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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 on the opening or outside of the anus can become itchy, and according to the National Library of Medicine, scratching itchy hemorrhoids might cause them to bleed. Hemorrhoids also become itchy as a result of contact with certain types of fibers in clothing. Certain soaps and detergents can cause itching.