Hemorrhoids are swollen veins in or around the anus, and their appearance depends on the type. External hemorrhoids look like small, firm bumps around the opening of the anus, ranging from pea-sized to much larger. Internal hemorrhoids are hidden inside the rectum and invisible unless they prolapse, or push outward. Here’s how to identify each type and tell them apart from other conditions.
External Hemorrhoids
External hemorrhoids form under the skin just around the anus. They often look like one or more rounded, slightly raised lumps. The color can match your surrounding skin tone, or they may appear reddish or purplish if there’s significant swelling and blood pooling in the tissue. They feel firm to the touch, not soft like a skin tag, because the vein beneath is engorged with blood.
Size varies widely. A mild external hemorrhoid can be as small as a pea, while more severe swelling produces a noticeably larger lump. The skin over the bump is usually smooth and intact, though it may look stretched or shiny when the swelling is pronounced. You might notice it most easily in the shower or with a handheld mirror.
Thrombosed Hemorrhoids
When a blood clot forms inside an external hemorrhoid, it changes appearance dramatically. A thrombosed hemorrhoid looks like a hard, dark blue or purple lump on or near the anus. It’s the most visually alarming type and also the most painful, often described as a firm, bruised-looking knot that appears suddenly.
The dark color comes from pooled, clotted blood beneath the skin. Unlike a regular external hemorrhoid that you might barely notice visually, a thrombosed one is hard to miss. Pain tends to peak within the first 48 to 72 hours, then gradually eases as your body begins to reabsorb the clot. As healing progresses, the lump softens and the deep purple color fades. Once the clot fully resolves, the stretched skin sometimes remains as a small, painless skin tag.
Internal Hemorrhoids
Internal hemorrhoids sit inside the rectum, so you can’t see or feel them in their earliest stage. The only sign is often bright red blood on toilet paper or in the bowl after a bowel movement. Doctors classify internal hemorrhoids into four grades based on how far they protrude:
- Grade I: The swollen tissue stays inside the anal canal. You won’t see anything externally.
- Grade II: The hemorrhoid pushes out during a bowel movement but slides back inside on its own afterward.
- Grade III: It protrudes during straining and stays out until you gently push it back in with your finger.
- Grade IV: The hemorrhoid is permanently outside the anus and can’t be pushed back in.
What a Prolapsed Hemorrhoid Looks Like
A prolapsed internal hemorrhoid (Grade II through IV) is the type most people are startled by, because it’s a soft, moist lump protruding from the anus that wasn’t there before. It looks like a small, fleshy bump, pinkish-red or skin-colored, with a smooth, almost rubbery texture. The surface is covered by the moist lining of the rectum rather than regular skin, so it often appears wetter and shinier than the surrounding area.
Prolapsed hemorrhoids sometimes leak mucus, a clear or whitish fluid you might notice on underwear. Bleeding is also common, typically bright red and most noticeable during or right after a bowel movement. The lump itself is generally soft and compressible, which is one feature that helps distinguish it from something more concerning.
Hemorrhoids vs. Skin Tags
Anal skin tags are harmless flaps of extra skin that can feel similar to a hemorrhoid at first touch, but the two look and feel quite different. A skin tag is soft, flat or slightly raised, and matches your normal skin color. It doesn’t bleed during bowel movements and doesn’t change size day to day. A hemorrhoid, by contrast, feels firmer because it contains a swollen vein, often appears reddish or purple, and can bleed with straining.
Skin tags sometimes form after a thrombosed hemorrhoid heals. The clot resolves and the swelling goes down, but the stretched skin doesn’t fully retract. If you’ve had a painful lump that gradually shrank and left behind a small, painless flap of skin, that’s likely a residual skin tag rather than an active hemorrhoid.
Hemorrhoids vs. Anal Warts
Anal warts are caused by HPV and look distinctly different from hemorrhoids. They appear as small, flesh-colored or grayish growths with an irregular, bumpy surface, sometimes described as cauliflower-like. They can show up as a single bump or in clusters and tend to be flat or only slightly raised. Hemorrhoids, on the other hand, are more uniform and rounded, with a smooth surface and a reddish to purple color when swollen. Warts are also painless and don’t bleed in the same way hemorrhoids do during bowel movements.
When a Lump May Not Be a Hemorrhoid
Most anal lumps are hemorrhoids, but a few visual features suggest something that needs medical evaluation. A lump that feels hard, has irregular or rough edges, doesn’t change in size over a couple of weeks, or bleeds persistently without an obvious trigger like straining could point to a different condition, including rare possibilities like anal cancer. The key differences: hemorrhoids are soft or rubbery, relatively smooth, and their size fluctuates with bowel habits and activity. A lump that is fixed in place, coarse or uneven to the touch, or accompanied by an ulcer that won’t heal looks and feels different from a typical hemorrhoid. If you’re unsure, a physical exam can settle the question quickly.