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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.
External hemorrhoids may develop painful blood clots. If this happens, theyâre called thrombosed hemorrhoids. Internal hemorrhoids may prolapse, which means they drop through the rectum and bulge from the anus. External or prolapsed hemorrhoids can become irritated or infected and may require surgery.