or external haemorrhoids, situated beneath the skin around the anus.

Internal Haemorrhoids: These can be graded from I to IV based on their severity:

Grade I:

Grade I internal haemorrhoids are small bumps that form within the lining of the anus. They are not visible from the outside and often cause minimal symptoms. People with Grade I haemorrhoids might experience minor itching or occasional painless bleeding during bowel movements. This bleeding typically shows up as bright red spots on toilet paper or in the toilet bowl. Because they are internal, these haemorrhoids usually do not cause significant discomfort, and many people may not even realise they have them.

Grade II:

Grade II internal haemorrhoids are larger than Grade I but remain inside the anus. During bowel movements, these haemorrhoids may protrude out of the anus but retract on their own afterwards. Symptoms of Grade II haemorrhoids can include bleeding, itching, and a sensation of fullness or pressure in the rectum. The bleeding is more noticeable than with Grade I haemorrhoids but is still usually painless. The temporary prolapse during bowel movements can cause some discomfort and irritation, prompting people to seek medical advice or treatment.

Grade III:

Grade III internal haemorrhoids are more severe and protrude out of the anus during bowel movements without retracting on their own. These haemorrhoids need to be manually pushed back inside the anus after prolapsing. Symptoms of Grade III haemorrhoids include significant discomfort, bleeding, and irritation. Manually repositioning these haemorrhoids can be painful and inconvenient, often leading individuals to seek more intensive treatment options. The persistent prolapse and associated symptoms can interfere with daily activities and quality of life.

Grade IV:

Grade IV internal haemorrhoids are the most severe form and are characterised by their constant prolapse outside the anus. These haemorrhoids cannot be manually pushed back in and require medical treatment. Symptoms of Grade IV haemorrhoids include constant pain, bleeding, and a high risk of thrombosis, where a blood clot forms within the haemorrhoid. The ongoing external presence of these haemorrhoids causes continuous discomfort, inflammation, and irritation. Due to their severity, Grade IV haemorrhoids often necessitate surgical intervention or other advanced medical treatments to alleviate symptoms and prevent further complications. The constant presence and associated symptoms can significantly impact a person's quality of life, making prompt medical attention essential.

External Haemorrhoids

Swollen veins located just beneath the skin around the anus are known as external haemorrhoids. Unlike internal haemorrhoids, external haemorrhoids can be seen and felt as lumps around the anal area. These lumps often cause itching, discomfort, and pain, especially when sitting or during bowel movements. The skin over these lumps may feel tender and swollen, and can sometimes appear bluish because of the pooled blood in the swollen vein.

A significant issue with external haemorrhoids is the possibility of a blood clot forming inside the lump, known as thrombosed haemorrhoid. When this happens, the haemorrhoid becomes very painful and swollen. The area around the anus may become hard and change colour, and the pain can be severe, particularly when sitting, walking, or using the toilet.

The pain from a thrombosed haemorrhoid is usually most intense within the first two days. After this period, the pain might slowly lessen as the body starts to absorb the clot over several days to weeks. Sometimes, the skin over the clot can break, leading to bleeding and a higher chance of infection.

Home remedies like warm sitz baths, over-the-counter creams and ointments, and pain relievers can be helpful in treating external haemorrhoids. However, if a blood clot forms, a medical procedure called a thrombectomy might be needed. In this procedure, a doctor makes a small cut in the haemorrhoid to remove the clot, which can provide immediate pain relief.

Preventing external haemorrhoids involves maintaining a high-fibre diet, drinking plenty of fluids, avoiding sitting for long periods, and practising good hygiene. These steps help keep stools soft and reduce the need to strain during bowel movements, which lowers the pressure on the veins around the anus and helps prevent haemorrhoids from developing or worsening.

Piles Laser Surgery

The national capital Delhi hosts some of the most modern and sophisticated healthcare institutions in the country. These institutions offers various treatments for piles, including laser surgery. This modern treatment uses a laser to shrink and remove the swollen veins, offering benefits like less pain, quick recovery, lower risk of complications, and precision targeting. Laser surgery is extremely precise and also very low-risk for patients. It can be performed with minimal incisions in your body, which can make the recovery period very easy for patients.

Conclusion

Haemorrhoids, whether internal or external, need proper treatment to avoid complications. Knowing the differences between these types and the treatments available can help you make informed decisions about your health. Piles laser treatment in Delhi at MASSH offers excellent care for haemorrhoids, ensuring effective management and relief from this common condition. We specialise in laser surgery and offer highly targeted and safe laser surgery for patients with haemorrhoids or piles. You can check out our website to learn more about our treatment options or visit us today to consult directly with our specialists.