Simply stated, there are two kinds of hemorrhoids - the external type which can be seen with the naked eye and the internal type which can only be examined by a doctor. If the tissue that supports the veins in the anal canal weakens, the swollen veins and tissue can bulge into the anal canal (internal hemorrhoids) or under the skin surrounding the anus (external hemorrhoids). Both conditions are identical in nature, in treatment and they share common symptoms which include bleeding during or after bowel movements, itching or a burning sensation in the anus and rectal pain before, during or after bowel movements.

External hemorrhoids are the hemorrhoids visible to the naked eye. They most commonly appear as a cluster of grape-like, discolored skin surrounding the anus. While irritating and unsightly, this form of onset is the easiest to treat and is usually not the precursor to more serious conditions. However, rectal pain occurs mainly with this form of hemorrhoid outbreak. Also, because the swollen veins are on the outside of the anus, bright red blood streaks will appear on toilet paper after, and usually only after, a bowel movement. Blood spotting before a bowel movement would indicate that the patient is suffering from either internal hemorrhoids or both internal and external hemorrhoids, a rare but not impossible scenario.

In some cases of people suffering from external hemorrhoids, there is the possibility that a vein inside one of the external protrusions may break. In this instance, blood can possibly collect under the skin and may form a hard, painful lump. This lump is called a thrombosed, or clotted hemorrhoid. If this is present, the thrombosed needs to be shrunk or drained quickly to avoid further complications.