What Are the Different Types of Hemorrhoids?

types of hemorrhoids

Story at-a-glance -

  • There are actually four types of hemorrhoids, and you can tell them apart by their location, symptoms and possible side effects that are itchy, painful or both
  • Learn the different types of hemorrhoids and their symptoms so you can properly treat them

It's important to know that not all hemorrhoids are the same. There are actually four types of hemorrhoids, and you can tell them apart by their location, symptoms and possible side effects that are itchy, painful or both.

Internal Hemorrhoids

Internal hemorrhoids grow from within the rectum above the pectinate line, a boundary that divides the upper two-thirds of the anal canal from the lower one-third of the said area.1,2 Internal hemorrhoids are encased in a lining called mucosa that isn't sensitive to touch, pain, stretching or temperature.3

These hemorrhoids can be classified into four stages, depending on the level of the protrusion:4

  • Grade I: While the hemorrhoids are prominent, they don't protrude into the anal canal. However, they may bleed
  • Grade II: Hemorrhoids prolapse outside of the canal during bowel movement, but they spontaneously move back inside
  • Grade III: Hemorrhoids protrude due to either a bowel movement or another form of exertion, and they have to be pushed back inside the anal canal using a finger5
  • Grade IV: Hemorrhoids have prolapsed and are found outside the anal canal. They do not remain inside the rectum and cannot be pushed back in

If you notice bleeding during a bowel movement, whether on your stool or toilet paper or in the toilet bowl, this is a sign that you may have internal hemorrhoids.6,7Bleeding happens when you pass stool, which scrapes off the thinned lining of the hemorrhoid.8 When inflamed, an internal hemorrhoid can swell, but there's not much pain because no pain fibers are attached to the veins above the pectinate line. However, spasms of muscles surrounding your rectum and anus could occur because of this swollen hemorrhoid.

These spasms are painful if the hemorrhoids protrude or prolapse through the anus, wherein a lump can be sensed at the anal verge.9 These spasms can also lead to the formation of a painful thrombose or clot. Mucus from the hemorrhoid may also leak, and this can inflame the skin around the anus and cause pruritus ani or anal itching.10,11

Prolapsed Hemorrhoids

As the name suggests, prolapsed hemorrhoids are hemorrhoids that have protruded through the anal canal.12 Just like internal hemorrhoids, prolapsed hemorrhoids often cause bleeding that may appear on your stool, in the toilet bowl or on your toilet paper. In some cases, people with prolapsed hemorrhoids also feel anal itching or incomplete evacuation, a subjective feeling that occurs when a person feels he or she may have not passed stool completely.13,14

Pain can arise in prolapsed hemorrhoids because of the pain-sensing nerves within them, as well as other causes such as:15,16

  • Thrombosis, or the formation of a blood clot.17 Patients with Grade IV hemorrhoids have the greatest risk for a blood clot
  • Edema or swelling that has developed within the hemorrhoid
  • Strangulated hemorrhoids, wherein the hemorrhoids' blood supply has been obstructed because of pressure from the anal sphincter that surrounds the anal canal18

External Hemorrhoids

Also called peranial hematoma,19 external hemorrhoids develop under the skin located around the outer portion of your anus.20 These hemorrhoids can be itchy or painful, feel lumpy and have a bluish color.21 Common symptoms of external hemorrhoids include:22

  • Itching, burning and/or irritation23 around the anus or rectal area
  • Pain around the anus
  • Lumps near or around the anus
  • Blood in the stool

External hemorrhoids have pain fibers attached to them, similar to prolapsed internal hemorrhoids. However, external hemorrhoids are covered with "regular skin" that can lead to excess skin tags that may be felt at the anal verge.

The skin tags appear because the blood clot stretches the overlying skin, and it continues to be stretched even if the blood clot is absorbed by the body.24 Skin tags may cause difficulties with cleaning after a bowel movement, as well as trigger secondary skin infections.25

Thrombosed External Hemorrhoids

Often seen as a hard and painful lump in the anus, thrombosed external hemorrhoids occur when an underlying vein in the hemorrhoid forms a clot in one or more of the small veins,26 resulting in pain.27 These clots, commonly seen under the skin, arise after the hemorrhoids split, as the vein becomes inflamed and blood supply is cut off.28,29 Pain also occurs, especially if there is rapid stretching of the skin covering the hemorrhoid.30


Hemorrhoids: Introduction

What Are Hemorrhoids?

Hemorrhoids Causes

Hemorrhoids Types

Hemorrhoids Symptoms

Hemorrhoids In Pregnancy

Hemorrhoids Treatment

Hemorrhoids Surgery

Hemorrhoids Prevention

Essential Oils for Hemorrhoids

Hemorrhoids Diet

Hemorrhoids FAQ

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