Hemorrhoids usually announce themselves with a combination of itching, swelling near the anus, and bright red blood on the toilet paper after a bowel movement. About half of all people develop hemorrhoids by age 50, so if you’re noticing these signs, you’re far from alone. What you feel and see depends on whether the hemorrhoid is internal or external, and knowing the difference helps you figure out what’s going on and what to do about it.
External Hemorrhoids: What You Can See and Feel
External hemorrhoids form under the skin around the opening of the anus, so they’re the ones you can actually detect with your fingers. A non-thrombosed external hemorrhoid is typically soft to the touch, the same color as your surrounding skin, and sits as a small bump near the anus. It might itch, feel tender when you sit, or cause mild discomfort during a bowel movement. Unlike internal hemorrhoids that can sometimes be pushed back in, external ones stay where they are.
The telltale signs of an external hemorrhoid include:
- A soft lump at the edge of the anus that you can feel when wiping or in the shower
- Itching or irritation around the anal area, sometimes persistent
- Mild soreness that worsens with sitting or during bowel movements
- Swelling around the anus that may come and go
When a Blood Clot Forms
Sometimes an external hemorrhoid develops a blood clot inside it, turning it into what’s called a thrombosed hemorrhoid. This is a noticeably different experience. You’ll see a blue, purple, or dark-colored lump at or near the anus. It feels firm rather than soft, and the pain can be severe, especially when sitting or walking. Most people describe the first 48 hours as the worst, with the pain gradually easing after that.
A thrombosed hemorrhoid is hard to miss. The combination of visible discoloration and intense tenderness sets it apart from a regular external hemorrhoid. It isn’t dangerous, but the pain alone often sends people to a doctor.
Internal Hemorrhoids: Harder to Detect
Internal hemorrhoids form inside the rectum, where there are fewer pain-sensing nerves. That means they often cause no pain at all. The most common sign is painless bleeding: bright red blood on the toilet paper, dripping into the bowl, or coating the surface of your stool. You might not know you have one until you see that blood.
Internal hemorrhoids progress through stages based on how far they bulge outward:
- Grade I: Bleeds but stays inside the rectum. You won’t feel a lump.
- Grade II: Pushes out during a bowel movement but slides back in on its own.
- Grade III: Pushes out and stays out until you gently push it back in with your finger.
- Grade IV: Stays outside the anus all the time and can’t be pushed back in.
At the later stages, you may feel a soft, moist bulge protruding from the anus, along with a sensation of fullness or incomplete evacuation after using the bathroom. Mucus discharge and persistent itching are also common with prolapsed internal hemorrhoids.
Hemorrhoid vs. Anal Fissure
Both hemorrhoids and anal fissures cause bleeding and discomfort in the same area, which makes them easy to confuse. The key difference is pain. Most hemorrhoids cause mild discomfort or no pain at all, while an anal fissure is a small tear in the skin of the anus that produces sharp, stinging pain during and after a bowel movement. If the worst of your pain happens in the moment you’re passing stool and feels like a cut, a fissure is more likely. If you’re mostly dealing with itching, swelling, and a palpable lump, hemorrhoids are the better bet.
Hemorrhoid vs. Polyp
Colon and rectal polyps are tissue growths on the inner lining of the colon or rectum. Unlike hemorrhoids, polyps almost never cause itching or external swelling, and you typically can’t feel them with your finger. Most polyps produce no symptoms at all. When they do, the signs tend to be changes in bowel habits, abdominal pain, or mucus in the stool rather than the localized anal discomfort of a hemorrhoid. Polyps are found during colonoscopies, not during self-exams at home. If a growth ever protrudes from the anus without the soft, cushion-like feel of a hemorrhoid, that warrants a medical evaluation.
Who Gets Hemorrhoids
Hemorrhoids are essentially swollen blood vessels, and anything that puts prolonged pressure on the veins around your rectum can trigger them. The most common contributors are straining during bowel movements, chronic constipation or diarrhea, sitting on the toilet for long stretches, pregnancy, obesity, and heavy lifting. There’s also a genetic component: if your parents dealt with hemorrhoids, your odds go up. People between 45 and 65 are at the highest risk, though hemorrhoids can develop at any age.
How Doctors Confirm the Diagnosis
External hemorrhoids are straightforward. A doctor can see and feel them during a visual exam. Internal hemorrhoids require a bit more. A digital rectal exam, where the doctor inserts a gloved, lubricated finger into the rectum, can check for tenderness, blood, and internal lumps. For a closer look, doctors use an anoscope, a short, hollow tube with a light that lets them see the lining of the anus and lower rectum. This is a quick office procedure that usually doesn’t require any anesthesia. For deeper concerns or to rule out other conditions, a colonoscopy or sigmoidoscopy may be recommended.
When Bleeding Needs Attention
Bright red blood on toilet paper after a bowel movement is the classic hemorrhoid sign, but rectal bleeding can also come from more serious conditions, including colorectal cancer. Don’t assume bleeding is from a hemorrhoid if your bowel habits have changed, your stool looks different in color or consistency, or you notice dark or tarry blood rather than bright red. Hemorrhoids that don’t improve after a week of home care also deserve a professional look. Large amounts of rectal bleeding, dizziness, or faintness call for emergency care.