Hemorrhoids typically look like small, soft lumps on or around the anus. Their exact appearance depends on the type: external hemorrhoids show up as swollen bumps beneath the skin surface, often with a bluish or purple tint from the dilated veins underneath, while internal hemorrhoids aren’t visible unless they’ve prolapsed (pushed through the anal opening), in which case they appear as pinkish-red, fleshy protrusions.
External Hemorrhoids
External hemorrhoids form under the skin around the anus. They aren’t always visible, especially when small. As they swell, they become easier to see and feel as raised lumps on the anal surface. The color can range from skin-toned to dark blue or purple, depending on how engorged the veins are beneath the skin. They’re generally soft to the touch and may feel tender or itchy.
Some external hemorrhoids stay relatively flat and only become noticeable during a flare-up, while others form a distinct, grape-like lump that you can feel when wiping or bathing. The size varies from a small pea to roughly the size of a marble.
Thrombosed Hemorrhoids
When a blood clot forms inside a hemorrhoid, it becomes what’s called a thrombosed hemorrhoid. These are the most visually distinctive type. You’ll typically see a firm, blue-purple lump around the anus. The color comes from the clot inside, which gives the swelling a noticeably darker appearance than the surrounding skin.
Thrombosed hemorrhoids are also the most painful variety. They tend to feel hard rather than soft, and the surrounding skin may look swollen or stretched. In severe cases, a small dark or necrotic point can develop at the center of the lump, which signals that the tissue isn’t getting enough blood flow. If the lump turns black or develops areas of very dark discoloration, that warrants prompt medical attention since it can indicate tissue death.
Internal and Prolapsed Hemorrhoids
Internal hemorrhoids sit inside the rectum, so you can’t see them under normal circumstances. What you might notice instead is bright red blood on toilet paper or in the bowl after a bowel movement. They’re painless in most cases because the tissue inside the rectum has fewer pain-sensing nerves.
Internal hemorrhoids are graded on a four-point scale based on how far they protrude:
- Grade I: Stays inside the rectum. No visible lump. You may only know it’s there from occasional bleeding.
- Grade II: Pushes out during a bowel movement but slides back in on its own afterward.
- Grade III: Protrudes during straining and stays out until you gently push it back in.
- Grade IV: Permanently prolapsed. Cannot be pushed back inside.
A prolapsed hemorrhoid looks like a small, fleshy bump protruding from the anus. It’s typically soft, and its color ranges from pinkish-red to skin-toned. The size varies, but most are roughly the size of a fingertip. Grade IV prolapsed hemorrhoids can develop chronic inflammation around the surrounding skin, sometimes with mucus discharge or persistent irritation.
How Hemorrhoids Change as They Heal
During a flare-up, hemorrhoids appear swollen, discolored, and prominent. As they begin to resolve, the swelling gradually decreases over several days to a couple of weeks. The bluish or purple tint fades as blood flow normalizes, and the lump shrinks and softens. With thrombosed hemorrhoids, the clot is slowly reabsorbed by the body, which can take two to three weeks. The area may remain slightly tender during this time.
After healing, some external hemorrhoids leave behind a small fold of excess skin called a skin tag. These are harmless, painless, and the same color as surrounding skin. They don’t swell or change color the way an active hemorrhoid does, but they can sometimes be confused with a new hemorrhoid.
What Hemorrhoids Don’t Look Like
Several other conditions can cause bumps or changes around the anus, and knowing the differences helps you figure out what you’re actually dealing with.
Anal skin tags are flat, soft flaps of skin that match your natural skin tone. Unlike hemorrhoids, they don’t swell, change color, or bleed. They’re painless and don’t come and go. If you had a hemorrhoid that healed and left behind a small flap of skin, that’s likely a skin tag.
Anal warts (caused by HPV) are small, flesh-colored or grayish growths that tend to be irregularly shaped. They often appear in clusters rather than as a single lump. Hemorrhoids, by contrast, are more uniform in size and tend toward darker red or purple tones rather than the flat, cauliflower-like texture of warts.
Anal fissures are tears in the lining of the anal canal, not lumps. You won’t see a visible bump. The hallmark of a fissure is sharp, severe pain during a bowel movement that can linger for minutes or even hours afterward. While hemorrhoids can be uncomfortable, they rarely cause that kind of intense, sustained pain unless they’re thrombosed.
If you notice a lump that’s very dark or black, feels rock-hard, keeps growing over weeks, or comes with symptoms like unexplained weight loss or changes in bowel habits, those features don’t fit the typical hemorrhoid pattern and should be evaluated by a doctor.