What Makes Hemorrhoids Painful?

Hemorrhoids are generally not painful. Pain arises from excessive irritation or from thrombosis.

Thrombosed hemorrhoids occur when blood clots form in the hemorrhoidal tissues. It is a very painful condition and is preceded by a bout of constipation or diarrhea. When internal hemorrhoids form blood clots and get trapped outside the anus, with an associated spasm of the sphincter, they are referred to as strangulated hemorrhoids.

Whereas internal thrombosed hemorrhoids may require surgical intervention, external thrombosed hemorrhoids have a tendency to clear up on their own in a few days, but some cases may actually require removal of the clot.
 

NON-HEMORRHOIDAL SOURCE OF PAIN

A sharp, cutting pain that comes on with defecation may be caused by an anal fissure, and a dull ache with fever and tenderness around the anal opening may be caused by an abscess.

ANAL ABSCESS
Occasionally bacteria and minute fecal particles may penetrate through the anal wall, lodging on the sides of the anus forming an abscess. This pus collection may be lanced surgically or may open spontaneously in the skin. The tract so formed from the anal canal toward the outside is called an anal fistula.

ANAL FISSURE
Anal fissure is a crack in the lining of the anal canal. It may be caused by the passage of hard stools. Fissures usually heal promptly with medical management, but if the acute fissure does not heal in a timely fashion, it leads to scarring in the area and becomes a source of recurring pain and bleeding.