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Dr. Ritha Belizaire, board-certified colorectal surgeon and Founding Clinical Advisor of Betty Health, explains internal vs external hemorrhoids.
Video Summary
What’s the difference between internal and external hemorrhoids?
Internal hemorrhoids are located inside the rectum; external hemorrhoids are on the outer portion of the anus. Internal hemorrhoids are covered by mucosa (the rectal lining), while external hemorrhoids are covered by skin.
Why location matters (nerves & pain)
Internal hemorrhoids don’t have pain fibers, so they typically don’t hurt—though they can cause discomfort. External hemorrhoids lie below the dentate line and are covered by skin rich in pain fibers, which is why swollen external hemorrhoids can be extremely painful and often lead people to seek urgent care.
Typical symptoms
- Internal: prolapse (tissue protruding outside the anal canal) or bleeding; pain is uncommon.
External: significant pain when swollen; may also have tenderness and swelling.
How treatment differs
Internal hemorrhoids: often managed with ointments and, in some cases, rubber band ligation to help them shrink.
External hemorrhoids: treated symptomatically to reduce pain and swelling (e.g., ointments). When severe, surgical removal may be needed.