How the different types of hemorrhoids are manifested

Written by: Dr. Kubrat Sajonia Coburgo
Edited by: Anna Raventós Rodríguez

Depending on its location in the anus, we distinguish two types of hemorrhoids:


  • External hemorrhoids: are those veins that are in the part of the anus covered with skin, so they remain in the "visible". When these veins are thrombosed by a defecating effort, a lump appears in the anal region of purplish blue that causes pain to the patient. It is what we know as hemorrhoidal thrombosis. This type of hemorrhoids does not usually bleed (since they are covered with skin, and the skin protects), they only do it in cases of very acute thrombosis, in which the hematoma pressure causes a skin ulcer with clotting and bleeding.



  • Internal hemorrhoids : are those that remain in the inner part of the anus, so they are not visible under normal conditions. They are not covered with skin, but with mucosa, and are much more vulnerable to rubbing and pressure. They often manifest with bleeding or heaviness. With the years they are sliding towards the outside, reason why they are exposed to the external friction; That is when they erode and bleed.

Perianal thrombosis


Classification of hemorrhoids

Hemorrhoids are classified on the basis of internal hemorrhoids, not external ones. We distinguish 4 different types:


  • Grade I: bleeding with deposition, dilation of internal hemorrhoidal packets (without departing); Cause itching and feeling of weight.
  • Grade II: Prolapse of the hemorrhoids to the outside in the deposition, but then return to their position. They cause itching and feeling of occupancy in the rectum.


Hemorrhoid types


  • Grade III: bleeding, prolapse in deposition; The patient should be helped to reintroduce them with manual pressure, toilet paper or sitting on something hard after going to the bathroom. They cause itching, pain and sometimes spotting of underwear.
  • Grade IV: They stay outside most of the day, and cause bleeding, constant suppuration, spotting of the underwear and burning sensation.



For more information, consult your coloproctologist.

*Translated with Google translator. We apologize for any imperfection

By Dr. Kubrat Sajonia Coburgo
Colon & Rectal Surgery

Expert surgeon in anal pathologies, with special skill in the use of CO2 laser for this type of operations, accumulates extensive experience in various hospitals in Madrid. He holds the certificate in colo-proctology of one of the world reference centers of the specialty, St. Mark's and Northwick Park Hospital. NHS Trust of London.

Author of numerous articles of the specialty and assistant to presentations and conferences, the doctor is also a member of the advisory board of Tokuda Hospital and a member of the advisory board of the health consultant Mensor. He currently visits his patients at the Quirón San Camilo Hospital.

*Translated with Google translator. We apologize for any imperfection

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