Hemorrhoids can look like a soft, skin-coloured lump at the anal opening, a firm blue-purple lump that suddenly hurts, or moist, grape-like tissue that slips out when you pass stool. Internal hemorrhoids usually cannot be seen at all — they announce themselves as painless bright-red blood on the paper.
Checked against ASCRS, NHS and Mayo Clinic guidance
Descriptive, never diagnostic
Illustration, not a clinical photograph. Appearance varies from person to person.
Types and grades
Four ways a hemorrhoid can look
Where it sits relative to one line inside the anal canal decides how it looks, whether you can see it — and whether it hurts.
Grade I–II
01Internal hemorrhoid
Where
Inside the anal canal, above the dentate line, under moist mucosa.
Looks like
Usually nothing you can see from outside. Through an anoscope: smooth, moist, bright-red bulges of mucosa at the three classic cushion positions. A grade II may briefly slip out on straining and go back by itself.
Feels like
Soft and compressible. The lining here has visceral nerves, so it registers fullness rather than sharp pain.
Typical symptoms
Painless bright-red blood on the paper, streaked on the stool or dripping into the bowl at the end of a bowel movement; sometimes a mild itch or a sense of fullness.
Grade III–IV
02Prolapsed internal hemorrhoid
Where
Emerging from inside and visible at the anal opening.
Looks like
Soft, moist, grape-like lobules arranged in radial columns with grooves between them, bright red to purple. Grade III can be pushed back with a finger; grade IV stays out and may look swollen or dusky if the blood supply is pinched.
Feels like
Spongy. Usually a dull ache or pressure rather than sharp pain — unless the tissue is strangulated or clotted.
Typical symptoms
Something “hanging out” after a bowel movement, mucus, itching, soiled underwear and a feeling of incomplete emptying.
Not graded
03External hemorrhoid
Where
Below the dentate line, at the anal verge, covered by ordinary skin.
Looks like
Soft, fleshy, skin-coloured or slightly reddish lumps or ridges around the opening. You can see them without any instrument.
Feels like
Pliable and compressible; mildly tender at most.
Typical symptoms
A lump you can feel, itching, burning, and occasional spotting after vigorous wiping.
Acute
04Thrombosed external hemorrhoid
Where
At or just inside the anal verge.
Looks like
A tense, dome-shaped nodule with stretched, shiny skin, bluish-purple or dark red from the clot inside — anywhere from a few millimetres to several centimetres.
Feels like
Firm and exquisitely tender to the touch.
Typical symptoms
Sudden severe pain that peaks within 24–48 hours, is worse when sitting or passing stool, and eases over about a week as the clot is reabsorbed. Often leaves a soft skin tag.
Comparison of hemorrhoid types by appearance, symptoms and pain
Type
Typical appearance
Typical symptoms
Pain
Internal (grade I–II)
Usually not visible; smooth bright-red mucosal bulges seen only with an anoscope
Painless bright-red bleeding at the end of a bowel movement; mild itch or fullness
Usually none
Prolapsed internal (grade III–IV)
Soft, moist, grape-like lobules in radial columns at the opening; red to purple; reducible (III) or permanently out (IV)
Tense, dome-shaped, shiny bluish-purple or dark-red nodule, a few mm to several cm
Sudden severe pain, worse sitting or passing stool; darker clotted blood if the skin breaks
Severe, peaking at 24–48 h
Anal skin tag (after a hemorrhoid)
Soft, stable flap of normal-coloured skin at the anal margin
Mostly none; mild itch or awkward cleaning
None
This table is descriptive, not diagnostic. Colour, size and pain vary, and several conditions can coexist.
Why some hurt and some do not
It comes down to one line inside the canal
The dentate line sits roughly halfway up the 4 cm anal canal. Above it, the lining has visceral nerves that sense pressure but not sharp pain — that is why internal hemorrhoids bleed painlessly. Below it, the anoderm is skin-like and richly supplied by the pudendal nerve — that is why an external hemorrhoid, and especially a thrombosed one, can hurt so much.
External. Visible lump, tenderness, a blue clot when thrombosed.
Three cushions
Left lateral, right anterior, right posterior — the classic positions.
Interactive schematic: the anal canal seen end-on with its three vascular cushions. The orange cushion is engorged and stands out — as a symptomatic hemorrhoid does. Not to scale.
Not everything is a hemorrhoid
Is it a hemorrhoid — or something else?
Seven conditions share the same neighbourhood and are regularly mistaken for hemorrhoids. Here is what sets each one apart.
