Hemorrhoids are vascular cushions in the anal canal that can become swollen or inflamed, a condition often called piles. These swollen veins occur when increased pressure engorges blood vessels in the lower rectum and anus. External hemorrhoids specifically develop underneath the highly sensitive skin just outside the anal opening. Understanding their appearance helps distinguish them from other conditions causing similar discomfort in the perianal area.
The Physical Appearance of the Swelling
An uncomplicated external hemorrhoid typically presents as a small lump or bulge located directly at the anal verge. These lesions are usually soft to the touch and are covered by the same skin that surrounds the anus. The size of the swelling can vary, sometimes resembling a small pea or an enlarged, fleshy bump.
The color of the uncomplicated external hemorrhoid is often similar to the surrounding skin tone. It can appear slightly pink or reddish if irritated by rubbing or hygiene practices. Because they are located in an area rich with pain receptors, these swellings are prone to discomfort, itching, or a feeling of tenderness. They are readily visible during an external examination and do not usually retract back into the anal canal.
How They Differ from Internal Hemorrhoids
The anatomical location of a hemorrhoid determines its classification and is marked by a boundary called the dentate line. External hemorrhoids form below this line, placing them in an area covered by anoderm, which is highly sensitive due to somatic nerve innervation. This is why external hemorrhoids are typically associated with pain and discomfort.
Internal hemorrhoids, in contrast, develop above the dentate line inside the rectum, where they are covered by less sensitive rectal mucosa. They are usually not visible from the outside unless they prolapse, or bulge out of the anus, at which point they may look like moist, pinkish protrusions. Unlike the soft, skin-covered external swelling, internal hemorrhoids are more commonly characterized by painless, bright red bleeding during a bowel movement.
Secondary Visual Indicators and Related Symptoms
The appearance of an external hemorrhoid changes dramatically if a blood clot forms within the swollen vein, a condition known as thrombosis. A thrombosed external hemorrhoid transforms into a firm, tense nodule. It is often dark purple, bluish, or black, depending on skin tone, and indicates the presence of clotted blood. This condition is typically accompanied by a sudden onset of severe pain.
Perianal skin tags are another common visual finding, appearing as small, soft flaps of excess skin near the anus. These tags often remain after a thrombosed external hemorrhoid has resolved and the body has reabsorbed the pooled blood. Skin tags generally match the color of the surrounding skin and are typically asymptomatic, though they can sometimes complicate hygiene.
When to Consult a Healthcare Provider
While many external hemorrhoids resolve with home care, certain symptoms indicate the need for medical evaluation to ensure an accurate diagnosis. You should consult a physician if you experience persistent or severe pain, particularly if it worsens rapidly, as this may signal a thrombosed hemorrhoid. Symptoms that do not improve after a week of at-home remedies also warrant professional attention.
Excessive or prolonged bleeding should always be evaluated by a healthcare provider. Though bright red blood is often associated with hemorrhoids, any significant bleeding requires testing to rule out other, more serious conditions. It is especially important to seek immediate care if you notice dark red or tar-like stools, which suggests bleeding higher up in the digestive tract and is not related to hemorrhoids.