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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 do not always hurt. In fact, you may have hemorrhoids that you can't see or feel and that only cause painless bleeding when they're aggravated. Sometimes, however, external hemorrhoids-hemorrhoids around the anus-can collect excess blood and form a clot, which can be very painful.emorrhoids do not always hurt. In fact, you may have hemorrhoids that you can't see or feel and that only cause painless bleeding when they're aggravated. Sometimes, however, external hemorrhoids-hemorrhoids around the anus-can collect excess blood and form a clot, which can be very painful.