Most people dealing with hemorrhoid symptoms have never actually had anyone explain what they're looking at — or looking for. It's one of those questions that feels awkward to ask but makes complete sense to want answered.
Want personalized guidance for your symptoms? Talk directly with a board-certified colorectal surgeon.
Book a virtual consultMost people don't know what a hemorrhoid actually looks like. They know something doesn't feel right, but because this is not exactly dinner table conversation, they've never had anyone explain it clearly. Let's fix that.
Hemorrhoids are swollen blood vessels in and around the rectum and anus. Depending on where they are and how advanced they've become, they can look quite different — which is part of why people get confused about what they're dealing with.
Internal hemorrhoids form inside the rectum, above the dentate line — the internal boundary between the anal canal and the lower rectum. Because they're inside, you typically can't see them by looking in the mirror.
The most visible sign of an internal hemorrhoid is bright red blood — on the toilet paper, coating the stool, or in the toilet bowl. The tissue inside is sensitive and bleeds easily during bowel movements.
In more advanced cases, internal hemorrhoids prolapse — meaning they push through the anal opening. At that point, you'd see soft, pink or reddish moist tissue protruding from the anus. Grade II hemorrhoids retract on their own; Grade III require you to gently push them back; Grade IV stay out permanently.
External hemorrhoids develop under the skin around the outside of the anus. They typically appear as small, soft lumps at the anal opening — anywhere from pea-sized to grape-sized depending on how inflamed they are.
The skin over them may look normal, slightly darkened, or reddish and irritated. They can be a single lump or a cluster. Because they're covered by skin (not internal mucous membrane), they tend to itch and sting more than internal hemorrhoids.
A thrombosed hemorrhoid is an external hemorrhoid with a blood clot inside it. This one looks and feels distinctly different: it's a firm, tense, bluish-purple lump at the anal margin, often marble-sized or larger. The surrounding skin may look stretched and inflamed.
The pain tends to peak in the first 24 to 72 hours, then gradually improves as the clot reabsorbs — a process that can take 2 to 3 weeks. If you're seen within that early window, a minor in-office procedure can drain the clot and provide immediate relief.
After a hemorrhoid heals — whether on its own or after treatment — it sometimes leaves behind a small, soft flap of skin called a skin tag. These are flesh-colored, painless, and don't bleed. They're not hemorrhoids anymore, but they're commonly mistaken for active ones.
Skin tags don't need treatment unless they're causing irritation or hygiene issues. Many patients are relieved to find out that what they've been worried about is just leftover tissue from a hemorrhoid that already resolved.
Bright red blood that's occasional and minor is usually hemorrhoidal. But blood that's recurring, heavy, or dark red — or any lump that's growing, hard, or behaving unusually — is worth getting looked at. A quick evaluation with Dr. Chung can give you a clear answer and real peace of mind.
Some hemorrhoids are internal and not visible. Other lumps, like skin tags, fissures, or, rarely, more serious lesions, can mimic hemorrhoids. A specialist can tell the difference quickly and painlessly.
If you're seeing or feeling something that worries you, get it looked at.
Get expert, personalized guidance from Dr. Albert Chung, a board-certified colorectal surgeon focused on getting you back to comfort, fast.
Book a virtual consultCall (714) 988-8690