A hemorrhoid is a swollen vein in the lower rectum or anus, similar to a varicose vein, that can become inflamed under pressure from straining or prolonged sitting. While hemorrhoids are common and often resolve with at-home care, they can occasionally develop complications like a bacterial infection or an abscess. Understanding the difference between a typical flare-up and the specific signs of an infection is important for knowing when to seek professional medical care. This information is for educational purposes only and is not a substitute for professional medical diagnosis or treatment.
Hemorrhoid Appearance
A non-infected external hemorrhoid typically presents as a small, soft lump or bulge around the anal opening, often skin-colored or slightly reddish. These swellings cause localized itching, irritation, and mild discomfort, but they are generally not associated with systemic illness. When an internal hemorrhoid swells and prolapses, or protrudes outside the anus, it appears as a moist, pinkish lump that may be manually pushed back inside. The most common symptom for both types is bright red blood visible on the toilet paper or in the toilet bowl after a bowel movement, which is usually painless.
A complication known as a thrombosed hemorrhoid occurs when a blood clot forms within the external vein, causing the lump to become firm and tender. This complication is not an infection but changes the appearance to a dark purple, bluish, or even black color due to pooled blood. Although a thrombosed hemorrhoid is intensely painful, it does not display the distinct signs of pus or systemic illness that signal a bacterial infection.
Specific Visual Indicators of Infection
When a hemorrhoid or the surrounding tissue becomes infected, the visual presentation shifts from a simple swollen vein to a mass that often resembles a perianal abscess. The most telling visual sign is the presence of an abnormal discharge, such as thick, yellowish or greenish pus leaking from the site. This pus indicates a collection of bacteria and white blood cells, often manifesting as a raised, fluid-filled lump that may have a distinct white or yellow point.
The skin surrounding the affected area will show signs of cellulitis, appearing intensely red compared to a normal flare-up. An infected hemorrhoid or abscess will also be noticeably warmer to the touch due to the body’s localized inflammatory response. In severe cases, a lack of blood flow to the tissue, known as strangulation, can lead to necrosis, causing the tissue to appear blackened and dead. This is a medical emergency.
Systemic Symptoms Suggesting Infection
An infection or associated abscess often triggers a response throughout the entire body, leading to systemic symptoms. Localized pain intensifies, typically becoming a constant, throbbing sensation not relieved by common pain medications or position changes. This deep, pulsing pain is often a hallmark of a developing abscess.
A fever of 100.4°F (38°C) or higher, along with sudden shivering or chills, strongly indicates a spreading infection. The body fighting the bacterial invasion can also result in generalized fatigue and malaise. These systemic reactions confirm the problem has progressed beyond local irritation and requires immediate medical intervention.
When to Seek Medical Attention
Seek professional medical attention immediately if you notice visual indicators of infection, such as pus discharge, excessive localized warmth, or blackened tissue. The development of systemic symptoms like a high fever, chills, or flu-like feelings alongside hemorrhoid pain also signals an urgent medical need. These symptoms could indicate a perianal abscess or a deeper infection requiring prompt treatment.
Seek immediate care if you experience profuse or continuous rectal bleeding that does not slow down, or if you notice large blood clots. Furthermore, severe pain that makes sitting or walking difficult, or any inability to pass urine, warrants an emergency room visit. Delaying treatment for an infected hemorrhoid or abscess allows the infection to spread, leading to more serious conditions.