There are often patients who come to the clinic with complaints of bleeding during stool without pain, or anal pain and discomfort, or foreign body sensation, and when they meet in the clinic, they often discuss and communicate with each other about their conditions, and then they ask the doctor the question: “Why do I have the same pain and he doesn’t? Hemorrhoids, why do I have pain and he doesn’t?” . This is because there is a difference between internal and external hemorrhoids. The nucleus of the hemorrhoid, depending on its location, can be divided into two types: external and internal hemorrhoids. The nucleus of the lower hemorrhoid vein below the dentate line is called the external nucleus, and the nucleus of the upper hemorrhoid vein above is called the internal nucleus (or simply the nucleus). The location of external hemorrhoids is almost always at the edge of the anus, but they can also be born in the inner anal canal where they cannot be seen from the outside, but they must be below the dentate line because the dentate line is a standard line that divides internal and external hemorrhoids, and those above the dentate line are internal hemorrhoids and those below the dentate line are external hemorrhoids. External hemorrhoids are generally painful, while internal hemorrhoids are generally painless, because the nucleus of external hemorrhoids occurs in the epiglottis of the anus where the painful nerves gather, while the nucleus of internal hemorrhoids grows in the lower part of the rectum where there are no painful nerves. As mentioned earlier, external hemorrhoids do not usually bleed, but occasionally they can bleed due to friction, injury, or rupture, and can be painful due to rupture, whereas internal hemorrhoids have painless blood in the stool as the main symptom (even if the internal nucleus ruptures, it is not painful). The internal hemorrhoid nucleus grows in a place where there is no painful nerve, so it is reasonable to say that you should not feel pain when you have internal hemorrhoids, but if you have advanced internal hemorrhoids, the nucleus cannot return to the inside of the anus in time after it is prolapsed, and it gets stuck outside the anus and becomes ischemic and necrotic, then it will cause severe pain. Therefore, if you have internal hemorrhoids, they are usually painless, while if you have inflammatory or thrombosed external hemorrhoids, you will have more pain.