What the Different Types of Hemorrhoids Look Like

Hemorrhoids can form inside the rectum or on the exterior around the anus. Sometimes they protrude from the rectum and retract once the swelling subsides. How they’re managed depends on how severe they are.

Also known as piles, hemorrhoids develop when clusters of veins in the rectal or anal area become enlarged (dilated).

As these veins enlarge, blood accumulates and causes them to bulge into the surrounding tissue of the rectum and anus. This swelling can lead to discomfort or pain.

According to the National Institutes of Health, hemorrhoids affect 1 in 20 people in the U.S.

Hemorrhoids are commonly classified into four types:

• internal
• external
• prolapsed
• thrombosed

Continue reading to find out more about each type, how they present, and typical treatment approaches.

Internal hemorrhoids

Internal hemorrhoids lie within the rectum and aren’t always visible. They are usually not serious and often resolve without intervention.

Because the rectum lacks pain-sensitive nerves, internal hemorrhoids may go unnoticed. When they enlarge, however, they can produce symptoms, including:

• pain or aching
• itching
• burning sensations
• rectal bleeding
• mucous discharge with stool
• palpable lumps or swelling near the anal opening

Prolapsed hemorrhoid

A prolapsed hemorrhoid is an internal hemorrhoid that has swollen enough to protrude outside the anus. They often appear as red, swollen lumps or bumps and may be visible using a mirror.

A clinician may grade a prolapsed hemorrhoid according to how far it extends:

• Grade 1: No prolapse.
• Grade 2: Prolapses but returns on its own. These may emerge during straining (for example, when having a bowel movement) and then retract.
• Grade 3: Prolapses and must be manually pushed back in. These often require treatment to avoid pain or bleeding.
• Grade 4: Prolapses and cannot be reduced without significant pain. These typically need medical intervention to prevent ongoing pain, discomfort, or other issues.

Prolapsed hemorrhoids might not cause symptoms beyond the protrusion, or they can produce pain, itching, and burning.

Sometimes surgery is necessary to remove or correct a prolapsed hemorrhoid to relieve symptoms and prevent complications.

External hemorrhoids

External hemorrhoids develop on the skin surrounding the anus. They may be hidden at times but can create noticeable lumps on the anal surface when they swell.

The symptoms are largely similar to those of internal hemorrhoids.

Because they sit outside the rectal canal, external hemorrhoids can cause more discomfort while sitting, during activity, or with bowel movements.

When swollen, they’re easier to see; the enlarged veins often give a bluish tint visible beneath the skin around the anus.

Thrombosed hemorrhoid

A thrombosed hemorrhoid is a complication in which a blood clot (thrombus) forms within the hemorrhoidal tissue. They may present as lumps or swelling around the anus.

Clots can form in either internal or external hemorrhoids. Symptoms can include:

• severe pain and itching
• swelling
• skin color changes, such as a bluish hue around the affected area

If you have worsening pain, increasing itch, or notable inflammation around the rectal or anal region, see a physician. Thrombosed hemorrhoids should be treated within 72 hours; after that, the clot may begin to break down and surgical options may no longer be feasible, leaving healing to occur naturally.

When should I see a doctor?

Consult a healthcare provider if a hemorrhoid causes persistent pain or discomfort that does not improve after about 7 days.

Seek urgent medical care if you have severe rectal pain or if the pain is accompanied by:

• fever
• ongoing rectal bleeding
• pus draining from hemorrhoids
• mucous in your stool

How are hemorrhoids diagnosed?

To evaluate hemorrhoids, a clinician may perform several examinations, such as:

• visual inspection of the anus and surrounding area
• digital rectal exam (a gloved finger inserted to feel for internal hemorrhoids)
• anoscopy
• sigmoidoscopy

These assessments help determine the reason for your symptoms and the specific type of hemorrhoid present.

How are hemorrhoids treated?

Management depends on the hemorrhoid type, degree of prolapse, and how severe the symptoms are.

Treatment may include a mix of conservative measures:

• over-the-counter topical creams, gels, and ointments
• OTC pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs)
• home care such as cold compresses or sitz baths

When necessary, hemorrhoids may be removed or treated with procedures like:

• rubber band ligation
• sclerotherapy
• infrared coagulation
• hemorrhoidectomy
• hemorrhoidopexy

Frequently asked questions

Should I push my hemorrhoid back in?

If you have external hemorrhoids, you can try very gently to press them back inside to reduce the risk of strangulation. Make sure your hands are clean and be extremely gentle. A warm bath or sitz bath beforehand can make this easier.

Does Preparation H shrink hemorrhoids?

Preparation H is one of several OTC options for managing hemorrhoid symptoms. Some formulations include ingredients like witch hazel or hydrocortisone, which can help relieve symptoms and may reduce swelling.

Can drinking cause hemorrhoids?

Yes. Research indicates that alcohol use may be a risk factor for developing hemorrhoids.

How do you know if it’s a hemorrhoid or not?

Hemorrhoids aren’t always visible but can present as small lumps inside or outside the anus. Other signs include discomfort, burning, itching, or pain in the rectal region.

What can be mistaken for a hemorrhoid?

Symptoms like rectal pain, itching, and painful bowel movements can arise from other conditions, such as:

• anal fissures
• anal abscesses
• ulcers
• colorectal cancer
• gastrointestinal infections

A healthcare professional can make an accurate diagnosis and recommend appropriate treatment.

Do hemorrhoids go away by themselves?

Hemorrhoids often resolve without treatment. However, medical care may be needed if complications arise or if they don’t improve.

What do bad hemorrhoids look like?

Prolapsed or thrombosed hemorrhoids can look like swollen lumps with discoloration, blood, or mucus. If you notice this, seek medical attention to avoid complications.

Takeaway

Hemorrhoids can be uncomfortable or painful, though many people have no noticeable symptoms.

Internal and external hemorrhoids typically heal without major issues. Prolapsed and thrombosed types are more likely to cause pain and increase the chance of complications.

If you have symptoms of hemorrhoids, consult a healthcare professional for a diagnosis and a suitable treatment plan.