Hemorrhoids are swollen veins that can form in the rectum or around the anus. They can develop internally, within the rectum, or externally, under the skin surrounding the anal opening. While internal hemorrhoids often remain unseen, they can sometimes protrude outside the anus. This article describes the visual characteristics of hemorrhoids visible outside the anus, whether external or prolapsed internal.
Appearance of External Hemorrhoids
External hemorrhoids are located just outside the anal opening, beneath the skin. They appear as small lumps or bumps around the anal rim. Their size can vary, ranging from small, pea-sized formations to larger, grape-sized swellings, especially if inflamed or clotted with blood.
Their color varies by state. Non-thrombosed external hemorrhoids are skin-toned or slightly darker. If a blood clot forms (thrombosed), they often appear reddish-blue, purplish, or black. The skin covering a thrombosed hemorrhoid might also look stretched and shiny. These lumps can feel firm, tender, or lumpy to the touch, often with surrounding swelling.
Appearance of Prolapsed Internal Hemorrhoids
Prolapsed internal hemorrhoids originate inside the rectum but have pushed out through the anus. Unlike external hemorrhoids, which are covered by skin, prolapsed internal hemorrhoids are covered by moist mucus membrane, giving them a distinct appearance. They often present as pinkish or reddish, moist, grape-like clusters of tissue protruding from the anal opening.
These prolapsed tissues may feel soft and moist to the touch. Their shape can vary, appearing as a single rounded lump or multiple lobes of tissue. In earlier stages of prolapse, these hemorrhoids might spontaneously retract back inside the anus, or they can sometimes be gently pushed back in. Visible signs accompanying prolapsed internal hemorrhoids can include mucus discharge or streaks of bright red blood on toilet paper or in the toilet bowl.
When to Seek Medical Advice
While many hemorrhoids can be managed with home care, certain visual cues and symptoms warrant medical evaluation. If hemorrhoids do not show improvement with home remedies within approximately one week, consult a healthcare provider. Persistent discomfort, pain, or itching that does not resolve also indicates a need for professional assessment.
Seek medical attention if a hemorrhoid becomes severely swollen, hard, and intensely painful, suggesting a thrombosed external hemorrhoid. Any rectal bleeding should be evaluated by a doctor, especially if heavy, persistent, dark red, or black, or accompanied by dizziness or faintness. Also seek medical advice if uncertain about a visible lump, or if experiencing changes in bowel habits or unexplained weight loss.