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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.
But straining or irritation when passing stool can damage a hemorrhoid's delicate surface and cause it to bleed. Occasionally, 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.ometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation. When to see a doctor. Bleeding during bowel movements is the most common sign of hemorrhoids.