Hemorrhoids look different depending on their type and severity. External hemorrhoids appear as small, soft lumps just outside the anus, usually skin-colored or slightly pink. Internal hemorrhoids are hidden inside the rectum and often invisible unless they prolapse, in which case they look like fleshy, pinkish-red bumps protruding from the opening. A hemorrhoid with a blood clot inside it turns into a firm, blue-purple lump that’s hard to miss.
External Hemorrhoids
External hemorrhoids form under the skin around the outside of the anus. You can usually see and feel them. They look like small, rounded lumps or swollen bumps sitting right at the anal opening. The texture is soft and tender to the touch, and they’re typically close to your natural skin color.
When an external hemorrhoid flares up, the surrounding area often swells noticeably. You might see redness or irritation on the skin nearby. These hemorrhoids can range from pea-sized to roughly the size of a grape, though they sometimes grow larger. They tend to feel itchy or uncomfortable, especially when sitting, and you may notice streaks of bright red blood on toilet paper after wiping.
Internal Hemorrhoids by Grade
Internal hemorrhoids develop inside the rectum, above the opening of the anus. In their earliest stage (grade 1), they’re completely hidden. You can’t see or feel them, and the only sign is usually painless bleeding, small amounts of bright red blood on toilet paper or in the bowl.
Grade 2 internal hemorrhoids are larger. They bulge out of the anus during a bowel movement or sometimes during physical activity, then slide back inside on their own once the straining stops. Grade 3 hemorrhoids also push out during straining, but they won’t retract by themselves. You have to gently push them back in with a finger. Grade 4 hemorrhoids stay prolapsed permanently and can’t be pushed back in at all.
What a Prolapsed Hemorrhoid Looks Like
A prolapsed hemorrhoid is an internal hemorrhoid that has pushed far enough to poke out of the anus. It looks like a small, fleshy bump protruding from the opening. The tissue is typically soft and moist, pinkish-red in color or close to your skin tone. It can sometimes leak mucus, which may cause additional irritation or wetness in the area. The size varies, from barely noticeable to clearly visible.
If you only see the bump during or right after a bowel movement and it disappears shortly after, that’s a grade 2 prolapse. If it stays out until you push it back, that’s grade 3. A prolapse that remains out all the time is grade 4, and it often causes persistent discomfort.
Thrombosed Hemorrhoids
A thrombosed hemorrhoid contains a blood clot, and it looks distinctly different from a regular one. On lighter skin, it appears as a purple-blue lump near the anus. On darker skin, it may look grey, black, or dark brown. The lump is firm and hard rather than soft, and it’s often noticeably swollen.
This is the type most people find alarming because the color change is dramatic and the pain is severe. Thrombosed hemorrhoids can hurt intensely when you walk, sit, or stand. The surrounding tissue often becomes inflamed and tender. Both internal and external hemorrhoids can become thrombosed, though it’s more common and more visible with external ones.
How They Differ From Similar Conditions
Not every bump or pain near the anus is a hemorrhoid. An anal fissure, for instance, is a small tear in the skin of the anus. It causes sharp, cutting pain during bowel movements and may bleed, but there’s no visible lump. Hemorrhoids, by contrast, always involve swelling of the veins and produce a noticeable bump you can see or feel.
Anal skin tags are another common source of confusion. These are small flaps of excess skin near the anus that are painless and don’t bleed. They can actually form after a hemorrhoid heals, leaving behind a bit of stretched skin. Unlike an active hemorrhoid, a skin tag is flat, doesn’t swell, and doesn’t change color. Anal warts have a rougher, cauliflower-like texture and tend to appear in clusters, which looks quite different from the smooth, rounded shape of a hemorrhoid.
What You Can Check at Home
External hemorrhoids are the easiest to identify on your own. Using a hand mirror, you can look for soft lumps around the outside of the anus. They’ll be skin-colored, pinkish, or (if thrombosed) blue-purple. You can gently feel the area with a clean finger for tender, swollen spots.
Internal hemorrhoids are harder to spot. Because they form inside the rectum, they’re usually invisible unless they’ve prolapsed. The main clue is bright red blood on toilet paper or in the toilet bowl after a bowel movement, without any visible external lump. If you notice a soft, moist bump protruding during or after straining, that’s likely a prolapsed internal hemorrhoid.
A hard, discolored lump that appeared suddenly and causes intense pain points toward a thrombosed hemorrhoid. Any rectal bleeding that’s dark in color, persistent, or accompanied by changes in bowel habits warrants a medical evaluation, since those symptoms can overlap with other conditions. Doctors can confirm the diagnosis with a simple visual or digital exam, and for internal hemorrhoids, a short scope examination of the lower rectum provides a clear picture.