Hemorrhoids, commonly referred to as piles, are swollen veins that develop in the anus and lower rectum, similar to varicose veins. They occur when increased pressure stretches the vessels, often due to straining during bowel movements or prolonged sitting. While most active hemorrhoids appear red, purple, or blue due to the presence of blood, a white or pale discoloration is a specific change. This shift in color indicates an alteration in the tissue’s blood supply, texture, or surface composition.
Understanding the Causes of White Discoloration
The most serious cause for a hemorrhoid turning white or gray involves a disruption of blood flow, a process called ischemia. This typically follows a thrombosed external hemorrhoid, where a blood clot forms within the vein, creating a hard, painful lump. When the clot grows large enough, it can cut off the blood supply to the overlying tissue, leading to tissue death, known as necrosis. Necrotic tissue loses its deep red or purple color and may appear white, gray, or even black as the cells die and shrink.
Another cause is the development of an anal skin tag. After a hemorrhoid swells significantly, such as during a thrombotic episode, the stretched skin may remain even after the swelling and clot have resolved. This residual, excess skin is not an engorged blood vessel but simply scar tissue, which is naturally paler than an active hemorrhoid. Since skin tags are composed of normal skin cells, they appear flesh-toned or white and are typically soft and pliable to the touch.
Another mechanism for a white appearance is the formation of a biological coating. When a hemorrhoid, especially a prolapsed one, is irritated or develops a superficial ulcer, the body may cover the raw area with a layer of fibrin. Fibrin is a white, sticky protein involved in blood clotting and wound healing, which acts as a temporary bandage over the damaged tissue. Excessive mucus production from the rectal lining, a symptom of irritation, can also coat the surface of a hemorrhoid, giving it a transient whitish sheen.
Associated Symptoms and Determining Severity
The accompanying symptoms are the most important factors in distinguishing between a harmless skin tag and a condition requiring urgent medical attention, such as necrosis. A white lump resulting from necrosis due to acute thrombosis is almost always characterized by the sudden onset of severe, unrelenting pain. This tissue will also feel hard and firm to the touch, and the white discoloration may be patchy, sometimes appearing alongside areas of blue or black.
In contrast, a white anal skin tag is generally painless and may have been present for a long time. The texture is soft and pliable, resembling normal excess skin, and it will not feel like a rock-hard lump. Skin tags are not prone to bleeding unless they are physically irritated or torn.
A white appearance caused by a fibrin or mucus coating is often associated with mild to moderate irritation, itching, or a feeling of dampness. If a white spot is soft and easily wiped away, it is more likely a mucus discharge rather than deeply necrotic tissue. Therefore, the combination of intense pain and a rigid texture indicates a much higher level of severity than mild discomfort and a soft, pale area.
Immediate Self-Care and Medical Triage Steps
Immediate self-care should focus on soothing the area and reducing swelling. Warm sitz baths, where the anal area is soaked in warm water for 10 to 15 minutes several times a day, can help increase blood flow and relieve discomfort. Increasing dietary fiber and fluid intake is also beneficial, as softer stools prevent straining and further irritation to the affected veins.
Certain signs should prompt an immediate consultation with a healthcare professional. Severe, constant pain that prevents sitting or walking, especially when combined with a firm, discolored lump, suggests possible thrombosis and tissue compromise. The development of a fever or widespread redness and swelling spreading beyond the perianal area are signs of a potential infection that requires urgent medical evaluation. Do not attempt to treat a white or discolored hemorrhoid with harsh cleaners or unprescribed topical products, as this can worsen irritation or mask a more serious underlying issue.