What does internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids mean?

Nov 14, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

Internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids are the three main types of hemorrhoidal disease. Internal hemorrhoids are located above the dentate line, external hemorrhoids below the dentate line, while mixed hemorrhoids span across the dentate line, exhibiting features of both internal and external hemorrhoids and often presenting more complex symptoms. Persistent rectal bleeding or prolapsed and incarcerated hemorrhoidal tissue warrants timely medical evaluation. Internal hemorrhoids arise from the hemorrhoidal venous plexus beneath the mucosa and are typically not associated with significant pain.

Internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids are the three main types of hemorrhoidal disease. Internal hemorrhoids occur above the dentate line, external hemorrhoids below the dentate line, and mixed hemorrhoids span across the dentate line, exhibiting features of both internal and external hemorrhoids, resulting in more complex symptoms. If persistent rectal bleeding or prolapsed hemorrhoidal tissue becomes trapped (incarcerated), prompt medical attention is recommended.

Internal hemorrhoids develop from varicose veins in the mucosal venous plexus beneath the dentate line. They are typically painless and mainly present with rectal bleeding and prolapse of hemorrhoidal tissue. Bleeding usually occurs painlessly after defecation, manifesting as dripping or even jet-like bleeding. As the condition progresses, prolapsed hemorrhoidal tissue may no longer spontaneously reduce.

External hemorrhoids arise from varicosities, inflammation, or thrombosis in the subcutaneous venous plexus distal to the dentate line. They commonly present as a lump at the anal margin, accompanied by pain, itching, or a sensation of a foreign body. Thrombosed external hemorrhoids can cause severe pain that interferes with daily activities. Mixed hemorrhoids exhibit combined symptoms, including rectal bleeding, tissue prolapse, anal lumps, and pain.

To manage hemorrhoids, avoid prolonged sitting or squatting, and limit time spent on the toilet to within 5 minutes. Clean the perianal area daily with warm water to maintain hygiene. Increase dietary intake of whole grains to prevent constipation and reduce irritation and injury to hemorrhoids.

View All

What do hemorrhoids look like?

These lesions are categorized into internal and external hemorrhoids. Internal hemorrhoids are clusters of varicose veins located above the dentate line of the anal canal and cannot be directly observed. When internal hemorrhoids develop to a certain extent and prolapse outside the anus, they present as mucosal elevations appearing dark red or purplish red, with a soft surface, and sometimes accompanied by bleeding. External hemorrhoids are located below the dentate line, and skin tags or masses can be observed around the anus; in the early stages, they may appear as soft skin elevations.

View Full Answer

When is surgery not necessary for hemorrhoids?

Whether hemorrhoids require surgery generally depends on the severity of symptoms. Surgery is usually not needed for mild internal hemorrhoids, asymptomatic external hemorrhoids, mild hemorrhoids during pregnancy, mixed hemorrhoids that have improved with conservative treatment, or occasional minor bleeding. If internal hemorrhoids only occasionally cause slight discomfort after bowel movements, without prolapse or significant bleeding—especially when symptoms can be relieved through dietary adjustments and regular bowel habits—surgical intervention is typically unnecessary.