Hemorrhoids, commonly referred to as piles, are swollen veins located in the lowest part of the rectum and anus. This condition often causes discomfort, itching, or bleeding. The appearance of hemorrhoids outside the body varies significantly depending on their origin and current state of inflammation. Understanding the different forms is helpful for recognizing symptoms and determining the appropriate next steps for care.
The Two Main Types of Hemorrhoids
Hemorrhoids are classified primarily by where they form in relation to the dentate line, a boundary inside the anal canal. Internal hemorrhoids develop above this line, deep within the rectum where pain-sensing nerves are sparse. They often cause painless bleeding or may go unnoticed unless they become irritated or bulge outward.
Conversely, external hemorrhoids form beneath the skin surrounding the anal opening, an area dense with sensitive nerves. Because of this location, external hemorrhoids are the type most frequently associated with symptoms like pain, burning, and intense itching. Only external hemorrhoids or internal ones that have moved can be seen or felt outside the body.
Identifying External and Prolapsed Hemorrhoids
External hemorrhoids, when inflamed, typically appear as small, soft lumps or bumps situated right at the edge of the anal opening. Their color often matches the surrounding skin but may take on a reddish or purplish hue when swollen. They may feel like a small, tender cushion or a rubbery lump upon touch.
These lumps can range in size, sometimes being as small as a pea, and become more noticeable when irritated or swollen. Since they are covered by skin, external hemorrhoids are prone to irritation from wiping or sitting, leading to greater discomfort.
The other type visible outside the body is a prolapsed hemorrhoid, which is an internal hemorrhoid that has pushed through the anal canal. These usually appear as a larger, moist, pinkish or bright red mass protruding from the anus. Unlike the skin-colored external type, a prolapsed hemorrhoid is covered by the delicate lining of the rectum.
A prolapsed mass can resemble a fleshy rosette or a small, swollen balloon-like structure. Depending on its grade, it may retract on its own (Grade 2) or require gentle manual pushing to return it inside (Grade 3). Grade 4 prolapsed hemorrhoids remain permanently outside the body and appear consistently swollen and inflamed.
When Appearance Signals an Emergency (Thrombosis)
A sudden change in appearance and sensation can signal a complication called a thrombosed hemorrhoid. This occurs when a blood clot (thrombus) forms within an external hemorrhoid, causing an abrupt increase in size and pain. The visual characteristic that sets this condition apart is its distinct color and firmness.
A thrombosed hemorrhoid presents as a hard, singular lump that is dark blue, purple, or sometimes nearly black. This discoloration is caused by the clotted blood trapped inside the vein. The lump feels firm, appears suddenly, and is accompanied by severe, constant pain that is worse than a standard flare-up. This appearance should prompt a discussion with a healthcare provider.
Next Steps and When to See a Doctor
Initial care for most external hemorrhoids focuses on reducing pressure and inflammation to allow the swollen veins to shrink. Simple measures involve increasing dietary fiber and fluid intake to soften stools and minimize straining during bowel movements. Soaking the affected area in a warm sitz bath several times a day can help relieve discomfort and itching.
Over-the-counter creams or medicated wipes containing ingredients like witch hazel or hydrocortisone can provide localized symptom relief. If the visible lump does not improve or the symptoms do not lessen after a week of consistent home care, a medical consultation is warranted.
You should seek prompt medical attention if you experience heavy or continuous rectal bleeding, especially if accompanied by dizziness or lightheadedness. The sudden appearance of a hard, dark blue or purple lump, indicative of a thrombosed hemorrhoid, requires quick evaluation for pain management. A healthcare provider can confirm the diagnosis and rule out other conditions that cause similar visual signs, such as an anal fissure or an abscess.