Seen here is the anus and perianal region with prominent prolapsed true (internal) hemorrhoids. Hemorrhoids consist of dilated submucosal veins which may thrombose and rupture with hematoma formation. External hemorrhoids form beyond the intersphincteric groove to produce an "acute pile" at the anal verge. Chronic constipation, chronic diarrhea, pregnancy, and portal hypertension enhance hemorrhoid formation. Hemorrhoids can itch and bleed (usually bright red blood, during defacation). Seen below is on colonoscopy are views of hemorrhoids at the anorectal junction.