Is there any way to be so sure if i have internal hemorrhoids?

Texture/Doctor Exam: Most hemorrhoids (varicose veins of the anus) are soft, squishy tissue that distend after straining or having a bm, and may bleed. If a hemorrhoid becomes firm, enlarged, and tender, it may have thrombosed (clotted). This is treated w/ pain medication and time. Anal lump present all the time requires medical attention to assure that it isn't something else. See fp, gi, or surgeon! good luck!