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Written by: Hemocure Medical Team (The first institution specialized in treating proctological diseases using laser technology in Egypt and the Middle East).
Publication Date: May 2026 | Last Medical Review: May 2026
Hemorrhoids — They Are Not All the Same
One of the most common scenarios I encounter in the clinic is a patient arriving after years of suffering without even realizing they have hemorrhoids. When I ask them, “Why didn't you come sooner?” the answer is almost always: “Because I didn’t feel anything.”
This is precisely what distinguishes internal hemorrhoids from external hemorrhoids; internal hemorrhoids are completely silent in their early stages. Patients live their normal lives, completely unaware that the problem is escalating behind the scenes.
First: Causes of Internal and External Hemorrhoids
Hemorrhoids develop due to the swelling and expansion of veins in the anal and rectal area, caused by chronic and repetitive pressure. It is important to note that the triggers vary from one patient to another based on lifestyle and concurrent medical conditions—which is why an accurate diagnosis is essential before choosing a treatment plan. The causes are categorized into:
1. Bowel Pressure and Defecation
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Chronic Constipation: Straining heavily during bowel movements repeatedly increases pressure on the veins.
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Chronic Diarrhea: Frequent and sudden bowel movements irritate the anal lining and weaken the veins.
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Impaired Bowel Motility: Whether it is slowness or irregularity in natural bowel movements.
2. Lifestyle Factors
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Prolonged Sitting: Constantly increases pressure on the veins of the pelvic and rectal region.
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Weight Gain: Puts continuous and heavy pressure on the lower pelvic area.
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Low-Fiber Diet: Directly leads to chronic constipation and difficulty passing stool.
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Overuse of Laxatives: Disrupts natural bowel movements and causes dependency.
3. Physiological Causes
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Pregnancy and Childbirth: The progressive pressure on the pelvic area throughout pregnancy is a primary cause among women.
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Aging: Supporting tissues around the veins lose their elasticity over time, making them more prone to stretching and swelling.
Second: Internal Hemorrhoids — The Silent Enemy
Internal hemorrhoids develop deep inside the rectum and anal canal—an area completely devoid of pain-sensitive nerve endings. This is why patients usually feel no pain initially. Internal hemorrhoids progress through four distinct stages:
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Grade 1 & 2 (Complete Silence): In most cases, patients have no idea they are affected. They might notice drops of bright red blood during bowel movements but tend to ignore it. There is no pain, no prolapse, and the condition worsens silently.
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Grade 3 (The Awakening): The hemorrhoids prolapse (pop out) during bowel movements but return inside either spontaneously or when pushed back manually by the patient. This is usually when the patient realizes there is a problem, but only after it has advanced.
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Grade 4 (Resembling External Hemorrhoids): The hemorrhoids remain permanently prolapsed outside the anus and cannot be pushed back. At this stage, they visually resemble external hemorrhoids, which frequently leads to misdiagnoses by non-specialists.
💡 Note: An accurate examination using the advanced Proctostation device is the only definitive way to determine the exact type and grade of hemorrhoids.
Third: External Hemorrhoids — Painful and Visible
External hemorrhoids develop under the skin just outside the anal opening—an area highly enriched with pain-sensitive nerve endings. Therefore, they are characterized by the following:
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Extremely painful during sitting, walking, or passing stool.
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Readily visible and felt as hard or soft swellings around the anal opening.
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Can develop into a thrombosed hemorrhoid (a small blood clot forming inside the hemorrhoid), which severely multiplies the pain and swelling.
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Patients usually seek medical help very quickly due to the intensity of the pain, unlike those with internal hemorrhoids.
Fourth: Quick Comparison Table between Internal and External Hemorrhoids
| Criterion | Internal Hemorrhoids | External Hemorrhoids |
| Location | Inside the rectum and anal canal | Outside the anal opening, under the skin |
| Pain | Mostly painless in the early stages | Highly painful, especially when sitting |
| Bleeding | Bright red blood accompanying stool | Rare (unless a thrombosed hemorrhoid ruptures) |
| Sensation | The patient cannot feel them in early grades | Always felt and visible from the outside |
| Grade 4 | Prolapse and remain outside permanently | Inherently present outside the anus at all times |
| Treatment | Laser — THD — Rubber Band Ligation | Laser — Surgical excision (depending on the case) |
Fifth: Why is an Accurate Diagnosis So Crucial?
