Hemorrhoids are a common condition where the veins in the lower rectum and anus become swollen and enlarged. Also known as piles, they are a frequent source of discomfort and affect nearly half of all people by age 50. Recognizing the appearance and sensations of hemorrhoids is the first step toward finding relief. Symptoms depend heavily on where these swollen tissues are located within the anal canal.
Differentiating Internal and External Hemorrhoids
The symptoms of hemorrhoids are dictated by their anatomical position relative to the pectinate line. This line divides the anal canal into two distinct areas, each with a different nerve supply. Internal hemorrhoids form above the pectinate line, inside the rectum, where the lining is sensitive only to pressure and stretching. External hemorrhoids develop below the pectinate line, under the skin surrounding the anal opening. This outer area is covered by highly sensitive skin called the anoderm, which contains many somatic nerve endings. This difference in location explains why the two types of hemorrhoids present with such different physical sensations.
Describing the Appearance of Hemorrhoids
The appearance of a hemorrhoid depends on whether it is internal or external, and if it is inflamed or prolapsed. External hemorrhoids are often visible as small, soft lumps or swellings near the anal opening. When not inflamed, they may resemble skin tags—small pieces of excess tissue remaining after a swollen hemorrhoid subsides. If external hemorrhoids become irritated or engorged with blood, they take on a reddish or purplish hue and become more noticeable.
Internal hemorrhoids are not visible unless they protrude, or prolapse, through the anal opening. In this state, the tissue appears as a moist, pink or reddish cushion extending from the anus. The most common visual sign of an internal hemorrhoid is bright red blood, often noticed on the toilet paper or streaking the stool. This bleeding occurs because the delicate tissue covering the internal hemorrhoids is easily damaged by the passage of hard stool.
The Physical Sensations of Hemorrhoids
The experience of a hemorrhoid can range from unnoticeable to painful, depending on its type and state. External hemorrhoids cause distinct, sharp sensations due to the dense network of pain-sensing nerves in the perianal skin. Symptoms include localized pain, tenderness, and a burning sensation, especially when sitting or after a bowel movement.
Internal hemorrhoids are generally painless, but they can create a feeling of rectal fullness or incomplete evacuation after passing stool. The tissue may also produce a mucus discharge, leading to irritation and pruritus (anal itching) on the surrounding skin. If an internal hemorrhoid has prolapsed, the feeling of a lump or pressure is common. The protruding tissue may cause a sensation like sitting on a foreign object, often accompanied by swelling and discomfort from friction caused by clothing and movement.
Recognizing Acute Changes and Complications
The appearance and sensation of a hemorrhoid can change suddenly if a complication develops. A thrombosed hemorrhoid occurs when a blood clot forms inside an external hemorrhoid, causing an abrupt onset of severe pain. This condition presents as a hard, tense lump that may appear dark blue or purple due to the trapped blood.
Advanced internal hemorrhoids (Grade III or IV) can also cause intense discomfort. This represents a prolapse that either requires manual effort to push back inside or is permanently irreducible. If the prolapsed tissue becomes trapped or strangulated by the anal muscles, it can swell significantly, causing severe pain and tissue damage. These acute changes require prompt attention.