Is rectal bleeding caused by internal or external hemorrhoids?

Rectal bleeding may be caused by internal or external hemorrhoids, but the two differ in symptoms and underlying causes. 1. **Internal hemorrhoids**: Bleeding is typically painless, with blood appearing on the surface of stool, sometimes dripping or even spurting. Internal hemorrhoids develop above the dentate line and result from the dilation and varicosity of the hemorrhoidal venous plexus beneath the mucosa. Prolonged or recurrent bleeding can lead to severe anemia. 2. **External hemorrhoids**: While external hemorrhoids themselves rarely cause direct rectal bleeding, patients with external hemorrhoids who also have internal hemorrhoids or anal fissures may experience bleeding. External hemorrhoids are located below the dentate line in the anal canal and often present as soft, palpable masses, sometimes accompanied by pain and bleeding. Rectal bleeding may either stem from painless bleeding due to internal hemorrhoids or occur as a symptom when external hemorrhoids coexist with other conditions such as internal hemorrhoids or anal fissures. Accurate diagnosis requires clinical examination and professional medical evaluation.