How Do Hemorrhoids Look? Step by Step

Hemorrhoids are swollen veins in the lowest part of the rectum and anus. They look like small, soft lumps or cushions of tissue, similar to varicose veins. The exact appearance depends on whether they are internal, external, or prolapsed, and each type has a distinct visual signature.

What Do External Hemorrhoids Look Like?

External hemorrhoids form under the skin around the anus. They look like small, round, bluish or skin-colored lumps at the rim of the anal opening. They can range in size from a pea to a grape.

When a blood clot forms inside one, the lump turns a darker blue or purple color. This is called a thrombosed external hemorrhoid. It feels firm to the touch and is often quite tender. The skin over it may look shiny and stretched.

You can usually see external hemorrhoids in a mirror without any special equipment. They sit right at the edge of the anus and do not disappear back inside.

What Do Internal Hemorrhoids Look Like?

Internal hemorrhoids start inside the rectum, above the anal opening. You cannot see them from the outside in their early stages. They look like small, pink or red cushions of tissue lining the inside of the anal canal.

As they grow, they may push out through the anal opening. This is called prolapse. A prolapsed internal hemorrhoid looks like a moist, pink or red lump protruding from the anus. It may look like a small cherry or a cluster of grape-like tissue.

A prolapsed hemorrhoid can sometimes slide back inside on its own. In more advanced cases, it stays outside and requires manual pushing to return it. If it cannot be pushed back, it may become strangulated, which means the blood supply is cut off. This is a medical emergency.

Step by Step: How to Check for Hemorrhoids at Home

Checking yourself at home can give you a good idea of what is going on. It cannot replace a medical exam, but it helps you understand what you are seeing.

Step 1: Wash your hands. Use soap and warm water. Put on a clean pair of medical gloves if you have them.

Step 2: Get into position. Squat down or sit on the toilet. Use a hand mirror to see the area around your anus.

Step 3: Look at the outside. Gently spread the buttocks apart. Check for any lumps, swelling, or skin tags around the anal opening. External hemorrhoids are visible here.

Step 4: Gently feel the area. Use your finger to feel for any firm lumps or tender spots just inside the anal rim. Do not push hard. If you feel sharp pain, stop.

Step 5: Check after a bowel movement. Hemorrhoids often swell after straining. Look again right after you use the bathroom for any tissue that has come out.

Step 6: Note what you see. Write down the size, color, and location of any lumps. This information helps your doctor understand your situation.

How Can You Tell a Hemorrhoid from Other Lumps?

Not every lump near the anus is a hemorrhoid. Several other conditions look similar and require different treatment.

Anal warts look like small, fleshy bumps that can cluster together. They are caused by a viral infection and have a cauliflower-like surface.

Anal abscesses appear as swollen, red, painful bumps filled with pus. They feel warm to the touch and often cause throbbing pain.

Skin tags are soft, painless flaps of skin that remain after a hemorrhoid resolves. They are usually harmless but can be mistaken for hemorrhoids.

Rectal prolapse looks like a ring of tissue protruding from the anus. Unlike a prolapsed hemorrhoid, it involves the full thickness of the rectal wall and looks like a donut or rosette.

Anal cancer is rare but can present as a persistent lump, ulcer, or bleeding area. It typically does not resolve on its own and may be painless in early stages.

If you are not sure what you are looking at, see a doctor. Visual inspection alone cannot always distinguish these conditions.

Do Hemorrhoids Bleed and What Does the Blood Look Like?

Bleeding is a common symptom of internal hemorrhoids. The blood is usually bright red because it comes from the lower rectum and anus. You may see it on toilet paper after wiping or streaked on the surface of your stool.

External hemorrhoids can also bleed, especially if a clot breaks through the skin. This may produce a small amount of dark blood or a blood clot on the toilet paper.

Bright red blood on the toilet paper is the classic sign of a hemorrhoid. However, blood in the stool can also signal more serious conditions like colorectal cancer or inflammatory bowel disease. Any new rectal bleeding should be evaluated by a doctor, especially if you are over 40 or have a family history of colon cancer.

What Do Hemorrhoids Feel Like?

Appearance matters, but symptoms tell you just as much. External hemorrhoids often cause itching, burning, and discomfort when sitting. A thrombosed hemorrhoid causes sudden, sharp pain that peaks within 48 hours.

Internal hemorrhoids usually do not hurt because the area above the anal canal has fewer pain-sensing nerves. Instead, they cause painless bleeding or a feeling of fullness in the rectum. A prolapsed internal hemorrhoid can cause a sensation of something falling out of the anus.

Mucus discharge is another common symptom. The protruding tissue produces mucus that can cause dampness and skin irritation around the anus.

When Should You See a Doctor?

See a doctor if you notice any of the following:

• Bleeding that lasts more than a few days or is heavy
• Blood that is dark, maroon, or mixed into the stool
• A lump that does not go away or gets larger
• Severe pain that interferes with daily activities
• A prolapsed hemorrhoid that you cannot push back inside
• Changes in bowel habits lasting more than two weeks

These symptoms can indicate conditions other than hemorrhoids, including colorectal cancer. A doctor can perform a digital rectal exam or an anoscopy to look directly at the area. This takes only minutes and provides a clear diagnosis.

Do not assume rectal bleeding is just a hemorrhoid. That assumption delays diagnosis of more serious conditions. The American Cancer Society recommends regular colorectal cancer screening starting at age 45 for average-risk adults.

Can Hemorrhoids Go Away on Their Own?

Mild hemorrhoids often resolve without treatment. Small external hemorrhoids may shrink within a few days. Internal hemorrhoids that bleed occasionally can improve with dietary changes and better bathroom habits.

Thrombosed external hemorrhoids usually resolve within one to two weeks as the body reabsorbs the clot. The pain typically improves after the first two to three days, even without treatment.

Larger or recurring hemorrhoids may not go away on their own. They can persist for months or years and require medical treatment. Procedures like rubber band ligation, sclerotherapy, or surgery are effective for hemorrhoids that do not respond to conservative care.

No home remedy can shrink a hemorrhoid instantly. Fiber supplements, warm sitz baths, and over-the-counter creams can ease symptoms but do not cure the underlying swollen veins.