Hemorrhoids look different depending on the type. External hemorrhoids appear as soft lumps around the anus, usually the same color as your skin. Internal hemorrhoids aren’t visible unless they’ve pushed through the anal opening, in which case they look like small, pinkish-red or skin-colored bumps. A hemorrhoid with a blood clot inside turns a distinctive blue or purple color and feels firm to the touch.
External Hemorrhoids
External hemorrhoids form under the skin around the anus, so they’re the easiest type to see and feel. When they aren’t clotted, they’re typically soft, the same color as the surrounding skin, and tender or sore to the touch. They can range from pea-sized to grape-sized. Unlike internal hemorrhoids, you can’t push them back inside because they originate outside the anal canal.
These lumps may swell during a bowel movement or after prolonged sitting and then shrink back down. Some people notice them only by feel rather than by sight, depending on their exact location.
Internal Hemorrhoids and Prolapse
Internal hemorrhoids develop inside the rectum, so in their earliest stage you can’t see or feel them at all. The only sign is often painless bright-red blood on toilet paper or in the bowl. Doctors classify internal hemorrhoids into four grades based on how far they’ve shifted out of position:
- Grade I: Stays inside the rectum. Not visible. May bleed.
- Grade II: Pushes out during a bowel movement but slides back in on its own.
- Grade III: Protrudes and needs to be gently pushed back in with a finger.
- Grade IV: Stays outside permanently and cannot be pushed back in.
When an internal hemorrhoid does push through (a prolapsed hemorrhoid), it looks like a small, soft, fleshy bump protruding from the anus. The tissue is typically pinkish-red or skin-colored, because it’s rectal lining rather than regular skin. It may feel moist and sometimes leaks clear or white mucus. Prolapsed hemorrhoids can be itchy and uncomfortable, and you might notice blood when wiping.
Thrombosed Hemorrhoids
A thrombosed hemorrhoid is the most visually distinctive type. When a blood clot forms inside an external hemorrhoid, the lump turns a striking blue-purple or dark purple color. It’s noticeably firmer than a regular hemorrhoid, often described as feeling like a hard marble under the skin. This is also typically the most painful type, with sharp, intense pain that peaks in the first 48 to 72 hours.
The dark color comes from the trapped, deoxygenated blood inside the clot. As the clot gradually reabsorbs over a week or two, the color fades from deep purple to brownish, then back toward your normal skin tone. The lump shrinks and softens during this process, though it can leave behind a small flap of stretched skin (more on that below).
How to Tell Hemorrhoids From Similar-Looking Conditions
Anal Skin Tags
After a hemorrhoid heals, particularly a thrombosed one, the stretched skin sometimes stays behind as a small flap or fold. These perianal skin tags are painless, don’t bleed, and feel like soft extra skin rather than a swollen lump. They’re harmless but can be confused with an active hemorrhoid. The key difference: skin tags don’t swell, don’t hurt, and don’t change color.
Anal Fissures
Fissures are tiny tears in the anal lining, not swollen lumps. They cause sharp, cutting pain during bowel movements and can bleed, which makes people wonder if they have hemorrhoids. The simplest way to tell the difference is whether you can feel a lump. Pain during a bowel movement without any lump is more likely a fissure. A fissure also tends to cause pain that lingers for minutes to hours after the bowel movement, while external hemorrhoid pain is more constant.
When the Appearance Should Raise Concern
Hemorrhoid bleeding is almost always bright red. If you notice dark red or very dark blood, that can signal something deeper in the digestive tract or, rarely, a more serious condition like anal cancer. Hemorrhoids also tend to come and go, improving with simple treatments like warm baths and fiber. A lump that keeps growing, pain that steadily worsens over weeks, or bleeding that doesn’t follow the usual pattern are all reasons to get evaluated rather than assume it’s a hemorrhoid. Early-stage anal cancers can feel similar to a hemorrhoid, but they don’t respond to the same home treatments and their symptoms progress rather than cycle.
What Hemorrhoids Look Like as They Heal
A healing hemorrhoid gradually shrinks in size over one to two weeks. External hemorrhoids become less swollen and less tender, eventually flattening back to normal skin or leaving a small skin tag. A thrombosed hemorrhoid’s purple color fades as the clot breaks down. Prolapsed internal hemorrhoids that are grade II or lower typically retract on their own. You might notice decreasing amounts of blood when wiping, less itching, and the lump becoming softer and harder to detect. If a hemorrhoid hasn’t improved after two weeks of home care (sitz baths, added fiber, staying hydrated), that’s a reasonable point to get it looked at professionally.