backup og meta
Health Screening
Ask Doctor

Prolapsed, Internal, and External Hemorrhoids: What You Need To Know

Medically reviewed by Mike Kenneth Go Doratan, MD · General Surgery · The Medical City Ortigas

Written by Jan Alwyn Batara · Updated Dec 12, 2022

Prolapsed, Internal, and External Hemorrhoids: What You Need To Know

Different types of hemorrhoids can have different symptoms. Some can cause mild discomfort that can usually be managed with over-the-counter medication. However, there are also types of hemorrhoids that cause more severe pain, and may even require surgery.

But before we get to the types of hemorrhoids, we first need to understand what hemorrhoids are.

What Are Hemorrhoids?

When people say hemorrhoids, they usually refer to a painful condition. But hemorrhoids are actually veins located in the anus or rectum. This means that everyone technically has hemorrhoids.

When these veins become swollen or turn into varicose veins, then a person experiences the symptoms usually associated with hemorrhoids.

Hemorrhoids are also a pretty common condition. In fact, most adults might experience hemorrhoids at one point in their lives. In addition, having chronic constipation or being pregnant can also increase the risk of swollen hemorrhoids.

Types of Hemorrhoids

There are three main types of hemorrhoids: internal, prolapsed, and external hemorrhoids. Below is a detailed description of each.

External Hemorrhoids

The pectinate line divides the anus into proximal and distal parts. External hemorrhoids are those below that line.

External hemorrhoids usually feel like hard lumps and can have a bluish tinge. Touching these hemorrhoids are more painful than internal hemorrhoids, as the skin covering it is very sensitive. These types of hemorrhoids usually appear after a person strains too much while they are defecating.

In some cases, blood clots form (thrombosed), causing a lot of pressure on the tissues. As the pressure increases, the pain becomes more severe and constant. When there’s too much pressure, the skin can sometimes break and blood starts to leak.

Defecating with external hemorrhoids can be very painful, and even sitting down or having pressure near the anus can also cause pain.

External hemorrhoids can sometimes go away on their own. However, medication or even surgery might be required in order to treat this type of hemorrhoid.

external hemorrhoids

Internal Hemorrhoids

Internal hemorrhoids are hemorrhoids that are found above the pectinate line. These hemorrhoids are usually painless, but it’s possible for them to cause bleeding especially if a person strains while defecating or is constipated.

The reason why internal hemorrhoids are usually painless is because they are covered by a lining called “mucosa.” This mucosa is not sensitive to temperature, pain, or touch, so patients with internal hemorrhoids usually do not notice it until they experience bleeding.

Internal hemorrhoids usually go away on their own. However, if a person suffers from chronic constipation, then it’s possible for it to get worse.

Prolapsed Hemorrhoids

Prolapsed hemorrhoids are a severe form of internal hemorrhoids. Being prolapsed means that the hemorrhoid has “stretched” or “drooped,” and is coming out of a person’s anus.

There are four different grades of prolapse that a person might experience:

  1. Grade 1 means that there is no prolapse.
  2. Grade  2means a person has a prolapse, but it goes back in on its own.
  3. A Grade 3 prolapse is a prolapse that needs to be manually pushed back in.
  4. Lastly, a Grade 4 prolapse is the most severe, and can’t be pushed back in.

Prolapsed hemorrhoids are very painful and can also cause bleeding. More serious cases of prolapsed hemorrhoids require treatment.

The most common forms of treatment for prolapsed hemorrhoids include the following:

  • Eating a high fiber diet
  • Over-the-counter hemorrhoid medication
  • Undergoing a procedure called rubber band ligations where the hemorrhoid is tied off
  • Sclerotherapy or a procedure that contracts the blood vessels
  • Surgery to remove the hemorrhoid or hemorrhoidectomy

Key Takeaways

When it comes to hemorrhoids, knowing what type of hemorrhoids you have lets you know what steps you can take in order to treat it. As always, if you feel that the symptoms are getting worse, or your condition is not going away or healing on its own, don’t hesitate to consult your doctor.

Learn more about Digestive Health here


Hello Health Group does not provide medical advice, diagnosis or treatment.

Medically reviewed by

Mike Kenneth Go Doratan, MD

General Surgery · The Medical City Ortigas

Written by Jan Alwyn Batara · Updated Dec 12, 2022

ad iconadvertisement

Was this article helpful?

ad iconadvertisement
ad iconadvertisement