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When a patient has external hemorrhoids, they will lie under the skin around the anus. They can become very itchy and may bleed. Sometimes, the blood may accumulate and form a thrombus (clot), which can be painful; the area will swell and become inflamed. External hemorrhoids are more likely to present with pain.
Hemorrhoids generally are classified as external (outside of the anal canal), which can be very painful, and internal (inside the anal canal), which can protrude and bleed. External hemorrhoids can become thrombosed (develop blood clots inside) and become very tender. Large blood clots can produce pain with walking, sitting or passage of stool. It is not clear why healthy people suddenly develop clots in external hemorrhoids.