A hemorrhoid typically looks like a round, swollen lump at or near the anus. The exact appearance depends on the type: external hemorrhoids sit on the outer skin and are usually visible, while internal hemorrhoids form inside the rectum and can only be seen if they push outward. Color ranges from skin-toned to deep purple, depending on whether a blood clot has formed.
External Hemorrhoids
External hemorrhoids develop under the skin around the anus, so they’re the type you’re most likely to notice. They appear as a firm, swollen bump that’s skin-colored or reddish. The surface may be smooth or slightly shiny, and the lump can feel tense or hard to the touch rather than soft. Some external hemorrhoids itch or produce a thin layer of mucus.
These lumps have a broad base, meaning they look like a rounded bulge rising directly from the surrounding skin rather than dangling from a stalk. They can range from pea-sized to roughly the size of a grape, and they often become more noticeable after a bowel movement or prolonged sitting.
Internal Hemorrhoids by Grade
Internal hemorrhoids form inside the rectum, so in their mildest form you won’t see anything at all. They’re classified into four grades based on how far they protrude.
- Grade I: Completely inside the rectum. No visible lump. The only sign is usually painless bleeding, bright red blood on toilet paper or in the bowl.
- Grade II: The hemorrhoid pushes out during a bowel movement but slides back in on its own. You might briefly see a soft, pinkish-red bulge at the opening of the anus that disappears within seconds or minutes.
- Grade III: The tissue protrudes and stays out until you gently push it back in. It looks like a soft, moist, reddish lump sitting outside the anus. Itching and minor soiling of underwear are common at this stage.
- Grade IV: The hemorrhoid stays outside permanently and can’t be pushed back. At this point, the protruding tissue often looks inflamed, darker in color, and may have a moist or irritated surface from chronic exposure.
Because internal hemorrhoids are covered in the moist lining of the rectum rather than regular skin, they tend to appear wetter and pinker than external hemorrhoids when they do prolapse.
What a Thrombosed Hemorrhoid Looks Like
A thrombosed hemorrhoid contains a blood clot, and it looks distinctly different from a regular one. The hallmark is a blue-purple or dark purple lump near the anus. It’s firm, often very tender, and the color comes from pooled blood trapped beneath the skin. Some people describe it as looking like a small, dark blister.
Thrombosed hemorrhoids tend to appear suddenly, reaching their full size within hours. The pain usually peaks in the first 48 to 72 hours. As the clot gradually reabsorbs over one to two weeks, the lump softens and the deep purple fades toward a brownish or skin-toned color before flattening out. In some cases, the skin stretches enough during a thrombosed episode that a small, deflated flap of skin remains afterward.
Hemorrhoid vs. Skin Tag
Anal skin tags are one of the most common things mistaken for hemorrhoids. They’re soft, pliable, and smooth, with a texture that feels like loose excess skin. Many hang from a narrow stalk and move freely when touched. A hemorrhoid, by contrast, is firm and swollen with a broad base. It looks like a taut bulge rather than a floppy flap of skin.
Skin tags are painless and don’t change size. Hemorrhoids swell and shrink depending on pressure, straining, and activity. Interestingly, skin tags sometimes form as a leftover after a thrombosed hemorrhoid heals, so the two conditions can be related.
Hemorrhoid vs. Anal Fissure
Fissures and hemorrhoids can both cause pain and bleeding, but they look completely different. A hemorrhoid is a lump caused by swollen veins. An anal fissure is a visible tear or crack in the skin of the anal canal, similar to a paper cut. If you can see a small linear split in the skin rather than a raised bump, that points toward a fissure. Fissures also tend to cause sharp, stinging pain during bowel movements, while hemorrhoids more often produce a dull ache or pressure.
How Hemorrhoids Change as They Heal
Most hemorrhoids resolve on their own within one to two weeks. As they heal, the swelling gradually decreases and the color shifts from red or purple back toward normal skin tone. A prolapsed internal hemorrhoid that was pushing outward will retract back inside as inflammation subsides. The lump shrinks day by day until it’s no longer noticeable, though a small amount of loose skin can sometimes linger at the site.
Over-the-counter treatments containing witch hazel or hydrocortisone can help speed this process by reducing swelling and soothing irritation. Warm sitz baths, increased fiber intake, and avoiding straining all support healing and help the hemorrhoid return to its normal, non-visible state more quickly.
Colors That Signal a Problem
Color is one of the most useful visual cues for gauging severity. A skin-colored or mildly reddish lump is a standard hemorrhoid. A blue or purple lump signals a blood clot has formed. If the tissue turns very dark purple, grayish, or black, that can indicate the blood supply to the tissue has been cut off, a condition called strangulation. This is uncommon but requires prompt medical attention, as tissue without blood flow can begin to break down.
Bright red blood on toilet paper is the most typical bleeding pattern and is rarely dangerous on its own. Dark red or black blood, or bleeding that doesn’t stop within a few minutes, warrants a closer look from a doctor since those patterns can point to issues higher in the digestive tract rather than hemorrhoids.