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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.
Internal hemorrhoids can also cause similar symptoms. But when internal hemorrhoidal veins in the anal canal rupture, the result is bright red blood that accompanies a bowel movement. Rectal bleeding is the most common symptom of ruptured hemorrhoids. In most cases, bleeding hemorrhoids are not a serious problem.