Hemorrhoids typically look like small, round lumps ranging from pea-sized to grape-sized around the anus. Their exact appearance depends on the type: external hemorrhoids show up as swollen bumps on the skin surface, often with a bluish or purple tint, while internal hemorrhoids are hidden inside the rectum and usually aren’t visible at all unless they push outward. Knowing what to look for can help you tell hemorrhoids apart from other conditions that affect the same area.
External Hemorrhoids
External hemorrhoids form on or around the opening of the anus, right on the skin surface. They appear as round, bulging masses that can range from about 1 millimeter to the size of a grape. When swollen, they often look purple, red, or blue because dilated veins are visible just beneath the skin. The texture is firm and swollen, especially compared to normal surrounding skin.
External hemorrhoids aren’t always visible. Smaller ones may only become noticeable when you strain during a bowel movement or sit for a long time, causing them to swell temporarily. Bleeding during bowel movements is common, and you’ll typically notice bright red blood on the toilet paper.
Internal Hemorrhoids
Internal hemorrhoids sit inside the rectum, so you can’t see them by looking in a mirror. Harvard Health describes them as small, grape-like masses. They’re typically discovered only when they bleed or when they prolapse, meaning they swell enough to push out through the anus.
Doctors classify internal hemorrhoids into four grades based on how far they protrude:
- Grade 1: Stay inside the rectum entirely. No visible signs from the outside.
- Grade 2: Push out during a bowel movement but slide back in on their own.
- Grade 3: Push out during a bowel movement and need to be manually pushed back in.
- Grade 4: Stay permanently outside the anus and can’t be pushed back in.
What Prolapsed Hemorrhoids Look Like
When an internal hemorrhoid prolapses, it appears as a soft, swollen red lump protruding from the anus. One distinguishing feature is the surface: prolapsed internal hemorrhoids are covered with a moist, pinkish mucous membrane (the same tissue that lines the inside of the rectum), while external hemorrhoids are covered with regular skin. This difference in surface texture is one way to tell them apart.
A prolapsed hemorrhoid can look alarming, but the appearance alone doesn’t always reflect the severity. Grade 2 hemorrhoids that slip back inside on their own are very common and often manageable at home. Grade 4 hemorrhoids that stay out permanently are more likely to need medical treatment.
Thrombosed Hemorrhoids
A thrombosed hemorrhoid is an external hemorrhoid that develops a blood clot inside it. The hallmark appearance is a firm, blue-purple lump that shows up suddenly at the rim of the anus. Cleveland Clinic describes it as a “blueish-purple lump” that forms around the anal opening. The dark color comes from the clot sitting just beneath the skin surface.
These are usually the most painful type. The lump feels hard rather than soft, and the surrounding area is often visibly swollen. Thrombosed hemorrhoids can grow rapidly compared to regular external hemorrhoids, which tend to develop more gradually.
Hemorrhoids vs. Skin Tags
Anal skin tags are one of the most common things people confuse with hemorrhoids. Skin tags are small, soft flaps of excess skin around the anus. They’re flesh-colored or slightly pink, have a smooth and pliable texture, and often hang from the skin by a narrow stalk. They’re painless and don’t bleed unless you irritate them physically.
Hemorrhoids, by contrast, are round and bulging rather than flat and floppy. They’re typically purple, red, or blue instead of flesh-colored. They swell, they can be painful, and they commonly bleed during bowel movements. Skin tags stay the same size over time, while hemorrhoids can swell rapidly, particularly if a clot forms. Interestingly, skin tags sometimes develop after a hemorrhoid heals, as leftover stretched skin.
Hemorrhoids vs. Anal Fissures
An anal fissure is a small tear or cut in the skin lining the anus. Fissures and hemorrhoids can both cause pain and bleeding, but they look completely different. A hemorrhoid is a raised, rounded lump caused by a swollen vein. A fissure is a visible linear crack in the skin, similar to a paper cut. It lies flat against the surface rather than protruding outward. Fissures tend to cause sharp, stinging pain during bowel movements, while hemorrhoid pain is more of a dull ache or throbbing pressure.
Hemorrhoids vs. Polyps and Warts
Rectal polyps are tissue growths on the inner lining of the colon or rectum. Unlike hemorrhoids, polyps almost never cause a visible lump you can see or feel from the outside. Doctors typically find them during a colonoscopy. In rare cases, a very large polyp can protrude from the anus, but this is uncommon and often signals something more serious that needs prompt evaluation.
Anal warts have a distinctly different surface texture from hemorrhoids. Warts tend to appear as small, rough, cauliflower-like clusters with an irregular surface. Hemorrhoids, on the other hand, are smooth or slightly shiny and appear as a single round mass rather than a cluster of bumps. Warts are also flesh-colored to white, while hemorrhoids lean toward red, purple, or blue.
When Appearance Changes Over Time
Hemorrhoids don’t always look the same from day to day. A mild external hemorrhoid might be barely noticeable in the morning and visibly swollen by the end of the day, especially after prolonged sitting or a difficult bowel movement. Color can shift too. A hemorrhoid that starts out pink or slightly red can turn darker purple if blood pools inside it.
As hemorrhoids heal, the swelling gradually decreases over days to weeks. The color fades from purple or blue back toward normal skin tone. Sometimes the area is left with a small, soft skin tag where the swollen tissue used to be. If a hemorrhoid suddenly changes from soft to hard and turns dark blue or purple, that’s the characteristic sign of a blood clot forming, which typically brings a sharp increase in pain along with the visible change.