External hemorrhoids appear as small, skin-colored or reddish lumps around the anal opening. They can range from the size of a pea to the size of a grape, and they feel firm or rubbery to the touch. While hemorrhoids look the same regardless of sex, women are more likely to develop them during pregnancy and postpartum, making this a common concern during those stages of life.
External Hemorrhoids
External hemorrhoids sit just outside the anal opening, where you can see and feel them. A typical external hemorrhoid looks like a round, slightly raised bump that matches your skin tone or appears reddish. The surface may look smooth or slightly shiny, and the area around it can appear swollen or puffy. Some external hemorrhoids itch or produce a thin layer of mucus.
If a blood clot forms inside an external hemorrhoid, the appearance changes noticeably. These thrombosed hemorrhoids turn a distinctive blue-purple color and feel harder than a regular hemorrhoid. The lump is usually very tender to touch and can appear suddenly, going from nothing to a visible, dark-colored bump within hours. Over time, a thrombosed hemorrhoid may shrink on its own as the clot dissolves, but it sometimes leaves behind a small flap of excess skin called an anal skin tag.
Internal Hemorrhoids
Internal hemorrhoids form inside the rectum, above a natural boundary called the dentate line. In their earliest stage, they’re completely hidden inside the body and invisible from the outside. The only sign is typically painless bleeding: small amounts of bright red blood on toilet paper or in the bowl after a bowel movement.
As internal hemorrhoids progress, they can push through the anal opening during a bowel movement. This is called prolapse, and what you’d see is soft, moist, pinkish-red tissue bulging outward. In mild cases, the tissue slides back inside on its own. In moderate cases, you may need to gently push it back in with your finger. In the most advanced stage (grade IV), the tissue stays permanently outside the body and cannot be pushed back in. At that point, it looks like a soft, reddish mass of tissue protruding from the anus.
Because early internal hemorrhoids aren’t visible, a doctor uses a short, lighted tube called an anoscope to look inside the lower rectum and confirm them.
Hemorrhoids During Pregnancy and Postpartum
Hemorrhoids and anal fissures affect roughly 40% of pregnant women and new mothers. They most commonly appear during the third trimester, when the weight of the uterus puts significant pressure on the pelvic veins, and again in the first couple of days after delivery due to the strain of pushing.
Pregnancy-related hemorrhoids look the same as any other hemorrhoid: skin-colored or reddish bumps externally, or protruding pinkish tissue if an internal hemorrhoid has prolapsed. The difference is mainly in timing and cause. The increased blood volume and hormonal changes of pregnancy make the veins in the rectal area more prone to swelling. Most pregnancy-related hemorrhoids resolve with basic self-care measures like sitz baths, increased fiber, and staying hydrated, though some women need further treatment if symptoms persist after delivery.
How to Tell Hemorrhoids From Other Conditions
Not every bump near the anus is a hemorrhoid. A few conditions can look similar but have distinct differences.
- Anal skin tags are small, soft flaps of excess skin near the anus. They’re the same color as surrounding skin, completely painless, and don’t bleed. They often form after a hemorrhoid heals.
- Anal warts are caused by HPV and look soft, flesh-colored, and irregularly shaped, sometimes with a rough, cauliflower-like texture. Unlike hemorrhoids, they don’t typically bleed and tend to appear in clusters.
- Anal fissures are tiny tears in the skin lining the anus. You won’t see a lump, but you’ll feel sharp pain during bowel movements and may notice bright red blood on the tissue.
Hemorrhoids are generally more uniform in shape, more prone to bleeding, and often darker in color (reddish or purple) compared to warts or skin tags.
What the Bleeding Looks Like
Hemorrhoid bleeding is almost always bright red, not dark. You’ll typically see it on the toilet paper after wiping, as drops in the bowl, or as a streak on the stool’s surface. The amount is usually small. If you notice dark red or black blood, blood mixed into the stool itself, or changes in your bowel habits alongside bleeding, that points to something other than hemorrhoids and warrants medical evaluation. Large amounts of rectal bleeding accompanied by dizziness or faintness require emergency care.