They can cause a lot of pain simply because of the multitude number of pain-sensing nerves surrounding the anus. In addition, another factor that makes them more painful than an internal hemorrhoid is the placement of the former, which is in the part of the skin that is constantly moving and shifting as we walk, bend, squat or sit. This, in turn, aggravates the already inflamed haemorrhoid.

Like internal hemorrhoids, external hemorrhoids can be accompanied with itchiness and burning sensations, mainly due to the mucus excreted by the hemorrhoid as part of its healing process. That is why individuals with hemorrhoid frequently experience a leaky butt, though not all of them dare admit it!

It is a relief, though, that the leak is not caused by the rupturing of the walls of the rectal veins.

The burden does not end there. Unfortunately, an unrelenting and irritating burning sensation is also felt when mucus touches the cut part of hemorrhoid. It is the same kind of burning sensation that you feel when perspiration gets into your fresh open wound.

Upon anal inspection, an external pile appears as tensed grape-like mass of abnormal growth in view around the outer anal canal. Using the naked eye, it is sometimes difficult to differentiate between the two types of hemorrhoids, most especially when the internal hemorrhoid becomes prolapsed or protrudes out of the anus. But if a physician uses a protoscope he can visualize them more closely.

Internal hemorrhoids are covered by columnar mucosa of the skin, while external ones by squamous mucosa.

There are some cases that the walls of the rectal veins bulge and rip apart. Blood pools under the skin and then forms into a hard, painful lump. The lump appears to have black, blue or dark purple or deep red tint. This is because the mass becomes filled with clot. It also has a shiny appearance due to the stretching of the skin. This lump is called a thrombosed or clotted hemorrhoid.

This occurs when an external hemorrhoid becomes strangulated – meaning that its blood supply has been cut off. A thrombosed hemorrhoid is associated with increased swelling, and therefore, will generate more pain. The pain usually peaks after 48 to 72 hours, and then gradually goes away over 7 to 10 days.

It may bleed a little for a few days and may gradually shrink to become a small excess skin. This small area of excess skin is called a ‘skin tag’. Several skin tags can give the anus a ruffled appearance. Skin tags usually do not cause discomfort but they can make cleaning your bottom after bowel movement harder due to the added crease they create. Smaller fecal particles may get lodged between the creases.

It is important to note that it is possible that you may get both internal and external hemorrhoids all at the same time.