Hemorrhoids look the same on women as they do on men: soft, swollen lumps near or around the anus that range in color from pink to dark purple depending on the type. While this article can’t replace a medical photo gallery, it can give you a detailed visual guide so you know exactly what to look for and what else it might be.
What you’ll actually see depends on whether the hemorrhoid is external, internal, or thrombosed (filled with a blood clot). Each type has a distinct appearance.
What External Hemorrhoids Look Like
External hemorrhoids form under the skin just outside the anal opening. They typically appear as one or more soft, rounded lumps that you can see and feel. The color ranges from skin-toned pink to dark red or bluish-purple, depending on how much blood has pooled inside. The surface is usually smooth, not rough or textured. A mild external hemorrhoid might be pea-sized, while a larger one can reach 15 to 20 millimeters across, roughly the width of a nickel.
They often look puffy or swollen, similar to a small balloon under the skin. You might notice them more clearly after a bowel movement, when straining temporarily increases their size. Between flare-ups, the swelling can shrink considerably, sometimes becoming barely visible.
What Internal Hemorrhoids Look Like
Internal hemorrhoids sit inside the rectum, so in early stages you won’t see anything at all. The main clue is bright red blood on toilet paper or in the bowl. As they progress, though, internal hemorrhoids can push through the anal opening, which is called prolapse. That’s when they become visible.
Doctors grade prolapse on a four-point scale:
- Grade 1: No prolapse. Nothing visible from the outside.
- Grade 2: Bulges out during straining but slides back in on its own afterward.
- Grade 3: Protrudes and stays out until you push it back in manually.
- Grade 4: Permanently prolapsed and cannot be pushed back in.
A prolapsed hemorrhoid looks like a moist, pinkish-red lump poking out of the anus. The tissue tends to look wetter and redder than the surrounding skin because it’s rectal lining, not outer skin. Grade 3 and 4 prolapsed hemorrhoids can be tender, swollen, and may bleed.
What a Thrombosed Hemorrhoid Looks Like
A thrombosed hemorrhoid contains a blood clot and has the most dramatic appearance. According to Cleveland Clinic, the hallmark sign is a blue-purple lump on or around the anus. The color is distinctly darker than a regular hemorrhoid because trapped, deoxygenated blood gives it that deep purple-blue hue.
These lumps are firm to the touch rather than soft, and they’re painful. A thrombosed hemorrhoid can appear suddenly and grow quickly over a day or two. The surrounding skin may also look swollen and shiny from the tension. In rare cases, a blood clot can cut off blood supply entirely (called strangulation), which causes the tissue to darken further and potentially break down. That progression warrants prompt medical attention.
Hemorrhoids During Pregnancy and Postpartum
About 30% to 40% of pregnant women develop hemorrhoids, most commonly in the third trimester. The growing uterus puts pressure on pelvic veins, blood volume increases significantly, and constipation from hormonal changes adds more strain. The result is swollen veins around the anus that look exactly like the hemorrhoids described above, just more likely to appear (or worsen) during this specific window.
Pushing during labor can make existing hemorrhoids larger and more swollen immediately after delivery. The good news is that pregnancy-related hemorrhoids typically improve within a few weeks postpartum as pelvic pressure decreases. One lasting reminder, though: after a hemorrhoid resolves, it sometimes leaves behind a small skin tag at the anal opening. These tags are harmless but permanent unless removed.
Conditions That Look Similar
Not every bump near the anus is a hemorrhoid. Two common lookalikes are worth knowing about.
Anal Skin Tags
Skin tags are small, flat flaps of skin around the anus. They’re skin-colored, painless, and don’t bleed. A hemorrhoid, by contrast, is swollen and vascular, often darker in color, and tends to cause discomfort or bleeding. Skin tags sometimes form after a hemorrhoid heals, so they can show up in the same location.
Anal Warts
Anal warts are caused by HPV and look quite different from hemorrhoids up close. They’re flesh-colored or grayish, irregularly shaped, and may have a rough, cauliflower-like texture. They can appear as single bumps or in clusters. Hemorrhoids, on the other hand, are smoother, more uniform in shape, and typically darker red or purple. Warts are painless in most cases but require treatment to prevent spreading.
What Color Tells You
Color is one of the most useful visual cues for identifying what you’re looking at. A quick reference:
- Pink or skin-toned: Likely a mild external hemorrhoid or a skin tag.
- Bright red or dark red: An active, swollen hemorrhoid with significant blood flow.
- Blue-purple: A thrombosed hemorrhoid with a blood clot inside.
- Very dark purple or black: Possible tissue strangulation. This needs medical evaluation.
- Flesh-colored and rough: More consistent with anal warts than hemorrhoids.
If you’ve noticed a lump and the color, texture, and symptoms don’t clearly match any of these descriptions, or if you’re seeing persistent bleeding, a physical exam can give you a definitive answer. Hemorrhoids are extremely common and straightforward to identify once a provider takes a look.