Hemorrhoids are common anatomical features—cushions of blood vessels in the anal canal—that have become swollen and inflamed. This condition, often referred to as piles, affects a large portion of the population. The visual presentation of hemorrhoids varies significantly depending on their location, whether they have protruded, and if complications have developed.
Distinguishing External Hemorrhoids
External hemorrhoids develop beneath the skin that surrounds the anal opening, placing them in an area rich with pain-sensing nerves. They typically appear as soft, tender lumps or swellings located right at the edge of the anus. In their uninflamed state, they may be flesh-colored or slightly pinkish, closely matching the perianal skin.
When irritated by straining or wiping, these masses can become inflamed and noticeably swollen. A standard external hemorrhoid may range in size from a small pea to that of a grape, feeling soft to the touch. If swelling subsides, the remaining excess skin may form a perianal skin tag, which is usually painless and the same color as the surrounding skin.
The Appearance of Internal and Prolapsed Hemorrhoids
Internal hemorrhoids originate higher up inside the rectum, above the dentate line where there are no pain-sensing nerve endings. Because of this high location, they are typically not visible or palpable from the outside. The most common visual evidence of an internal hemorrhoid is not the tissue itself, but the presence of bright red blood.
This bleeding is usually painless and appears as streaks on the toilet paper or drips into the toilet bowl after a bowel movement. If the internal hemorrhoid becomes large enough, straining can push it out of the anal opening, a state known as prolapse. A prolapsed hemorrhoid presents as a distinct, moist, pinkish or reddish cushion or mass protruding externally, due to the delicate mucous membrane covering the tissue.
The visual degree of prolapse can vary significantly. In a milder, Grade 2 prolapse, the tissue may emerge during a bowel movement but then retract spontaneously back inside the anal canal. More advanced prolapses (Grade 3 and 4) remain outside or require manual assistance to be pushed back into place. When permanently prolapsed, the tissue may become irritated, appear inflamed, and sometimes show signs of a sticky, clear mucus discharge.
Visual Characteristics of Complicated Hemorrhoids
Thrombosis occurs when a blood clot forms inside the swollen vein, dramatically changing the visual presentation of the hemorrhoid. A thrombosed external hemorrhoid is identifiable as a hard, firm lump near the anal opening. This sudden hardness is caused by the clotted blood trapped within the vessel.
The key visual identifier for a thrombosed hemorrhoid is a noticeable change in color. Due to the presence of the internal blood clot, the lump often appears much darker, typically presenting as a deep purple, bluish, or even black mass. This stark coloration is an immediate sign of the complication and is usually accompanied by intense, sudden pain. The skin overlying the thrombosed area may also appear stretched and shiny due to the rapid swelling.
Identifying Serious Symptoms Requiring Medical Attention
While most hemorrhoids are manageable, certain appearances warrant immediate consultation with a healthcare provider to rule out a more serious condition. Excessive bleeding is a warning sign, especially if the volume is substantial or if bleeding is continuous. The color of the blood is also an indicator, as dark red or maroon blood, or blood mixed with stool, suggests bleeding higher up in the digestive tract.
Other visual signs suggesting a non-hemorrhoidal problem involve the lump’s consistency and associated symptoms. These require professional evaluation:
- Excessive or continuous bleeding, especially if the volume is substantial.
- Dark red or maroon blood, or blood mixed with stool, suggesting bleeding higher up in the digestive tract.
- A lump that is extremely warm, intensely red, rapidly growing, or that produces a yellowish or thick discharge, which may indicate a perianal abscess or fistula.
- Any unusually firm mass that does not fluctuate in size and is accompanied by systemic symptoms like fever and chills.