Last Updated: April 3, 2026 | Medically Reviewed by the HemRid Medical Team

If you've noticed something unusual around your rectal area, your first instinct is probably to figure out what it is. Hemorrhoids are the most common cause, but knowing exactly what to look for — and what it's NOT — is important for getting the right treatment.

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External Hemorrhoids: What They Look Like

External hemorrhoids develop under the skin around the outside of the anus. They're the type you can usually see and feel.

Appearance:

• Shape: Soft, rounded lumps or swollen bulges. Can range from pea-sized to grape-sized or larger
• Color: Usually skin-colored or slightly pink/reddish. May appear darker or purplish if blood has pooled
• Texture: Soft and compressible when touched (not hard like a tumor)
• Location: Around the outer rim of the anus, often at the 3, 7, or 11 o'clock positions
• Number: Can be a single lump or multiple small bumps

What they feel like:

• Soft, tender swelling you can feel with your finger
• Itching or irritation around the anus
• Mild to moderate pain, especially during bowel movements or sitting
• Sensation of fullness or pressure near the anus

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Thrombosed Hemorrhoids: What They Look Like

A thrombosed hemorrhoid contains a blood clot. This is the most painful type and has a distinctive appearance.

Appearance:

• Color: Dark blue, purple, or blackish — the dark color comes from the blood clot inside
• Shape: Firm, round lump — harder than a regular hemorrhoid because of the clot
• Size: Often marble-sized or larger, can swell significantly
• Surface: Skin over the lump is typically taut and shiny due to swelling

What they feel like:

• Sudden, severe pain — often described as sharp or throbbing
• Hard, tender lump that appears quickly (sometimes overnight)
• Pain that peaks within 48-72 hours, then gradually improves
• May be too painful to sit comfortably

Important: Thrombosed hemorrhoids that are extremely painful can be treated by a doctor with an incision and drainage within the first 48-72 hours for immediate relief. After this window, the body typically reabsorbs the clot on its own over 2-4 weeks.

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Internal Hemorrhoids: What They Look Like

Internal hemorrhoids develop inside the rectum, above the dentate line. They're covered by the rectal lining (mucosa) rather than skin.

Appearance:

• Usually not visible — internal hemorrhoids are inside the rectum and can't be seen externally in early stages
• When prolapsed: May appear as a pink, moist, round protrusion from the anus during or after straining
• Color: Pink to dark red (covered in rectal mucosa, which is redder than skin)
• Texture: Soft, wet, and spongy — distinctly different from the dry skin around the anus

Grading system:

• Grade I: Not visible externally. May cause painless bleeding
• Grade II: Prolapse during straining but retract on their own
• Grade III: Prolapse and must be manually pushed back in
• Grade IV: Permanently prolapsed and cannot be pushed back in

What they feel like:

• Often painless (the rectal lining has fewer pain nerve endings than skin)
• Bright red blood on toilet paper or in the bowl — the most common symptom
• Feeling of incomplete bowel movement
• Mucus discharge from the anus
• If prolapsed: a noticeable lump that may retract on its own or need to be pushed back

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Hemorrhoid Skin Tags

After a hemorrhoid heals (especially a thrombosed one), it may leave behind a small flap of excess skin called a skin tag or sentinel tag.

Appearance:

• Color: Skin-colored — same as surrounding tissue
• Shape: Small, soft, painless flap of skin
• Size: Usually small (pea-sized or smaller)
• Texture: Soft and flexible, not firm or tender

Skin tags are harmless and don't require treatment unless they cause hygiene issues or discomfort. They can be removed by a doctor if desired.

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What Hemorrhoids Are NOT: Conditions That Look Similar

Several other conditions can be mistaken for hemorrhoids. If you're unsure, see a doctor for proper diagnosis.

Anal Fissure

• Looks like: A small tear or crack in the skin lining the anus
• Key difference: Sharp, cutting pain during bowel movements (vs. the dull aching/pressure of hemorrhoids). Pain may last hours after a bowel movement
• Bleeding: Bright red, usually on toilet paper

Anal Abscess

• Looks like: Red, swollen, warm, painful lump near the anus
• Key difference: Fever, increasing redness and warmth, possible pus. An abscess is an infection and requires medical treatment — often drainage and antibiotics

Rectal Prolapse

• Looks like: A larger, circular protrusion of tissue from the anus
• Key difference: Rectal prolapse involves a full section of the rectal wall pushing through, creating circular rings of tissue. Hemorrhoids are localized bulges. Rectal prolapse requires medical evaluation

Genital Warts or Herpes

• Warts look like: Small, rough, flesh-colored bumps (cauliflower-like texture)
• Herpes looks like: Small, painful blisters or ulcers that crust over
• Key difference: Hemorrhoids are smooth, soft lumps. Warts have a rough texture. Herpes blisters are small, clustered, and very painful. Read our detailed guide: Hemorrhoids vs Herpes: How to Tell the Difference

Colorectal Polyps or Cancer

• Important: Rectal bleeding should always be evaluated by a doctor, especially if you're over 40, have a family history of colorectal cancer, or notice changes in bowel habits, unexplained weight loss, or dark/tarry stools
• Hemorrhoids are the most common cause of rectal bleeding, but a healthcare provider should confirm the diagnosis

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When to See a Doctor

Consult a healthcare provider if:

• You're not sure if what you have is a hemorrhoid
• You see a dark blue or black lump with severe pain (possible thrombosed hemorrhoid — may benefit from drainage within 48-72 hours)
• You have rectal bleeding for the first time, especially if over 40
• Symptoms don't improve within 1-2 weeks of home treatment
• You notice fever, increasing redness, or pus (signs of infection)
• A lump is hard, irregular, or growing (hemorrhoids are soft and consistent)
• You have changes in bowel habits alongside bleeding

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How to Treat What You See

Once you've identified hemorrhoids:

• For immediate pain relief: Apply a 5% lidocaine cream directly to external hemorrhoids
• For lasting treatment: Start an oral supplement like HemRid Max to address the underlying vascular cause from within
• For comfort: Warm sitz baths 2-3 times daily, ice packs for swelling
• For prevention: Increase fiber to 25-30g daily, drink plenty of water, avoid straining

Read our complete guide: Best Hemorrhoid Treatment in 2026

This article is for informational purposes only and does not constitute medical advice. If you're unsure about any rectal symptoms, consult a healthcare provider for proper diagnosis.