Hemorrhoids are a common condition involving the swelling of veins located either inside the rectum or beneath the skin surrounding the anus. These enlarged blood vessels, often referred to as piles, are a natural part of the human anatomy but become problematic when they swell and become irritated. Increased pressure in the lower rectum, often caused by straining during bowel movements, chronic constipation, or pregnancy, leads to this swelling. The specific location of the hemorrhoid determines the symptoms and its physical appearance.
Defining the Color and Appearance of Internal Hemorrhoids
The color of an internal hemorrhoid is generally a shade of bright red or pink. This distinct coloration is due to the mucous membrane (mucosa) that covers them and lines the inside of the rectum. This tissue is highly vascular and soft, similar to the lining inside the mouth, indicating a rich blood flow.
Because of their internal location within the rectum, these hemorrhoids are usually not visible from the outside. They are typically only seen during a medical examination, such as an anoscopy, or if they enlarge enough to push out of the anal opening (prolapse). When prolapsed, the tissue appears as a moist, reddish or pinkish lump that may retract on its own or require gentle manual repositioning.
The color may change significantly if the internal hemorrhoid becomes strangulated, which occurs when the anal muscles cut off its blood supply after prolapsing. The lack of oxygenated blood can cause the tissue to turn a darker, purplish, or bluish hue. Internal thrombosis, where a blood clot forms inside the vein, is a less common complication that can also lead to a darker appearance and severe pain.
Key Differences Between Internal and External Hemorrhoids
The primary distinction between internal and external hemorrhoids lies in their location relative to the dentate line. Internal hemorrhoids form above this line, deep within the rectum, while external hemorrhoids form below it, beneath the skin around the anal opening. This difference in location dictates both the symptoms experienced and the physical appearance.
The tissue covering external hemorrhoids is the anoderm, which is skin-like and contains numerous pain-sensing nerve endings. External hemorrhoids that are not thrombosed generally appear the same color as the surrounding skin, often a fleshy or reddish tone. They are usually noticeable as hard, tender lumps near the anal opening.
When a blood clot forms within an external hemorrhoid (thrombosis), the appearance changes dramatically. The trapped blood causes the lump to appear blue, dark purple, or black, depending on the individual’s skin tone. Because external hemorrhoids are covered by sensitive skin, thrombosis typically causes a sudden onset of severe, sharp pain, unlike non-prolapsed internal hemorrhoids.
Understanding Hemorrhoid Bleeding and When to Consult a Doctor
Bleeding is one of the most common symptoms associated with internal hemorrhoids, and the blood is almost always bright red and fresh. This is frequently what leads individuals to question the tissue’s color. The blood originates from the lower gastrointestinal tract, specifically the anal canal, which is close to the body’s exterior.
The blood has not been exposed to digestive enzymes, resulting in the characteristic bright red color seen on toilet paper, streaked on the outside of the stool, or dripping into the toilet bowl. This type of bleeding is generally painless because the tissue lining the rectum lacks the sensory nerves that signal pain. Bleeding occurs when straining during a bowel movement scrapes or irritates the fragile lining over the swollen veins.
When to Seek Medical Attention
While small amounts of bright red blood are often attributed to hemorrhoids, professional confirmation is necessary. Bleeding can be a symptom of other more serious conditions, including colorectal cancer or inflammatory bowel disease. A medical consultation is necessary if bleeding is persistent, heavy, or accompanied by symptoms like lightheadedness or dizziness.
Warning Signs
You should seek immediate attention if the blood is dark, maroon, or mixed in with the stool. Immediate attention is also required if you experience a change in bowel habits or severe anal pain.