01Anal fissure
Looks like
A linear tear in the skin lining the canal, almost always in the midline — about 90% posterior. No lump, apart from a small sentinel tag at its lower end in chronic cases.
Feels like
Sharp, tearing or burning pain during a bowel movement that can last for hours afterwards; small streaks of bright-red blood.
Key difference: Pain far out of proportion to what you can see, and a tear rather than a swelling.
02Perianal abscess
Looks like
A red, hot, swollen area beside the anus that may feel boggy or fluctuant. Deeper collections may show nothing on the surface.
Feels like
Constant throbbing pain that is worse sitting or walking and is not relieved by passing stool; fever, chills or feeling unwell.
Key difference: Heat, redness and fever — this needs drainage, not a hemorrhoid cream.
03Anal skin tag
Looks like
A soft flap or fold of normal-coloured skin at the anal margin, from a few millimetres to a few centimetres, often the residue of an old thrombosed hemorrhoid.
Feels like
Nothing, or a mild itch; can make cleaning awkward.
Key difference: Stable over time, painless, does not bleed and does not change when you strain.
04Anal warts (condyloma)
Looks like
Soft, raised growths with a rough, cauliflower-like or finger-like surface, often several, sometimes spreading onto the surrounding skin.
Feels like
Usually painless; may itch or bleed slightly when rubbed.
Key difference: The textured, warty surface — hemorrhoids are smooth.
05Rectal prolapse
Looks like
A larger, circumferential sleeve of red tissue with concentric rings, sometimes several centimetres long.
Feels like
A mass after a bowel movement or on standing and coughing, mucus, difficulty holding stool; usually little pain.
Key difference: Concentric rings versus the radial columns of prolapsed hemorrhoids — and it does not settle on its own.
06Anal fistula
Looks like
A tiny opening in the skin near the anus, sometimes with a firm cord you can feel beneath it.
Feels like
Recurrent swelling that eases when pus or stool leaks out; often follows an abscess.
Key difference: Persistent discharge from an opening — hemorrhoids do not drain pus.
07Polyps, bowel inflammation or cancer
Looks like
Often nothing at all from the outside — which is exactly the problem.
Feels like
Blood mixed into the stool or darker blood, a change in bowel habit or stool shape, weight loss, tiredness from anemia, a sore that does not heal or a mass that persists.
Key difference: Appearance cannot exclude these. Guidelines are clear: rectal bleeding needs proper evaluation, including colonoscopy when indicated.
“Look at the folds. Prolapsed hemorrhoids form radial, grape-like columns with grooves between them. A full-thickness rectal prolapse forms a sleeve of tissue with concentric rings. That single observation changes the diagnosis — and the treatment.”
Evidence
What the numbers say
Hemorrhoids are common, mostly benign and usually manageable — but the figures also explain why a bleed should never simply be waved away.
4.4%
of adults in a US population survey reported symptomatic hemorrhoids at a given time — roughly 10 million people a year.
A clot forms inside an external hemorrhoid, pain climbs steeply and peaks within 24–48 hours, then fades as the clot is reabsorbed over 5–12 days. The shaded band marks the usual resolution window. Excision under local anaesthetic is most useful within the first 72 hours; after that, comfort measures usually suffice.
Schematic curve for orientation only — individual courses vary.
When to see a doctor
Know your red flags
Use this as a guide, not a verdict. Any new rectal bleeding deserves medical consideration — hemorrhoids can be present and still not be the whole story.
Seek urgent care now
Emergency department or urgent advice today
Bleeding that will not stop, a large amount of blood or large clots
Dizziness, light-headedness, fainting or unusual weakness
Severe or rapidly worsening anal pain
Fever, chills, pus or feeling generally unwell
A painful prolapsed lump that cannot be pushed back, especially if it turns dark or dusky
Book a prompt appointment
See your GP or family doctor within days
Any bleeding with bowel movements that is new, recurrent or unexplained
No improvement after about one week of home care
A new or enlarging lump, or any unusual change around the anus
A change in bowel habit or stool shape, weight loss, anemia or a family history of bowel cancer
Pain that seems out of proportion to what you can see
Self-care and review
Mild, short-lived symptoms without red flags
Mild itching, irritation or swelling that is settling
A soft, painless lump that has not changed
Brief spotting after straining that has already stopped
Start first-line measures and review after roughly one week
The examination is quick: inspection, a gentle finger examination and, if needed, a short look with an anoscope. Bring notes on colour, timing and bleeding.
