External haemorrhoids originate below the dentate line. They are bulging around the anal verge, very painful when inflamed, sometimes itchy.

Internal hemorrhoids originate above the dentate line. They often cause painless bleeding and sometimes come out of anal orifice during defecation.

No, surgery is not the only option for treating hemorrhoids. First and second-degree hemorrhoids are often managed with Ayurvedic medicines and Ksharakarma (a local application of alkaline herbal paste). Third and fourth-degree hemorrhoids typically require surgical intervention, such as Ksharasutra ligation, a minimally invasive Ayurvedic procedure.

Strangulation of hemorrhoidal mass causes ischemic necrosis. The kshara in the thread causes sclerosis of local tissue.

No such guarantee, but the incidence of recurrence is less as it cuts the swollen mass as well as scleroses the local tissue.