So you have established that hemorrhoids are a possibility.

Excellent.

Not because hemorrhoids are exciting, obviously, but because now we can get a little more specific.

There are two main kinds of hemorrhoids: internal hemorrhoids and external hemorrhoids.

They are related, but they can look and feel surprisingly different.

Think of it as the difference between an inside job and an outside problem.

🏠 What Are Internal Hemorrhoids?

Internal hemorrhoids develop inside the rectum.

Because that area does not have the same pain-sensitive nerves as the skin around the outside, internal hemorrhoids often do not hurt very much.

In fact, you may not realize you have one until something else gets your attention.

Common signs can include:

• bright red blood on the toilet paper
• blood on the outside of the stool
• a little blood in the toilet bowl
• a feeling of pressure or fullness
• tissue that seems to bulge out during a bowel movement
• mucus or irritation around the area

Sometimes there is no pain at all.

Which feels a little unfair.

If something is going to announce itself with blood, you would at least expect it to explain what it wants.

🩸 Why Can Internal Hemorrhoids Bleed?

Internal hemorrhoids contain swollen blood vessels.

Passing stool — especially hard stool — can irritate the surface and cause a small amount of bleeding.

This is one reason constipation and straining can become such a problem.

The blood is usually bright red, because it is coming from relatively close to the exit.

If blood on the toilet paper is your main concern, Why Is There Blood on the Toilet Paper? digs into the possibilities more closely.

And because rectal bleeding can have causes other than hemorrhoids, repeated or unexplained bleeding is worth discussing with a healthcare professional.

🚪 Can Internal Hemorrhoids Come Outside?

Yes.

An internal hemorrhoid can sometimes push down and protrude through the opening. This is called a prolapsed hemorrhoid.

That sounds dramatic, but the amount of prolapse can vary quite a bit.

Some only come out briefly during a bowel movement and then go back in on their own.

Others may stay outside longer or need medical evaluation if they become painful or difficult to manage.

When this happens, an internal hemorrhoid suddenly becomes much harder to ignore.

🍑 What Are External Hemorrhoids?

External hemorrhoids develop beneath the skin around the outside of the opening.

These are much more likely to make themselves known.

You may notice:

• itching
• burning
• soreness
• swelling
• tenderness
• a bump
• discomfort when sitting
• pain when wiping or cleaning

Unlike internal hemorrhoids, external hemorrhoids live in an area with lots of pain-sensitive nerves.

So while an internal hemorrhoid may quietly bleed and mind its own business, an external hemorrhoid can be the one yelling:

“HELLO. I LIVE HERE NOW.”

😬 What Does an External Hemorrhoid Feel Like?

It varies.

Some feel like a small soft bump.

Others may feel firmer or swollen.

They can be mildly annoying or genuinely painful depending on how irritated they are.

A suddenly painful, firm bump can sometimes happen when a blood clot develops inside an external hemorrhoid. This is called a thrombosed external hemorrhoid.

Again, the name sounds worse than it needs to.

“Thrombosed” simply means a clot has formed inside it.

But because these can be quite painful, a healthcare professional may be helpful if the pain is significant or comes on suddenly.

🤝 Can You Have Both at the Same Time?

Unfortunately, yes.

Internal and external hemorrhoids are not mutually exclusive.

You can have symptoms from both.

That means someone might notice:

• bleeding during a bowel movement
• itching afterward
• a bump on the outside
• some pressure or discomfort

At that point, your butt has apparently decided one problem was not enough.

🔥 Which Kind Causes More Pain?

Usually, external hemorrhoids.

That is largely because the skin around the outside contains more pain-sensitive nerves.

Internal hemorrhoids can still become uncomfortable, particularly if they prolapse or become irritated, but painless bleeding is a classic internal hemorrhoid pattern.

That distinction can sometimes give you a clue.

Mostly bleeding, little pain? Internal is more likely.

Tender bump, itching, soreness? External becomes more likely.

But these are clues, not a diagnosis.

