What Causes Hemorrhoid Problems? (Two Types of Hemorrhoids)

February 19th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Many people are unaware that hemorrhoids are actually a normal part of the body. They go completely unnoticed until there is a problem. Hemorrhoids are important fibrovascular structures located within the anal canal, and they help cushion the passage of stool. Hemorrhoids also function to maintain fecal contents within the rectum until it is time for elimination. For example, when you cough or sneeze, your hemorrhoids instantly swell with blood, and this helps keeps your anus sealed tight.

As we can see, hemorrhoids are actually very important. Also, there are two types of hemorrhoids, internal and external.

Internal Hemorrhoids

Internal hemorrhoids are located further inside the anal canal. They receive their blood and nerve supply from different sources when compared to the external hemorrhoids. The nerves that connect to the internal hemorrhoids are called visceral nerves. These nerves are not as sensitive to pain, thus making it possible to treat problematic internal hemorrhoids with little or no anesthesia. The internal hemorrhoids are separated by an anatomical line from the external hemorrhoids. This line is called the dentate line.

External Hemorrhoids

The external hemorrhoids are found on the outer side of the dentate line. The have nerve endings that are similar to the nerve endings found in your skin. So when external hemorrhoids are inflamed or swollen, they are very painful.

How Hemorrhoids Become Problematic

The anatomy and function of hemorrhoids helps us to understand how problems develop. Hemorrhoids naturally swell up in response to straining or pressure. If this pressure becomes too great or too prolonged, then the hemorrhoids become swollen beyond their limit. If they get stretched too far the lining over the hemorrhoids gets thin and can eventually break down. When this occurs you might see blood in the toilet bowl or when you wipe.

If this high pressure situation persists it can begin to also strain support muscles, like the Treitz’s muscle, for example. When this happens the hemorrhoids begin to bulge out of the anus.

Any situation that puts excessive or prolonged pressure on the anal area can lead to hemorrhoid symptoms. Some of these causes are:

  • Chronic constipation or diarrhea
  • Sitting on the toilet for long periods, reading on the toilet
  • Pregnancy

Internal hemorrhoids problems can extend outwards and involve the external hemorrhoids. Sometimes a blood clot forms in the external hemorrhoid, and this is called hemorrhoid thrombosis. It is a very painful condition that can require surgical excision.


Hemorrhoids are normal fibrovascular structures that help the body maintain proper bowel function and control. The two types of hemorrhoids, internal and external, are separated by the dentate line. Each type of hemorrhoid has a different blood and nerve supply, and this can be important when making diagnosis and treatment decisions.

Check out The H Doctor website. You will find many articles and videos that contain the latest information about hemorrhoid treatment and other important digestive health topics.

Take charge of your health today.


One Response to “What Causes Hemorrhoid Problems? (Two Types of Hemorrhoids)”

  1. May 29, 2013 at 8:10 pm, Anal Fissures - The H Doctor said:

    […] but the cause might surprise you. You can have rectal pain, bleeding and itching but not from hemorrhoid problems. In some cases, the culprit might actually be an anal […]


Leave a Reply