First-line self-care in the meantime
Eat more fibre and drink enough fluids — dietary and behavioural change is the first-line treatment in the ASCRS guideline.
Do not strain and do not linger on the toilet; go when the urge comes rather than putting it off.
Consider a fibre supplement or stool softener when constipation is driving the symptoms — ask a pharmacist.
Warm sitz baths and gentle cleansing ease discomfort; avoid perfumed wipes and other irritants.
Non-prescription creams or suppositories can relieve itch and pain for a short course; steroid creams only briefly.
Simple pain relief may help — check first if you take blood thinners or have other conditions.
Your questions
The questions people actually ask
Phrased the way you would describe it to a doctor — or type it into a search box at two in the morning.
I have a small lump beside my anus — what could it be?
The commonest causes are an external hemorrhoid (soft, skin-coloured, may itch), a thrombosed hemorrhoid (firm, blue-purple, painful) or a harmless skin tag (soft, stable, painless). A red, hot, throbbing swelling points to an abscess, and a lump with a rough cauliflower-like surface may be a wart. Any lump that is new, growing, bleeding or simply not going away should be examined.
There is a blue, painful bump after a bowel movement — is it a thrombosed hemorrhoid?
That description fits well. A clot forms inside an external hemorrhoid, the skin over it stretches, and the lump turns tense, shiny and blue-purple with pain that peaks over the first one to two days. It usually settles on its own over about a week, sometimes leaving a skin tag. Seek care promptly if the pain is severe — excision within roughly 72 hours can shorten the episode — and urgently if you have fever, pus, spreading redness or heavy bleeding.
Something comes out when I poop and goes back in — does that sound like a prolapsed hemorrhoid?
Very possibly a grade II internal hemorrhoid, which slips out on straining and reduces by itself; a grade III needs a gentle push back and a grade IV stays out. The tissue looks moist and grape-like, arranged in radial columns. A larger circumferential cylinder with concentric rings, or tissue that appears when you stand or cough, suggests rectal prolapse — a different condition that needs a specialist.
Can hemorrhoids look like a skin tag?
Yes — a skin tag is often what remains once a thrombosed external hemorrhoid has healed. The difference is behaviour: a tag is soft, the same colour as your skin, does not bleed and does not change when you strain. An active hemorrhoid is congested, red or purple, and bleeds easily.
Are hemorrhoids supposed to be hard, painful or blue?
Only when a clot is involved. Uncomplicated internal hemorrhoids are soft and painless; external ones are soft and, at most, mildly tender. Hardness, marked pain and a blue-purple colour together suggest thrombosis. None of these features alone confirms the diagnosis — an abscess is also hard and painful, and a persistent hard mass must always be examined.
Can hemorrhoids look like cancer — or hide it?
Hemorrhoids are the leading benign cause of bright-red rectal bleeding, but appearance cannot rule out polyps, inflammatory bowel disease or colorectal and anal cancer. Blood mixed into the stool, dark blood, a change in bowel habit, unexplained weight loss, anemia, a sore that does not heal or a persistent mass all need examination — and often colonoscopy — even when hemorrhoids are also present.
What do hemorrhoids look like during pregnancy or after childbirth?
The same four types apply; they are simply more common because the growing uterus and pushing during delivery raise the pressure in the pelvic veins. Swelling around the anus may be more pronounced and thrombosis is not unusual after delivery. The red flags are unchanged: heavy bleeding, severe pain, fever or a lump that cannot be reduced need assessment.
Can I safely compare mine with pictures online?
Pictures help you recognise patterns — colour, texture, position — but they cannot show what an examiner feels, they cannot show internal hemorrhoids at all, and they are easily confused with fissures, abscesses, warts and prolapse. Use them to describe what you see, not to close the question.
What should I tell a doctor about a new anal lump?
When it appeared and whether it is growing; its colour, firmness and whether it hurts; whether it goes back in by itself, with a push, or not at all; any bleeding — colour, amount, on the paper or mixed in; your bowel habit and straining; fever or discharge; and any family history of bowel cancer. A brief inspection and, if needed, a short look with an anoscope usually settle the diagnosis in minutes.
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Everything on this page condensed into a one-page PDF you can print, keep in a drawer or bring to an appointment.
The four-type comparison table, printable on one page
The “or something else?” differential at a glance
Red flags sorted into now / soon / routine
What to tell the doctor about a new lump or bleeding
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