Internal and external hemroids
This illustration shows the position of internal and external hemroids and their relation to the anus. As you see, the difference between internal and external hemroids is a matter of location; internal hemroids lie inside the anus while external hemroids lie outside the anus above and below the pectinate line respectively. Both share the same pathogenesis and the same pathology and they are caused by the same causes and are treated by almost the same treatment. However, they differ in symptoms and mode of presentation.
While the main complaint in internal hemroids is rectal bleeding with no or minimal pain, the main complaint in external hemroids is rectal pain with minimal bleeding. Also, external hemroids are felt as a hard tender mass around the anus, while internal hemroids can not be seen or felt except if they are prolapsed.
