Internal hemorrhoids, which lie inside the rectum, usually have no symptoms; the patient is not aware of them as they do not generally cause any discomfort. However, straining when passing a stool may cause them to bleed. Straining can also push an internal hemorrhoid so that it protrudes through the anus this is called a protruding or prolapsed hemorrhoid and can be painful.
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.