Internal or External? Your Bum's Two Very Different Moods

Haemorrhoids are already annoying enough without everyone whispering about them like a state secret. On top of that, you then discover there are two types. Internal. External. Same area, very different moods. Understanding which kind you have can make treatment feel a lot less mysterious and a lot more manageable.

What are haemorrhoids, in plain language

Haemorrhoids, often called piles, are swollen blood vessels in and around your bottom. They sit in soft tissue called anal cushions, which help keep everything nicely sealed until you go to the loo. When those cushions swell and become irritated, you get the familiar mix of itching, lumps, bleeding, and general bad mood from the rear.

Around a third to half of people in the UK will have haemorrhoids at some point in their lives, so if your bum feels like it is staging a protest, you are in very crowded company.

Internal vs external haemorrhoids, two very different moods

Internal haemorrhoids, the quiet sulker

Internal haemorrhoids live inside the back passage, higher up where the rectum meets the anus. They are covered in the smooth lining of the bowel, not normal skin. You often cannot feel them as lumps on the outside.

Typical internal haemorrhoid symptoms:

• Bright red blood on the toilet paper or in the bowl after a poo
• A feeling that you have not fully finished after going
• Mucus on the toilet paper or in your underwear
• Occasional discomfort or a dragging sensation, especially if they prolapse

Internal haemorrhoids are graded from 1 to 4 depending on how often they slip out and whether they go back in by themselves or need help.

External haemorrhoids, the loud drama queen

External haemorrhoids sit on the outside of the back passage and are covered in normal skin. These are the ones most people notice as tender lumps around the anus.

Typical external haemorrhoid symptoms:

• Visible or palpable lumps around the anus
• Soreness or tenderness
• Itchiness and irritation
• Sudden sharper pain if a clot forms inside (a thrombosed haemorrhoid)

External haemorrhoids can leave behind loose skin tags once the swelling settles, which can trap moisture and make hygiene feel more complicated than it should.

How can you tell which one you have

A quick rule of thumb:

• Bleeding without obvious external lumps often points to internal haemorrhoids.
• Tender, itchy, or sore lumps on the outside suggest external haemorrhoids.
• Lumps that come out during a poo and slide back in are usually prolapsing internal haemorrhoids.

A healthcare professional can confirm the diagnosis and rule out other causes like fissures or more serious conditions, so if symptoms are new or persistent, do check in with your GP.

What makes haemorrhoids flare in the first place

Both internal and external haemorrhoids can flare because of:

• Constipation and straining
• Sitting on the toilet too long
• Pregnancy
• Heavy lifting
• Low fibre diets
• Being less active than your body prefers

Research even suggests that spending ages scrolling on the loo raises the risk simply because you’re sitting there longer than nature intended.

Everyday care that helps both internal and external haemorrhoids

1. Softer stools, kinder toilets

Soft, easy to pass stools put less pressure on irritated blood vessels. Drink more water, increase fibre, avoid straining, and try not to turn loo time into a full reading session.

2. Gentle hygiene

• Pat, don’t scrub
• Avoid rough or perfumed toilet paper
• Use lukewarm water
• Keep the area clean and dry

3. Cooling, soothing ingredients

Botanicals like witch hazel are commonly used to calm irritated skin. Uranus Wiper wipes pair witch hazel with Cynanchum atratum, Agrimonia pilosa, male fern root extract, and ultra pure reverse osmosis water for a cool, gentle clean.