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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.
Signs and symptoms of hemorrhoids may include: 1  Painless bleeding during bowel movements â you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl. 2  Itching or irritation in your anal region. 3  Pain or discomfort.ccasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation. External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed.