We treat hundreds of patients a month for hemorrhoids, so we get this question a lot. For the most part, the answer is what you might guess. External hemorrhoids are on the outside around the anus, while internal hemorrhoids are inside the anal canal. But of course there’s a longer explanation.

External hemorrhoids are more obvious because they often present as swollen blood vessels or hard lumps that are painful or itchy. Internal hemorrhoids are inside the rectum, so chances are you might not even know they’re there. Patients usually realize they have internal hemorrhoids when they see blood around the stool or the hemorrhoids grow to the point of bulging (prolapsed) outside the anus.

Our friends at CRH O’Regan System do a nice job of explaining internal and external hemorrhoids in more detail.