External hemorrhoids are those hemorrhoids that occur outside the distal end of the anal canal. This type of hemorrhoids are varicosities of the veins draining the territory of the inferior rectal arteries. External hemorrhoids can bleed, and then the blood pools, causing a hard painful lump. This is called a thrombosed, or clotted, hemorrhoid. They can cause swelling and irritation, and are sometims painful. Itching itself is caused by skin irritation.

Thrombosed hemorrhoids occur if the vein ruptures and/or a blood clot develops. In other words, if a vein within an external hemorrhoid breaks open and bleeds, blood may form a hard, painful and bluish lump. Blood can pool in an external hemorrhoid forming a cloth or thrombus.

External hemorhoids may not cause any symptoms and because of that the patient may not be aware of having hemorrhoids.

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