Because Grade 4 internal hemorrhoids strongly resemble external hemorrhoids in their outward appearance, many non-specialized physicians fall into the trap of misdiagnosis.
🛡️ At Hemocure: Diagnosis is performed exclusively using the Proctostation device. This is the only system capable of identifying the type and grade of hemorrhoids with 100% precision, ensuring that the treatment plan is correct from the very start.
Sixth: Non-Surgical Treatment for Internal and External Hemorrhoids
Traditional surgery is no longer the only or mandatory option. Modern technologies now allow the treatment of most hemorrhoid cases without conventional surgery, without pain, and with exceptionally fast recovery times.
1. THD Doppler Technique (For Grade 1 & 2 Internal Hemorrhoids)
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The most advanced technique for treating hemorrhoids without tissue excision.
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The device accurately pinpoints the fine arteries feeding the hemorrhoids and ligates (ties) them, causing the hemorrhoids to shrink and return to their natural position.
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Advantages: No incisions, no stitches, no bleeding, and the patient returns to their daily life on the exact same day.
2. Laser Hemorrhoid Treatment — The Most Modern and Painless Option
Laser is the ideal choice for Grade 2 and 3 hemorrhoids and represents a fully non-surgical treatment in the modern medical sense.
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Leonardo Plus 1940nm Device: Available exclusively at Hemocure, this device operates at a 1940 nm wavelength, which minimizes thermal impact compared to older laser generations.
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Precision: It targets diseased tissues with microscopic accuracy without affecting surrounding healthy muscles or tissues.
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Recovery: Post-operative pain is virtually non-existent; patients can walk immediately after the procedure, and full recovery takes only 2 to 3 days (compared to weeks or months with traditional surgery).
How Laser Works Depending on the Type:
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For Internal Hemorrhoids: The laser shrinks and seals the swollen veins from the inside without any cutting.
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For External Hemorrhoids: The laser removes the external swelling with high precision while fully preserving the healthy surrounding skin.
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For Concurrent Anal Fissures: It can be treated in the very same session while removing any skin tags precisely.
🩺 Type of Anesthesia: At Hemocure, we utilize Saddle Block Anesthesia (a specialized regional/local anesthesia). The patient remains fully awake during the procedure and can walk out on their own feet immediately after completion.
When is Traditional Surgery Necessary?
Despite the massive leap in non-surgical techniques, certain advanced cases still require traditional surgical intervention:
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Grade 4 internal hemorrhoids accompanied by severe complications such as complete rectal prolapse.
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Hemorrhoids associated with other complex, concurrent anorectal diseases.
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Advanced cases where modern non-surgical techniques have previously failed.
The final decision is always determined after a comprehensive clinical examination and diagnosis, never before.
❓ Frequently Asked Questions by Patients
Can I have both types at the same time?
Yes. Many patients suffer from a combination of internal and external hemorrhoids simultaneously, and they may also have a concurrent anal fissure. A comprehensive examination using the Proctostation is what reveals the full clinical picture.
Is bleeding during bowel movements always caused by hemorrhoids?
In most cases, yes. However, any bleeding from the anal region requires immediate medical evaluation to rule out other potential causes and confirm whether it stems from internal hemorrhoids, an anal fissure, or other conditions.
Is laser hemorrhoid treatment genuinely painless?
Yes. Thanks to the advanced Leonardo Plus 1940nm device at Hemocure, the thermal effect on tissues is nearly zero. Combined with advanced local anesthesia, the procedure is entirely comfortable, and post-operative pain is very mild, requiring no bed rest.
When do external hemorrhoids become dangerous?
External hemorrhoids are not inherently dangerous, but if they develop into a thrombosed hemorrhoid (a blood clot), they cause sudden, excruciating pain that requires prompt medical intervention to relieve the suffering.
📚 Medical References
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European Society of Coloproctology (ESCP):
escp.eu.com -
American Society of Colon and Rectal Surgeons (ASCRS):
fascrs.org -
Biolitec — Manufacturer of the Leonardo Plus Device:
biolitec.com
About the Author: Dr. Mohamed Magdy El-Najjar
Founder of Hemocure: The pioneer institution specialized in treating anorectal diseases via laser in Egypt and the Middle East.
Global reference for laser proctology treatments since 2019.
Winner of the State Award for Excellence in Medicine (2018).
Hemocure — #1 in the Middle East and Africa
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