This type of haemorrhoids does not usually hurt since it lies inside the rectum where there are fewer pain-sensing nerves. The most common indication of internal haemorrhoids is bleeding. There are instances when it prolapses outside the anus. When this happens, it appears as pinkish-purplish lumps at the anal opening. Prolapsed haemorrhoids may hurt but it usually recedes back into the rectum on their own (Grade 2). If it doesn’t, it can be gently pushed back into place (Grade 3).
External haemorrhoids may cause great discomfort as they are situated outside the anus (Grade 4). When a person with external haemorrhoids passes stool, the piles to may prolapse outside, causing extreme pain. This condition, known as thrombosis, can be quite alarming as there is formation of blood clots and the piles turn purple or blue in colour. When the pain becomes unbearable, there is an option to undergo a day surgery that will remove the thrombosed haemorrhoid.