Types of Hemorrhoids: Internal, External, and Thrombosed Hemorrhoids Explained

Hemorrhoids are swollen veins in the rectum or around the anus that can create discomfort, pain, and bleeding. While many people assume all hemorrhoids are the same, the truth is that the condition comes in several forms—each with its own symptoms, risk factors, and treatment approaches. Knowing the exact type of hemorrhoid you’re dealing with helps determine the most effective way to relieve symptoms and prevent complications.

This comprehensive guide breaks down every major type of hemorrhoid, including internal, external, thrombosed, and prolapsed hemorrhoids, along with the medical grading system doctors use to classify the severity of internal hemorrhoids. If you want a broader overview of the condition itself, you can visit the main hemorrhoids pillar page for causes, remedies, and prevention strategies.

1. Internal Hemorrhoids

Internal hemorrhoids form inside the lower rectum, a region that lacks pain-sensing nerves. Because of this, many people don’t realize they have internal hemorrhoids until they notice signs like bright red blood on toilet paper or in the toilet bowl. These hemorrhoids typically present as painless, soft tissue inside the rectal canal.

However, internal hemorrhoids may grow over time and begin to prolapse outside the anus, especially during bowel movements. Mild cases often respond well to lifestyle changes, but advanced internal hemorrhoids may require medical procedures. To learn more, visit the full guide on internal hemorrhoids, which explains symptoms, stages, and treatments in detail.

2. External Hemorrhoids

External hemorrhoids develop under the skin surrounding the anus. Because this area contains numerous nerve endings, external hemorrhoids tend to be more painful than internal ones. They often appear as small, tender bumps and may cause itching, burning, or swelling that worsens with sitting or straining.

These hemorrhoids can become irritated by wiping, prolonged sitting, or friction from clothing. While home remedies such as sitz baths and cold compresses can help, stubborn cases may require clinical treatment. You can explore more details on the external hemorrhoids page, including symptom relief techniques.

3. Thrombosed Hemorrhoids

Thrombosed hemorrhoids occur when a blood clot forms inside an external hemorrhoid. This leads to sudden, severe pain and noticeable swelling. People often describe the pain as sharp or throbbing, especially when sitting or having a bowel movement. A thrombosed hemorrhoid appears as a firm, bluish lump near the anal opening.

While thrombosed hemorrhoids may improve over time, the intense discomfort often prompts people to seek quick treatment. In some cases, a doctor may perform a simple procedure to remove the clot, providing near-immediate relief. If you suspect you have this condition, visit the thrombosed hemorrhoids guide for treatment options and recovery tips.

4. Prolapsed Hemorrhoids

Prolapsed hemorrhoids begin as internal hemorrhoids that gradually extend outward through the anal opening. The extent of prolapse varies, ranging from mild bulging that retracts on its own to more severe cases that remain permanently outside the anus.

Prolapsed hemorrhoids can lead to irritation, mucus leakage, hygiene challenges, and significant discomfort. Chronic prolapse is often classified as Grade 3 or Grade 4 hemorrhoids. If you’re dealing with prolapse, it’s important to understand your treatment options, which you can find in the prolapsed hemorrhoids subcluster.

Hemorrhoid Grading System (Grade 1–4)

Doctors use a four-grade system to categorize internal hemorrhoids based on how far they extend from their normal position. This system helps determine the appropriate treatment approach.

Grade 1

These hemorrhoids do not prolapse outside the anus. Although they may cause bleeding, they typically respond well to lifestyle modifications, improved fiber intake, and hydration. More information can be found on the Grade 1 hemorrhoids page.

Grade 2

These hemorrhoids prolapse during bowel movements but retract automatically afterward. They may cause itching, discomfort, or mild bleeding. Visit the Grade 2 hemorrhoids subcluster for guidance on management.

Grade 3

These hemorrhoids prolapse and require manual reduction (pushing them back inside). Grade 3 hemorrhoids often require medical procedures to prevent further progression. They’re covered in depth on the shared Grade 3 & 4 hemorrhoids page.

Grade 4

These are permanently prolapsed hemorrhoids that cannot be pushed back in. They may become strangulated, which can limit blood flow and create a medical emergency. Grade 4 conditions are also addressed in the Grade 3 & 4 hemorrhoids resource.

Risk Factors That Influence the Type of Hemorrhoid

The type of hemorrhoid a person develops often relates to lifestyle habits and health conditions. Chronic constipation, a low-fiber diet, pregnancy, prolonged sitting, and obesity all increase the risk. Heavy lifting can strain the lower rectum and contribute to external or thrombosed hemorrhoids. Even daily routines, such as sitting on the toilet for long periods, can raise the likelihood of both internal and external hemorrhoids.

If you want to explore what triggers hemorrhoids and how to lower your risk, visit the hemorrhoids causes & risk factors cluster for a full breakdown.

How the Type of Hemorrhoid Determines Treatment

The treatment approach varies depending on the specific type of hemorrhoid you have. Internal hemorrhoids often respond to dietary improvements and minimally invasive procedures like rubber band ligation. External hemorrhoids typically require symptom-focused care because of their sensitivity. Thrombosed hemorrhoids may require clot removal, while prolapsed hemorrhoids often need procedural or surgical treatment.

If you’re exploring treatment options, visit the main hemorrhoids treatments cluster, which covers both non-surgical and surgical solutions.

Prevention Strategies for All Hemorrhoid Types

Regardless of the type, prevention plays a major role in long-term relief. Drinking enough water, eating high-fiber foods, and avoiding straining during bowel movements all help reduce symptoms and prevent worsening. Practicing healthy bowel habits and improving daily routines can significantly decrease recurrence.

For more prevention-focused guidance, explore the hemorrhoids diet and prevention cluster, which explains fiber targets, hydration tips, and foods that may aggravate symptoms.

When to Seek Medical Attention

While mild hemorrhoids often improve with at-home care, persistent bleeding, severe pain, or prolapsed tissue should be evaluated by a healthcare professional. Some people delay treatment due to embarrassment, but early care prevents complications and allows for faster recovery.

For medically reviewed insights, refer to the Cleveland Clinic’s overview at this resource.