Hemorrhoids typically look like soft, swollen lumps around the anus, ranging from skin-colored to dark purple depending on the type and severity. About half of adults over 50 develop them, so they’re extremely common. What you actually see depends on whether the hemorrhoid is internal or external and whether a blood clot has formed.
External Hemorrhoids
External hemorrhoids form under the skin around the anus, so they’re the type you can actually see or feel. A non-thrombosed external hemorrhoid is usually the same color as your surrounding skin. It feels soft, looks like a small rounded lump or swollen area near the anal opening, and can’t be pushed back inside. Some are barely visible, while others are clearly noticeable, especially when straining or sitting for long periods.
When an external hemorrhoid develops a blood clot (called a thrombosed hemorrhoid), the appearance changes dramatically. You’ll see a firm, blue-purple lump near or around the anus. It can also appear dark blue or nearly black. This type is noticeably harder to the touch than a regular hemorrhoid, and it’s usually quite painful. The discoloration comes from blood pooling and clotting inside the swollen vein. Thrombosed hemorrhoids are one of the most visually alarming types, but they often resolve on their own within a few weeks.
Internal Hemorrhoids
Internal hemorrhoids sit inside the rectum, so you typically can’t see them at all. Instead, the main visual sign is bright red blood on toilet paper, on the surface of your stool, or in the toilet bowl. The blood is characteristically bright red because the source is so close to the anal opening. Dark red, maroon, or black blood suggests bleeding from higher in the digestive tract and isn’t typical of hemorrhoids.
Internal hemorrhoids are classified into four grades based on how far they’ve progressed:
- Grade 1: Entirely inside the rectum. No visible bulge. You might only notice 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 and stays out until you manually push it back in. Often accompanied by itching and minor leakage.
- Grade 4: The hemorrhoid protrudes permanently and can’t be pushed back in at all.
What a Prolapsed Hemorrhoid Looks Like
A prolapsed hemorrhoid (grades 2 through 4) is an internal hemorrhoid that has pushed through the anal opening. It looks like a moist, pinkish-red, grape-like bulge protruding from the anus. The tissue has a different texture than the surrounding skin because it’s rectal lining rather than outer skin. Some prolapsed hemorrhoids leak clear or white mucus, which you might notice on underwear or toilet paper. They can range from small pea-sized bumps to larger clusters of swollen tissue.
How Hemorrhoids Change Over Time
Hemorrhoids often shrink on their own with basic self-care like warm baths, increased fiber, and over-the-counter treatments. As they heal, a swollen lump gradually becomes smaller and less tender. A thrombosed hemorrhoid will slowly lose its dark purple color as the clot breaks down, though this process can take two to three weeks.
After a hemorrhoid resolves, it sometimes leaves behind a small flap of loose skin called an anal skin tag. These are painless, soft, and don’t bleed. They’re harmless remnants of stretched skin, not active hemorrhoids, and they don’t require treatment unless they bother you.
Hemorrhoids vs. Other Anal Bumps
Not every lump near the anus is a hemorrhoid. Two conditions that sometimes cause confusion are anal skin tags and anal warts, and they look quite different from each other and from hemorrhoids.
Anal warts caused by HPV are small, flesh-colored or grayish growths that tend to be flat or slightly raised with an irregular, rough surface. They often appear in clusters and can spread into the anal canal. Hemorrhoids, by contrast, are swollen and more uniform in shape, often darker in color (red or purple), and feel distinctly different from the small, soft texture of warts.
Anal skin tags are tiny, painless flaps of skin that hang near the anus. They don’t bleed when irritated, while hemorrhoids commonly do. Skin tags also stay the same size over time, whereas hemorrhoids tend to swell and shrink depending on pressure and straining.
If you notice any lump, bump, or bleeding around the anus and aren’t sure what it is, especially if the bleeding is dark red or black rather than bright red, getting it checked is worthwhile. Hemorrhoids are by far the most common cause of rectal bleeding, but ruling out other causes gives peace of mind.