What Do Hemorrhoids Look Like?

Hemorrhoids, a common condition affecting the anal and rectal areas, can manifest itself in various ways, often causing discomfort and concern. Because hemorrhoids are located in a “private” area that is not readily accessible or in your typical range of vision, recognizing and identifying new occurrences can be easily overlooked or ignored. Understanding what hemorrhoids look like and identifying your symptoms is the first step toward realizing the development of hemorrhoids and seeking appropriate hemorrhoid treatment near you.

As swollen veins in the anus and rectum occur both internally and externally, identifying the stages of hemorrhoids and knowing what to look for can help you assess your current stage and help you decide on whether treatment is urgent or not. Here, we will explore some of the different appearances of hemorrhoids, their associated symptoms, and how you can find relief. 

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Identifying Internal Hemorrhoids

Internal hemorrhoids develop inside the rectum and are often not visible from the outside unless they prolapse. In their initial stages, internal hemorrhoids occur above the dentate line, where there are fewer nerve endings — which is why they are often less painful and undetectable. However, continuous strain from bowel movements, poor lifestyle habits, or poor hygiene can exacerbate the symptoms of early-stage internal hemorrhoids, causing significant issues over time. The development of hemorrhoids is identified through different stages or grades, each describing their appearance and symptoms:

Grade 1: These hemorrhoids exist within the lining of the anal canal. Hemorrhoids at grade 1 may cause painless bleeding during bowel movements but do not prolapse. During a colonoscopy, these hemorrhoids often go undetected and need to be visualized via anoscopy (a medical procedure that allows visualization of the anal canal).

Grade 2: At grade 2, internal hemorrhoids may prolapse during bowel movements, excessive strain, or other similar activities but spontaneously reduce and retract on their own. When these hemorrhoids are prolapsed, they may appear as moist, pinkish lumps protruding from the anus. 

Grade 3: These hemorrhoids prolapse during bowel movements or during periods of excessive strain. However, unlike grade 2 hemorrhoids, grade 3 hemorrhoids require manual reduction — gently pushing the hemorrhoid back into the anus with your finger. When prolapsed, their appearance resembles grade 2 hemorrhoids — a soft, reddish-pink bulge. 

Grade 4: As the most severe form of internal hemorrhoids, grade 4 hemorrhoids are chronically prolapsed and cannot be manually reduced. Grade 4 hemorrhoids appear as permanently protruding, often swollen, and inflamed lumps outside of the anus, causing significant pain, discomfort, and bleeding. 

Without medical examination, it can be difficult to identify internal hemorrhoids, especially in their earlier stages visually. According to recent statistics, about 75% of Americans experience hemorrhoids at some point in their life, with only 4.4% experiencing tell-tale symptoms. Primary signs of hemorrhoids to consider may include observations of blood on toilet paper, in the stool, or in the toilet bowl after a bowel movement. 

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External Hemorrhoids

External hemorrhoids develop beneath the skin around the anus, below the dentate line, an area rich with nerve endings. Their location in the body makes them much more likely to cause pain and other noticeable symptoms. External hemorrhoids can cause pain and pressure while sitting, making a bowel movement, or making other movements that cause friction around the anal area. 

Unlike internal hemorrhoids, external hemorrhoids exist outside the rectum and do not necessarily adhere to a grading system. External hemorrhoids are easier to identify and feel the effects of, making them easier to monitor and observe. External hemorrhoids may have these characteristics:

Small and lumpy: In its initial stages, external hemorrhoids may appear as small, soft lumps or bumps around the rim of the anus. These can be skin-colored or slightly darker, accompanied by itching or mild discomfort. 

Swollen and Inflamed: When irritated, external hemorrhoids can become swollen and turn red with inflammation. Excessive swelling can make hemorrhoids feel firm and tender to the touch, causing significant pain while making a bowel movement or when sitting. 

Thrombosed: A more severe form of external hemorrhoids, thrombosed hemorrhoids occur when blood clots form within them. A thrombosed external hemorrhoid may appear as a firm, often blueish or purple lump near the anus. Because of their size, thrombosed hemorrhoids can be intensely painful, especially in the first few days. Over time, the body may reabsorb the clot, eventually minimizing pain symptoms and leaving nothing but a skin tag. 

‍Skin Tags: After an external hemorrhoid flare-up, a small skin-colored flap of tissue may remain — known as a skin tag. Skin tags are usually painless but can be irritating or make hygiene a more difficult task.

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When to Seek Hemorrhoid Treatment

Mild symptoms and signs of hemorrhoids can be treated through home remedies and over-the-counter approaches. However, suppose you are experiencing any of the following symptoms. In that case, you should seek medical attention from a doctor or gastroenterology specialist and determine what treatments are most effective:

• Significant rectal bleeding
• Severe pain that doesn’t improve with home care
• Persistent hemorrhoid symptoms that don't resolve after 1-2 weeks
• New onset bowel incontinence
• Any uncertainty about whether symptoms are consistent with that of hemorrhoids

It is very important to see a doctor specializing in hemorrhoid treatment when evaluating a new lump on or near the anus. This will allow accurate diagnosis and avoid misdiagnosis of an important or dangerous medical problem. Healthcare professionals can help to get an accurate diagnosis of your hemorrhoid condition through comprehensive physical examinations and observations. When doctors evaluate patients for hemorrhoids, they may inspect the anus and surrounding areas, the rectum, and possibly require a colonoscopy or endoscopy to gather the necessary information needed to make a diagnosis.

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Dr. Ernest Castro, M.D. — Accurate Hemorrhoid Diagnoses in Denver, Colorado 

Understanding what hemorrhoids look like, both internally and externally, is extremely important in recognizing and detecting the presence of hemorrhoids. While internal hemorrhoids may be less visible, external hemorrhoids are more susceptible to pain, itching, and other symptoms that interfere with one’s quality of life. By visiting a doctor for hemorrhoid treatment near you, you can get one step ahead of your hemorrhoids before they become a debilitating issue. 

Dr. Ernest Castro, M.D. offers personalized care to help patients understand their gastrointestinal health. By offering suggestions and solutions for treatment, removal, and care, Dr.Castro and his team of professionals deliver the best care possible for patients to free themselves from hemorrhoids and live a pain-free, productive life. For more information or to request an appointment, visit our scheduling page or call us at (720) 358-6333 today.