Types of Hemorrhoids

There are two main types of hemorrhoids according to their location. These are internal hemorrhoids and external hemorrhoids. Internal hemorrhoids are within the anal canal while external hemorrhoids are located outside the anal canal often near the anal opening.

Internal Hemorrhoids 

Internal hemorrhoids are the most common type of hemorrhoids.These hemorrhoids develop along the passage to the anus above the dentate line. Internal hemorrhoids are normally painless, as the visceral nerves above the dentate line do not sense any pain. These nerves can only sense pressure. Sometimes, internal hemorrhoids could come out of the anus as protrusions. These protrusions appear as small lump-like masses. These are prolapsed hemorrhoids. These protrusions cannot be pushed back in to the anal canal. Sometimes these protrusions cause excessive pain. The anal sphincter muscles trap these protrusions and cut off the blood supply. This is the cause for the severe pain.
A hard stool could sometimes cause little discomfort while passing through the internal hemorrhoids during a bowel movement. Mucus leakage is a common symptom of internal hemorrhoids. This leakage causes extreme discomfort coupled with an itching sensation.
It is not possible to diagnose an internal hemorrhoid by yourself,as there are no signs. Only a doctor can diagnose an internal hemorrhoid after a complete exam. Internal hemorrhoids normally occur due to weakening of tissues supporting the anal canal veins.

Internal Hemorrhoids Grading System 

Internal hemorrhoids occur with different levels of severity and have a specific grading system. This includes:

First-degree hemorrhoids: These hemorrhoids bleed but do not protrude from the anus or prolapse.
Second-degree hemorrhoids:These hemorrhoids protrude from the anus during a bowel movement and retract on their own back into the anal canal although a little later.
Third-degree hemorrhoids: These hemorrhoids protrude from the anus during the bowel movement. However, they do not retract by themselves and you need to push them back inside with a finger.
Fourth-degree hemorrhoids: These hemorrhoids protrudeor prolapse from the anus and it is not possible to push them back into the anal canal.

External Hemorrhoids 

External hemorrhoids develop outside the anal canal, more so near the anal opening. These hemorrhoids are more painful as the skin around them is very sensitive. These hemorrhoids can develop ruptures and thereby cause bleeding. Sometimes, a vein within the external hemorrhoid breaks and forms blood pools under the skin. These lumps could become hard and cause severe pain. These are thrombosed or clotted hemorrhoids.
External hemorrhoids cause sharp pain during bowel movements and often for sometime after bowel movements. Further, these hemorrhoids cause severe itching and a burning sensation around the anus. People with external hemorrhoids can sense a hard lump. This lump is very sensitive and can bleed on rupture.

(The Complete Guide To Hemorrhoids)