External hemorrhoids are always outside by definition. They rarely bleed, but can cause embarrassing rectal itching and soreness. Rarely, a blood clot can form within an external hemorrhoid turning it blue. This thrombosed hemorrhoid causes sudden severe rectal pain and usually requires a trip to the Emergency Department or surgeon's office. Sitz baths, sitting in a few inches of warm water in a tub, several times a day may ease the pain of a clot enough that surgery is not needed.
Diagnosis is an important first step in treatment.
Hemorrhoids are seldom medically serious by themselves, but because they can bleed, they can sometimes lull people who have significant bowel disease into believing nothing much is wrong. Rectal bleeding might mean early colon cancer, not hemorrhoids. Your doctor has several diagnostic tools at his disposal to accurately evaluate the source of rectal bleeding and determine what treatment is best advised. A simple short scope test of the lower colon, called flexible fiberoptic sigmoidoscopy, is often sufficient. In some cases your doctor may suggest colonoscopy - a more complete examination of the entire colon.