Hemorrhoids can look different depending on whether they are internal, prolapsed, external, or thrombosed.
Photographs alone cannot confirm whether a lump is a hemorrhoid. Anal skin tags, fissures, abscesses, warts, rectal prolapse, and other conditions may have a similar appearance.
| Type or condition | Typical appearance | Common symptoms |
|---|---|---|
| Internal hemorrhoid | Usually not visible outside the anus | Painless bright-red bleeding, prolapse, pressure |
| Prolapsed internal hemorrhoid | Soft, moist, pink or reddish tissue protruding from the anus | Bleeding, irritation, mucus, incomplete evacuation |
| External hemorrhoid | Soft or swollen lump around the anal opening | Itching, tenderness, swelling, discomfort |
| Thrombosed external hemorrhoid | Firm, bluish-purple lump near the anus | Sudden pain, tenderness, swelling |
| Anal skin tag | Soft, flesh-colored fold of skin | Usually painless; hygiene difficulty or irritation |
| Anal fissure | Small tear rather than a lump | Sharp pain and bleeding during bowel movements |
See additional educational examples in our hemorrhoid image guide.
Internal hemorrhoids develop inside the lower rectum and are usually not visible from outside the body.
They commonly cause:
Internal hemorrhoids generally do not cause significant pain because they arise above the area containing pain-sensitive nerves. Pain may occur when a hemorrhoid becomes prolapsed, trapped, inflamed, or associated with another anorectal condition.
When an internal hemorrhoid protrudes through the anus, it may appear as:
A prolapsed hemorrhoid may retract spontaneously, require gentle manual reduction, or remain outside the anus.
| Grade | Typical appearance and prolapse |
|---|---|
| Grade I | Enlarged hemorrhoidal tissue remains inside the rectum |
| Grade II | Prolapses during straining but retracts spontaneously |
| Grade III | Prolapses and must be manually pushed back inside |
| Grade IV | Remains prolapsed outside the anus and cannot be reduced |
The grade describes the degree of prolapse, but treatment also depends on bleeding, discomfort, hygiene problems, and the effect on daily activities.
External hemorrhoids develop under the skin surrounding the anal opening.
They may appear as:
External hemorrhoids may cause itching, irritation, tenderness, or discomfort when sitting or cleaning the area.
A painless, soft fold of tissue may instead be an anal skin tag, particularly after a previous external hemorrhoid or anal fissure.
A thrombosed hemorrhoid develops when a blood clot forms inside an external hemorrhoid.
It typically appears as:
Pain often begins suddenly and may be severe during the first several days. The body may gradually absorb the clot, although residual swelling or a skin tag can remain.
Learn more about the symptoms and management of a thrombosed external hemorrhoid.
Hemorrhoids may feel soft or firm depending on their type and whether inflammation or thrombosis is present.
A persistently hard, irregular, enlarging, ulcerated, or unexplained anal lump should be medically evaluated rather than assumed to be a hemorrhoid.
Not every lump, swelling, or episode of rectal bleeding is caused by hemorrhoids.
Conditions that may resemble hemorrhoids include:
An anal skin tag is usually a soft, flesh-colored fold of skin. It is generally painless unless irritated.
An external hemorrhoid is more likely to be swollen, tender, itchy, or painful. A thrombosed hemorrhoid is usually firmer and may appear blue or purple.
An anal fissure is a tear in the anal lining rather than a swollen vein. It typically causes sharp or burning pain during and after bowel movements, often with a small amount of bright-red bleeding.
Rectal prolapse may appear as a larger circular or tubular segment of reddish tissue protruding from the anus. Prolapsed hemorrhoids more commonly appear as separate rounded bulges.
A physical examination is often required to distinguish between these conditions.
Hemorrhoidal tissue may bleed when it becomes irritated or traumatized during a bowel movement.
Bleeding may appear as:
Hemorrhoids commonly cause bright-red bleeding, but the appearance of the blood does not confirm the diagnosis.
Persistent, recurrent, heavy, dark, or unexplained rectal bleeding should be evaluated to exclude other colorectal conditions.
Learn more about the causes of rectal bleeding.
Hemorrhoids become enlarged when pressure increases within the veins and supporting tissues of the rectum and anus.
Common contributing factors include:
Reducing straining and maintaining soft, regular bowel movements may improve symptoms and reduce recurrence.
Medical evaluation is recommended if you experience:
Do not rely on photographs alone to diagnose rectal bleeding or an anal lump.
A colorectal specialist can determine whether symptoms are caused by hemorrhoids, an anal fissure, a skin tag, an abscess, rectal prolapse, or another colorectal condition.
Persistent bleeding, severe pain, swelling, or a new anal lump should be evaluated rather than diagnosed from appearance alone.
Dr. Aisha Akhtar, MD is a board-certified colon and rectal surgeon who evaluates and treats hemorrhoids, rectal bleeding, anal pain, skin tags, fissures, and related colorectal conditions in Phoenix, Arizona.
Treatment depends on the hemorrhoid type, degree of prolapse, symptom severity, and response to conservative care.
Initial treatment may include:
Short-term symptom relief may include:
Topical medications may reduce symptoms but do not permanently correct prolapse.
Persistent internal hemorrhoids may be treated with:
Large, recurrent, mixed, or advanced hemorrhoids may require:
A colorectal surgeon can recommend treatment after confirming the diagnosis and determining whether the hemorrhoids are internal, external, thrombosed, prolapsed, or mixed.
Internal hemorrhoids are usually not visible unless they prolapse through the anus. Prolapsed hemorrhoids may appear as soft, pink or reddish tissue.
External hemorrhoids may be skin-colored, reddish, purple, or blue. Thrombosed hemorrhoids are often dark blue or purple because of the blood clot inside them.
Yes. A previous external hemorrhoid may leave behind a soft skin tag after the swelling resolves. A clinical examination can distinguish an active hemorrhoid from residual skin.
Some anal or rectal growths may initially be mistaken for hemorrhoids. Persistent, hard, irregular, ulcerated, bleeding, or enlarging lesions require medical evaluation.
No. Thrombosis is a common cause of sudden severe pain, but prolapse, strangulation, fissures, abscesses, and other anorectal conditions may also cause pain.
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Dr. Aisha Akhtar, MD is a board-certified colorectal surgeon specializing in the evaluation and treatment of hemorrhoids and other anorectal conditions. She offers comprehensive care ranging from conservative management to office procedures such as hemorrhoid banding and advanced surgical treatments when necessary.
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