Hemorrhoids are swollen blood vessels located in the anal canal and the surrounding area. These vascular cushions are a normal part of human anatomy, but when inflamed or engorged with blood, they cause symptoms and may become visible outside the body. This condition is common, with many adults experiencing symptoms at some point. When visible outside the anus, the appearance of a hemorrhoid varies significantly depending on its type and whether complications have developed.
Visual Characteristics of External Hemorrhoids
External hemorrhoids develop beneath the skin around the anal opening, which is a highly sensitive area. When uncomplicated, they typically present as small, soft lumps or bumps directly at the anal verge, ranging in size from a small pea to a slightly larger grape. Their color generally resembles the surrounding skin, appearing flesh-colored or slightly reddish, though a faint bluish tinge may be visible due to underlying blood vessels. The texture is often described as spongy or soft to the touch when they are not inflamed. Irritation from wiping or straining can cause them to become more swollen and tender. Because they are covered by skin, external hemorrhoids are rich in pain-sensing nerves, making them prone to discomfort and itching. After a flare-up resolves, the stretched skin may remain as a small, non-symptomatic flap of tissue known as an anal skin tag.
Differentiating Prolapsed Internal Hemorrhoids
Not every lump protruding from the anus is an external hemorrhoid; internal hemorrhoids can push outward, a condition called prolapse. Internal hemorrhoids originate higher up in the anal canal, covered by rectal mucosa rather than skin. This difference significantly affects their appearance when they descend outside the body. A prolapsed internal hemorrhoid often appears as a larger, moister mass of tissue compared to a simple external lump. Because they are covered by reddish-pink mucosa, they tend to display this color, sometimes looking like a fleshy, soft bulge. Their appearance is generally more uniform and less like a distinct, skin-covered bump. Depending on the degree of prolapse, the tissue may retract spontaneously after a bowel movement or require manual repositioning. If the hemorrhoid remains outside, it can become irritated and swollen, leading to pain and visible inflammation.
Recognizing a Thrombosed Hemorrhoid
When an external hemorrhoid develops a blood clot inside it, known as thrombosis, its appearance transforms into a thrombosed hemorrhoid. The clot causes the lump to become noticeably larger and extremely firm or hard to the touch. The distinguishing visual feature is a rapid color shift to a dark blue, purple, or black hue, resulting from the trapped, clotted blood within the vein. This tense, discolored nodule usually appears suddenly and is accompanied by severe pain. On darker skin tones, the color may present as grey, black, or dark brown. This appearance indicates blocked blood flow, causing swelling and inflammation. The body often gradually reabsorbs the clot over time.
When Appearance Indicates Emergency Care
While most hemorrhoids can be managed with home care, certain visual cues signal a complication that requires immediate medical attention. The appearance of a dark blue or black, intensely painful, hard lump, indicative of a thrombosed hemorrhoid, should prompt a consultation if the pain is severe and unmanageable. A medical professional can assess whether a minor procedure to remove the clot is necessary for rapid pain relief. Any appearance accompanied by significant, uncontrollable bleeding is a serious trigger for seeking urgent care. This includes seeing large amounts of blood in the toilet bowl that turns the water red or the presence of large blood clots. Severe swelling that spreads beyond the immediate anal area, or visual signs of infection such as pus or discharge combined with a fever, necessitates prompt medical evaluation. Do not assume that all rectal bleeding is caused by hemorrhoids, as this symptom can be associated with more serious underlying conditions.