Which symptom signifies external hemorrhoids during defecation?

External hemorrhoids are characterized primarily by the presence of pain, especially during activities such as defecation. This pain occurs because external hemorrhoids are covered by sensitive skin that is rich in nerve endings. When stool passes over these swollen veins, it can cause significant discomfort or sharp pain, making this symptom particularly notable for individuals experiencing external hemorrhoids.

While bleeding, prolapse, and itching can be associated with hemorrhoids generally, they are more common in cases of internal hemorrhoids or may not indicate a specific type. Bleeding from hemorrhoids can occur regardless of whether they are internal or external, and prolapse is related to internal hemorrhoids that extend beyond the anal sphincter. Itching can occur in both internal and external hemorrhoids but is not exclusive to external hemorrhoids during defecation. Thus, the most indicative symptom that signifies external hemorrhoids during the act of defecation is pain.