Hemorrhoids look like small, soft lumps on or around the anus. They can range from barely visible swellings to firm, bluish-purple knots depending on the type and severity. About one in four people worldwide has hemorrhoids at any given time, so what you’re seeing (or feeling) is extremely common.
What a hemorrhoid looks like depends on whether it’s internal or external, whether it contains a blood clot, and how far it has progressed. Here’s how to identify each type.
External Hemorrhoids
External hemorrhoids form under the skin around the outside of the anus. When small, they may not be visible at all. As they swell, they appear as soft, rounded lumps on the anal surface. The dilated veins beneath the skin often give them a bluish tint, though milder ones can look flesh-colored or slightly pink.
These are the easiest type to spot because they sit on the outer skin rather than inside the anal canal. You might notice them while wiping or feel them as a tender bump when sitting. They can swell to the size of a grape or larger during a flare-up, then shrink back down over several days.
Internal Hemorrhoids
Internal hemorrhoids develop inside the anal canal and are graded on a four-point scale based on how far they protrude.
- Grade 1: Slightly enlarged veins that stay entirely inside the anal canal. You won’t see them from the outside. The most common sign is bright red blood on toilet paper or in the bowl after a bowel movement.
- Grade 2: These bulge out of the anus during straining but slide back in on their own afterward. You may briefly glimpse a reddish, moist-looking lump during a bowel movement.
- Grade 3: These prolapse outside the anus and stay there until you push them back in manually. They appear as soft, irregular tissue protruding from the opening.
- Grade 4: Permanently prolapsed, meaning the tissue hangs outside the anus and cannot be pushed back in. These are the most visible and often the most uncomfortable.
Prolapsed internal hemorrhoids look different from external ones. The tissue that protrudes is the moist inner lining of the anal canal, so it tends to appear pink, red, or dark red rather than skin-colored. You may also notice mucus on the surface.
Thrombosed Hemorrhoids
A thrombosed hemorrhoid is one that has developed a blood clot inside it. It looks distinctly different from a regular hemorrhoid: a hard, purple-blue lump on or around the anus. Cleveland Clinic describes the hallmark sign as a “blueish-purple lump” that is firm and often quite painful.
The dark color comes from the trapped, deoxygenated blood inside the clot. These lumps tend to appear suddenly and can be intensely tender, especially during the first 48 to 72 hours. They don’t feel soft and squishy like an uncomplicated hemorrhoid. Instead, they feel like a firm marble under the skin. Over the following week or two, the clot gradually reabsorbs and the color fades from deep purple to brownish, then back toward your normal skin tone.
What Bleeding Looks Like
Hemorrhoid bleeding is almost always bright red. You’ll typically see it on toilet paper, dripping into the bowl, or streaked on the surface of the stool. Bright red blood indicates the source is low in the digestive tract, near the rectum or anus, which is exactly where hemorrhoids sit.
If you notice dark, black, or tarry-looking stool instead, that points to bleeding higher up in the digestive system (the stomach or upper intestine) and is a different issue entirely. The color distinction matters because it helps determine the source.
What Hemorrhoids Leave Behind
After a hemorrhoid heals, the stretched skin doesn’t always snap back to its original shape. The excess tissue left over can form a small, painless skin tag near the anus. These tags are the same color as the surrounding skin, have a slightly wrinkled texture, and feel soft. They’re harmless but can be mistaken for a new hemorrhoid. The key difference is that skin tags don’t swell, bleed, or cause the throbbing discomfort of an active hemorrhoid.
Conditions That Look Similar
Several other conditions can produce bumps or swelling near the anus, and they’re easy to confuse with hemorrhoids at a glance.
Anal warts are soft, flesh-colored, and irregularly shaped, almost like tiny cauliflower florets. Hemorrhoids, by contrast, are more uniform, rounder, and often darker in color (red, blue, or purple). Warts are caused by a virus and tend to cluster in groups.
Perianal abscesses look like a swollen, red boil near the edge of the anus, similar to a large pimple. They’re warm to the touch and extremely tender, and they may drain pus. Hemorrhoids feel more firm and generally don’t produce pus or feel hot.
Rectal prolapse can resemble a severely prolapsed hemorrhoid, but the tissue looks different. Prolapsed hemorrhoids appear as one or several irregular lumps of short mucosal tissue. Rectal prolapse involves a longer, uniformly rounded tube of tissue with a concentric ring pattern, often coated in mucus. It looks more like a sleeve of tissue extending from the anus rather than distinct bumps.
When Appearance Changes Over Time
Hemorrhoids don’t stay the same size or color throughout a flare-up. A fresh external hemorrhoid might start as a small, flesh-toned bump and become more swollen and bluish over a day or two if blood pools inside it. During healing, swelling decreases gradually, the color lightens, and the lump softens. Most uncomplicated hemorrhoids resolve within one to two weeks with basic home care like warm baths, increased fiber, and avoiding prolonged straining.
Thrombosed hemorrhoids follow a more dramatic visual timeline. The initial dark purple lump is at its worst in the first few days, then slowly fades as the body breaks down the clot. If the clot is very large or the pain is severe, a doctor can make a small incision to remove it, which brings near-immediate relief. After the clot resolves, the stretched skin may persist as a tag.
Hemorrhoids that keep growing, bleed heavily, or progress from one grade to the next over months may benefit from a procedural treatment. The visual progression from a small internal swelling to tissue that stays permanently outside the anus is a practical signal that the condition has advanced beyond what home measures can manage.