Bodies have an annoying habit of refusing to follow flowcharts perfectly.

🪶 Which Kind Causes Itching?

External hemorrhoids commonly cause itching because they can irritate the surrounding skin.

Prolapsed internal hemorrhoids can also contribute to moisture, mucus, or irritation, which can make the area itchy.

And hemorrhoids are far from the only possible reason your butt might itch.

Skin irritation, aggressive wiping, moisture, certain products, diarrhea, and other conditions can all contribute.

That is why we are giving Why Is My Butt So Itchy? its own article in this cluster.

It has earned one.

🔎 Which Kind Causes a Bump?

A noticeable bump is more commonly associated with an external hemorrhoid.

A prolapsed internal hemorrhoid can also create tissue that appears or feels outside the opening.

But — important point — not every bump back there is a hemorrhoid.

Skin tags and several other things can look or feel similar.

That is where What Is That Weird Little Bump Back There? comes in.

🚽 What Makes Either Kind Worse?

The same general suspects show up again and again:

• constipation
• hard stool
• straining
• sitting on the toilet for long periods
• frequent diarrhea
• repeated wiping
• pregnancy
• heavy lifting
• ongoing pressure in the area

One particularly common habit is spending far too much time sitting on the toilet.

Your bathroom may have excellent Wi-Fi.

Your hemorrhoids do not care.

When the job is finished, it is usually better to get up instead of turning the toilet into a recliner.

🪨 Can Constipation Cause Both Types?

Constipation and straining can contribute to pressure in the veins around the rectum, which can worsen hemorrhoids.

Hard stool can also irritate existing hemorrhoids.

If you regularly have hard, dry bowel movements, our guide to Can Constipation Give Me Hemorrhoids? will connect the dots more directly.

You may also want to read Why Is My Poop Hard? Types 1 & 2 Explained if stool consistency itself seems to be part of the problem.

💦 What About Diarrhea?

Diarrhea can cause trouble from the opposite direction.

Frequent bowel movements mean:

• more wiping
• more moisture
• more irritation
• more inflammation

All of that can make the area sore and aggravate existing hemorrhoids.

That is the idea behind Can Diarrhea Wreck Your Butt?

Spoiler: it can certainly try.

🌿 Do Hemorrhoids Go Away?

Mild hemorrhoid symptoms can often improve with time and changes that reduce irritation and straining.

Helpful habits can include:

• getting enough fiber
• increasing fiber gradually
• drinking adequate fluids
• avoiding straining
• not lingering on the toilet
• staying physically active
• cleaning gently
• using warm baths or sitz baths for comfort

Some hemorrhoids settle down quickly.

Others keep returning, especially if whatever is causing the pressure or irritation continues.

⚠️ When Should You Get Checked?

It is worth talking with a healthcare professional if:

• bleeding is new, repeated, or heavy
• pain is severe
• a bump becomes suddenly very painful
• symptoms are not improving
• you have significant swelling
• bowel habits change noticeably
• you are losing weight without trying
• you feel weak, dizzy, or faint
• stool becomes black or tar-like
• you develop fever or worsening pain

Hemorrhoids are common, but that does not mean every symptom in the area should automatically be blamed on them.

Our cluster hub, Hemorrhoids!? How to Start Figuring Out What’s Going On, is designed to help you look at the whole pattern.

✅ The Bottom Line

Internal and external hemorrhoids are basically two versions of the same problem in different locations.

Internal hemorrhoids are more likely to cause painless bright-red bleeding, pressure, or prolapse.

External hemorrhoids are more likely to cause itching, swelling, tenderness, and a noticeable bump.

And yes, you can have both.

So if you are trying to figure out what is happening, ask yourself:

Is it mostly bleeding?

Is there a bump?

Does it hurt?

Does it itch?

Is constipation or diarrhea part of the story?

Those clues will not give you a perfect diagnosis, but they can help you start making sense of what is going on.

And if the answer turns out to be hemorrhoids?

At least now you know whether the trouble is coming from inside the house or waiting for you outside.