A hemorrhoid that comes out of the anus typically looks like a small, soft, fleshy bump protruding from the opening. It can range from skin-colored to pinkish-red, and the size varies from a pea to a grape or larger. What you see depends on whether the hemorrhoid is simply prolapsing, has developed a blood clot, or has been irritated over time.
What a Prolapsed Hemorrhoid Looks Like
Internal hemorrhoids sit inside the anal canal where you can’t normally see them. When they enlarge enough to push through the opening, they become “prolapsed.” At that point, you’ll notice a soft lump around the anus. The tissue is typically smooth and moist because it’s lined with the inner mucous membrane of the rectum rather than regular skin. The color is usually pinkish-red or close to your natural skin tone.
The size varies widely. Some prolapsed hemorrhoids are barely noticeable to the touch, while others form a cluster of swollen tissue that’s clearly visible. The texture is soft and compressible, not hard or rigid. You might also notice a mucus-like moisture on the tissue or on your underwear, since the exposed rectal lining produces mucus that wouldn’t normally reach the outside of the body.
Stages of Prolapse
Not all hemorrhoids that “come out” behave the same way. Doctors classify internal hemorrhoids into four grades based on how far they prolapse and whether they go back in on their own.
- Grade I: Swollen but still inside the canal. You won’t see anything, though you may notice bleeding.
- Grade II: Pushes out during a bowel movement or straining, then slides back in on its own. You might catch a glimpse of pink tissue that disappears shortly after.
- Grade III: Comes out during straining and stays out until you gently push it back in with a finger. This is the stage where most people first notice a visible lump.
- Grade IV: Permanently outside the anal canal and cannot be pushed back in at all. The tissue may be larger, more swollen, and more prone to irritation.
Grade II and III hemorrhoids are the ones most people are describing when they search for what hemorrhoids look like “coming out.” At grade II, the tissue appears briefly and retracts. At grade III, you’ll feel and see it consistently after bowel movements until you manually tuck it back.
When a Blood Clot Changes the Appearance
A thrombosed hemorrhoid looks noticeably different. When a blood clot forms inside the swollen vein, the lump turns a distinct blue-purple or dark purple color. Instead of being soft and compressible, it feels firm and is extremely tender to the touch. The clot creates visible discoloration you can see clearly, sometimes described as a dark blueish-purple marble sitting at the edge of the anus.
Thrombosed hemorrhoids are significantly more painful than a standard prolapse. The skin over the clot may become stretched and shiny. In some cases the clot erodes through the surface and you’ll see dark blood, which is different from the bright red bleeding that typically comes from a non-thrombosed hemorrhoid. The pain usually peaks in the first 48 to 72 hours and then gradually improves as the clot is reabsorbed, though a firm skin tag often remains afterward.
Hemorrhoid vs. Skin Tag vs. Rectal Prolapse
Several things can cause a visible lump near the anus, and telling them apart matters because the treatments differ considerably.
Perianal skin tags are small, flat flaps of excess skin that hang from the anal opening. They feel like soft folds, are usually painless, and don’t bleed. They often form after a previous hemorrhoid has healed, leaving behind a small tab of stretched skin. Unlike an active hemorrhoid, a skin tag isn’t swollen or engorged with blood, so it stays the same size and doesn’t change with bowel movements.
Rectal prolapse can look similar to a prolapsed hemorrhoid at first glance, since both involve tissue protruding from the anus. The key visual difference is what’s actually coming out. A hemorrhoid involves only the inner lining near the anal opening, so the bulge is localized, often appearing as one or a few distinct lumps. A rectal prolapse involves an entire segment of the bowel wall folding outward, producing a larger, circular or tube-like protrusion with concentric rings of tissue. If you see a sizable amount of tissue with circular folds rather than a small, grape-like bump, that’s more consistent with rectal prolapse and needs a different treatment approach.
What Bleeding Looks Like
Prolapsed hemorrhoids commonly bleed, and the blood is almost always bright red. You’ll typically notice it on toilet paper after wiping, dripping into the bowl, or streaked on the surface of stool. The bleeding comes from the fragile, engorged tissue being irritated by the passage of stool or by friction.
The amount ranges from a few spots on the tissue to enough to turn the toilet water pink. Bleeding from hemorrhoids is generally painless unless the hemorrhoid is also thrombosed or has become severely irritated. Dark red or black blood, or blood mixed into the stool rather than on its surface, suggests a source higher in the digestive tract and warrants a different evaluation.
When the Appearance Signals Something Serious
A prolapsed hemorrhoid that can’t be pushed back in (grade IV) can occasionally have its blood supply pinched off by the anal sphincter muscle. This is called a strangulated hemorrhoid, and it causes extreme, unrelenting pain. The tissue may darken from its usual pinkish-red to a deep purple or even blackish color as circulation is lost. If you notice a prolapsed hemorrhoid turning very dark, becoming increasingly painful rather than improving, or developing an unusual odor, these are signs that the tissue is losing blood supply and needs prompt medical attention.
Most prolapsed hemorrhoids, however, don’t reach that point. The typical appearance of a soft, pinkish lump that comes and goes with bowel movements is the most common scenario and is generally manageable with increased fiber, proper hydration, and avoiding prolonged straining.