Hemorrhoids: Internal or External. Does it Matter?

Hemorrhoids.  We All Have Them.

Hemorrhoids. Internal or External. Does It Matter?Hemorrhoids are a normal part of our anatomy.  They are a mix of arteries, veins, nerves and connective tissue.  They exist in the anal canal (the anus) for a reason.  Hemorrhoids act as cushions that facilitate the normal smooth passage of stool from the colon to the rectum and through the anal canal. The hemorrhoidal veins return blood to the heart.  Just like every other vein in the body.  We all have hemorrhoids.  They may be internal hemorrhoids or external hemorrhoids.

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Hemorrhoids know no gender preference.  They occur in rural areas and in big cities such as Los Angeles, Beverly Hills and Culver City.  Some hemorrhoids are internal hemorrhoids, some are external hemorrhoids, and some are mixed.   What is the difference and does it matter?  Is your proctologist, also known as a colorectal surgeon, the only expert with knowledge about hemorrhoids?  Continue reading to find out the difference.  And yes, it matters.

The Ten Plagues.

One half of the adult population over the age of 50 has hemorrhoids.  And, with hemorrhoids comes symptoms.  Some minor.  Some major.  The list reads like recitation of the ten plagues. 

  • Anal pain.
  • Bleeding.
  • Protrusion.
  • Itching.
  • Discharge.
  • Constipation.
  • Fullness.
  • Inability to keep clean.
  • Soiling.
  • And, an overall pain-in-the you know where.

Internal Or External. Inside And Outside.

In the anal canal, there is an irregularly shaped circumferential line marking the spot where the rectum meets the anus.  It is termed the dentate line.  “Dentate” refers to its saw-toothed appearance.  It was created during fetal development.  Hemorrhoids above this line are termed internal hemorrhoids.  Hemorrhoids below this line are termed external hemorrhoids.  External hemorrhoids can exist inside of the anal canal and still be external hemorrhoids.  The term “external” refers to the hemorrhoid’s location relative to the dentate line, and NOT to whether the hemorrhoid is inside or outside of the anus.

Internal and external hemorrhoids may exhibit similar sets of symptoms.  Or they may exhibit different symptoms.


External hemorrhoids tend to be those that protrude, making it difficult for you to adequately wipe your anal area after a bowel movement,.  They may become thrombotic, or thrombosed.  A thrombotic hemorrhoid is one that has a swollen blood clot in the vein.  The swelling can be intensely painful, present as a large outside lump, and may rupture through the skin and bleed profusely.  Most people become naturally fearful with the onset of this lump or with bleeding.  It is this condition that brings many patients to a proctologist, also known as a colon and rectal surgeon.  At Los Angeles Colon and Rectal Surgical Associates (in Beverly Hills and Los Angeles), the board certified surgeons are usually able to quickly give you a diagnosis and begin treatment to speed you on your way toward recovery.


Internal hemorrhoids, above the dentate line, are associated with a discharge, itching, bleeding, occasional prolapse , or “falling out” of the hemorrhoid.  There are various means to treat these.  Most treatments involve medications or local measures.  Occasionally, an operation is necessary.

Los Angeles Colon and Rectal Surgical Associates.

It is important to distinguish the symptoms that you are experiencing from something more serious, such as colon, rectal or anal cancer, or colon polyps.  Your colorectal surgeon will be able to do that and reassure you almost immediately.  You might need a colonoscopy, to look inside of your rectum and colon in order to be sure that your hemorrhoids are the only source of the problem.

For peace of mind, it is important to schedule an appointment with your surgeon at Los Angeles Colon and Rectal Surgical Associates, by calling (310)273-2310.

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