Hemorrhoids look like small, soft lumps or swollen bumps around the anus. Their exact appearance depends on the type: external hemorrhoids sit on the outer rim and look like firm, rounded bumps under the skin, while prolapsed internal hemorrhoids appear as soft, pinkish-red tissue protruding from the opening. A thrombosed hemorrhoid, which contains a blood clot, has a distinctive purple-blue color that makes it easy to identify.
External Hemorrhoids
External hemorrhoids form just outside the anal opening, beneath the skin. They typically look like one or more small, rounded lumps that you can see or feel when wiping. The color usually matches surrounding skin, though they can appear slightly darker or redder when irritated. They feel firm to the touch, almost like a hard pea or marble sitting just under the surface. Size varies, but most are roughly the size of a pea to a small grape.
When an external hemorrhoid becomes irritated from straining, sitting, or friction, the skin over it may look stretched, shiny, or inflamed. You might notice the area looks redder than usual or feels tender. Some external hemorrhoids cause minimal discomfort and are only noticeable as a small bump, while others swell enough to create visible bulging around the anus.
What a Thrombosed Hemorrhoid Looks Like
A thrombosed hemorrhoid is the most visually distinct type. It forms when blood pools and clots inside an external hemorrhoid, turning it a deep blue or purple color. The lump is firm, often quite tender, and can appear suddenly. One documented case measured 15 to 20 millimeters across, roughly the size of a large grape, though they can be smaller or larger.
The dark purple-blue color is the key visual marker. If you notice a lump around your anus that looks bruised or deeply discolored, that’s likely a thrombosed hemorrhoid. The surrounding skin may also appear swollen and inflamed. Over several days, the clot gradually breaks down and the color fades from deep purple to brownish, then back toward normal skin tone as the body reabsorbs the clot. The lump itself may take a couple of weeks to fully flatten, sometimes leaving behind a small skin tag.
Internal Hemorrhoids and Prolapse
Internal hemorrhoids sit inside the rectum, above a natural boundary called the dentate line. In their earliest stage (grade 1), they’re completely invisible from the outside. You wouldn’t know they were there by looking. The only sign is usually painless bleeding, noticed as bright red streaks on toilet paper or in the bowl.
As internal hemorrhoids grow, they can prolapse, meaning they push through the anal opening and become visible. What you see is a soft, fleshy bump protruding from the anus. It’s typically pinkish-red or skin-colored, moist-looking, and sometimes leaks mucus. The progression follows a clear pattern:
- Grade 2: The tissue bulges out during a bowel movement but slides back inside on its own afterward.
- Grade 3: The tissue protrudes during straining and stays out. You can push it back in with a finger, but it won’t retract on its own.
- Grade 4: The tissue stays outside the anus permanently and can’t be pushed back in. These are often accompanied by chronic irritation and visible inflammation of the surrounding skin.
A prolapsed hemorrhoid looks noticeably different from an external one. Where external hemorrhoids feel hard and sit under the skin, a prolapsed internal hemorrhoid is soft, wet-looking tissue that protrudes from inside. It may look like a small, pinkish cushion or grape-like mass poking out of the opening.
How to Tell Hemorrhoids From Other Conditions
Not every bump near the anus is a hemorrhoid. A few other conditions can look similar but have distinct differences.
Anal skin tags are soft, painless flaps of skin that hang near the anus. They feel like small folds rather than swollen lumps, and they don’t bleed. Hemorrhoids, by contrast, are swollen and often bleed when irritated. Skin tags sometimes form after a hemorrhoid heals, as leftover stretched skin that never fully flattened.
Anal fissures cause pain during bowel movements that can feel similar to hemorrhoid discomfort, but they look completely different. A fissure is a tiny tear or crack in the lining of the anus, not a lump. If you’re experiencing sharp pain during bowel movements but can’t feel or see any bump, a fissure is more likely than a hemorrhoid.
How Hemorrhoids Change as They Heal
Hemorrhoids don’t stay the same size forever. Mild external hemorrhoids often shrink on their own within a few days once the irritation that caused them (straining, prolonged sitting, constipation) stops. As they shrink, they gradually flatten and the redness or swelling fades. What was a firm, noticeable bump may become a barely detectable soft spot or a small residual skin tag.
When hemorrhoids are treated with procedures like banding, the tissue is cut off from its blood supply, causing it to wither and fall off within about a week. Internal hemorrhoids treated with heat-based techniques harden and shrivel. In either case, the visible lump progressively decreases in size over days as the tissue loses its blood flow.
Thrombosed hemorrhoids follow their own timeline. The intense purple-blue color typically starts fading within four to five days as the clot dissolves. The pain peaks in the first 48 to 72 hours and gradually eases. The lump itself can take two to three weeks to fully resolve, and it’s common for a small skin tag to remain at the site even after the swelling is completely gone.