The most common signs of hemorrhoids are bright red blood on toilet paper after wiping, itching around the anus, and a soft or tender lump near the anal opening. About 11% of adults have hemorrhoids at any given time, with the highest rates between ages 45 and 65. But because symptoms overlap with other conditions, knowing what to look for (and what doesn’t fit the pattern) matters.
External Hemorrhoids: What You Can See and Feel
External hemorrhoids form under the skin around the anus, and they’re the type most people notice first. You can usually see or feel them. They look skin-colored or reddish, feel soft to the touch, and form a bump near the anal opening. They don’t go back inside if you push on them because they aren’t coming from inside the rectum.
The hallmark symptoms are itching, tenderness, and a dull ache that can last throughout the day, especially when sitting. You may notice small amounts of blood when you wipe. The discomfort tends to be constant rather than tied only to bowel movements.
Sometimes a blood clot forms inside an external hemorrhoid. When this happens, the bump turns blue, black, or purple and becomes noticeably firmer and more painful. This is called a thrombosed hemorrhoid, and the pain tends to be more intense and come on suddenly. It’s not dangerous, but it can be severe enough to need treatment.
Internal Hemorrhoids: The Hidden Type
Internal hemorrhoids form inside the rectum, and you typically can’t see or feel them. They rarely hurt. The main clue is bright red blood, either on the toilet paper, in the bowl, or coating the stool. The bleeding is usually painless, which is what distinguishes internal hemorrhoids from most other causes of rectal bleeding.
Internal hemorrhoids become more noticeable as they progress. Doctors grade them on a scale of 1 to 4 based on how much they protrude:
- Grade 1: Slightly enlarged veins that stay inside the rectum. No visible bulge. The only sign is occasional bleeding.
- Grade 2: The hemorrhoid pushes out during a bowel movement but slides back in on its own afterward.
- Grade 3: The hemorrhoid pushes out during straining and stays out until you manually push it back in.
- Grade 4: The hemorrhoid protrudes permanently and can’t be pushed back inside.
If you notice tissue bulging from the anus during or after a bowel movement, that’s likely a prolapsed internal hemorrhoid. It may produce mucus discharge and itching in addition to bleeding.
How Hemorrhoids Feel Compared to Other Conditions
Several conditions cause similar symptoms around the anus, and telling them apart matters because the treatment is different.
An anal fissure is a small tear in the skin lining the anus. The key difference is the type of pain. Fissures cause sharp, searing pain during a bowel movement, often followed by a deep ache that lasts minutes to hours afterward. Hemorrhoid pain, by contrast, is more of a dull ache, pressure, or tenderness that persists throughout the day. Fissures may also bleed, but pain is always the dominant symptom. If you look closely, a fissure appears as a visible cut or crack, not a rounded lump.
Hemorrhoids also leave behind skin tags after swelling goes down. These painless flaps of skin near the anus are harmless but can be confused with new hemorrhoids. They don’t bleed or swell the way an active hemorrhoid does.
Rectal bleeding can also come from polyps, inflammatory bowel disease, or colorectal cancer. None of these conditions are common enough to panic about, but they’re the reason you shouldn’t automatically assume bleeding means hemorrhoids, particularly if your bowel habits have changed, your stool looks different than usual, or the bleeding doesn’t match the typical hemorrhoid pattern of small amounts of bright red blood.
What a Doctor’s Exam Involves
External hemorrhoids are straightforward to identify because they’re visible. Internal hemorrhoids require a closer look. A doctor will start with a digital rectal exam, checking for tenderness, blood, lumps, and the muscle tone of the anal sphincter. This takes a few seconds and, while uncomfortable, isn’t painful for most people.
If internal hemorrhoids are suspected, the next step is usually an anoscopy. A short, hollow tube is inserted into the anus so the doctor can see the lining of the lower rectum directly. This is done in the office, takes only a few minutes, and doesn’t require anesthesia. For a slightly deeper view, a rigid proctoscope can examine the rectum and lower colon using a similar approach.
Sometimes hemorrhoids are discovered incidentally during a colonoscopy performed for other reasons, like routine screening. If you’re already due for a colonoscopy based on your age or risk factors, that procedure can evaluate hemorrhoids at the same time.
Signs That Need Prompt Attention
Most hemorrhoids improve within a week with basic home care: warm baths, more fiber, staying hydrated, and avoiding straining. If your symptoms haven’t improved after a week of consistent effort, that’s reason enough to get evaluated.
Large amounts of rectal bleeding, lightheadedness, dizziness, or feeling faint alongside bleeding warrant emergency care. These aren’t typical hemorrhoid symptoms and suggest something more significant is going on. Similarly, if you notice changes in your bowel habits, unexplained weight loss, or stools that change in color or consistency, those patterns point away from hemorrhoids and toward conditions that need proper evaluation.