External hemorrhoids are swollen veins that appear just outside the anus. They are a common condition, often forming as small lumps or bumps near the anal opening. This article clarifies their visual characteristics.
Defining Characteristics of External Hemorrhoids
External hemorrhoids appear as small lumps or swellings around the anal opening. Their size can vary, from a pea to a grape. These lumps are generally soft, though they can become firm if inflamed.
Their color varies by state. Initially, they may appear flesh-toned or slightly reddish, blending with the surrounding skin. If engorged with blood, they can take on a bluish or purplish hue visible beneath the skin.
A thrombosed external hemorrhoid occurs when a blood clot forms inside the vein. This significantly alters the appearance, often resulting in a dark purple, blue, grey, or black lump, depending on skin tone. Thrombosed hemorrhoids are typically firmer and more tender than non-thrombosed ones, developing suddenly. The skin covering them may also appear stretched and shiny.
Common Accompanying Visual Signs
Other visual cues may be present beyond the primary lump of an external hemorrhoid. Fresh, bright red blood is a common observation, often seen on toilet paper after a bowel movement, in the toilet bowl, or on the surface of stool. This bleeding usually occurs because the delicate skin over the hemorrhoid is irritated or broken during defecation.
Another visual sign associated with external hemorrhoids is the presence of anal skin tags. These are small, benign flaps of excess skin located around the anus. Skin tags often form after an external hemorrhoid has resolved and the swelling has subsided, leaving behind stretched skin. Unlike active hemorrhoids, skin tags are typically flesh-colored, painless, and do not bleed unless irritated.
Distinguishing External Hemorrhoids from Other Conditions
It is important to differentiate external hemorrhoids from other conditions that may appear in the same area. Internal hemorrhoids, for instance, originate inside the rectum and are generally not visible unless they prolapse, or protrude outside the anus. A prolapsed internal hemorrhoid may appear as a moist, reddish-pink lump that can sometimes be pushed back inside.
Anal fissures are small tears in the lining of the anal canal. Visually, a fissure appears as a crack or cut in the skin, often causing sharp pain during bowel movements. Unlike hemorrhoids, fissures are not characterized by a distinct external lump. Perianal hematomas, while also presenting as a lump near the anus, result from a burst blood vessel under the skin, creating a bruise-like collection of blood. They often appear suddenly and can be more uniformly discolored than a typical external hemorrhoid.
When to Seek Medical Attention
While external hemorrhoids can often resolve on their own, certain visual signs warrant medical evaluation. Persistent bleeding, especially if heavy or dark, should prompt a doctor’s visit, as it could indicate a more serious underlying condition. If an external lump becomes intensely painful, very dark, or black, it may suggest a thrombosed hemorrhoid, which can require medical intervention.
Medical attention is also advisable if the external hemorrhoid does not improve within a week with home care, or if symptoms worsen over time. If there is uncertainty about the nature of the lump, or if it is accompanied by other concerning symptoms like changes in bowel habits or unexplained weight loss, a healthcare professional can provide an accurate diagnosis and recommend appropriate treatment.