What do hemorrhoids look like?
Jul 22, 2025
Source: Cainiu Health
Dr. Li Jingxiang
Introduction
These lesions are categorized into internal and external hemorrhoids. Internal hemorrhoids are clusters of varicose veins located above the dentate line of the anal canal and cannot be directly observed. When internal hemorrhoids develop to a certain extent and prolapse outside the anus, they present as mucosal elevations appearing dark red or purplish red, with a soft surface, and sometimes accompanied by bleeding. External hemorrhoids are located below the dentate line, and skin tags or masses can be observed around the anus; in the early stages, they may appear as soft skin elevations.
Generally speaking, hemorrhoids refer to piles. Hemorrhoids are classified into internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids, each with different appearances. The details are as follows:
Internal hemorrhoids are clusters of varicose veins located above the dentate line of the anal canal and cannot be directly observed. When internal hemorrhoids prolapse outside the anus at an advanced stage, mucosal elevations can be seen. These elevations appear dark red or purplish-red, have a soft surface, and may sometimes be accompanied by bleeding.
External hemorrhoids are located below the dentate line, formed by varicosities of the external hemorrhoidal veins or inflammation, hypertrophy, or connective tissue proliferation of anal margin folds or thrombotic retention. Skin tags or masses can be observed around the anus. Initially, they may present as soft skin elevations; however, if thrombosis or inflammation occurs, swelling, pain, a dark purple color change, and increased firmness may develop.
Mixed hemorrhoids span across the dentate line, existing both inside and outside the anus. They occur at the same location above and below the dentate line, where internal and external hemorrhoids merge into a single entity without a clear boundary. Mixed hemorrhoids typically form fleshy balls or masses at the anal opening, which can be single or multiple and vary in size—ranging from as small as a grain of rice to several centimeters in diameter. Their color is often red, dark red, purple, or deep purple. During acute episodes, due to congestion and edema, their color becomes more vivid, appearing bright red or purplish-red, while during remission periods, the color may become relatively dull.
In daily life, to prevent the occurrence of hemorrhoids, it is recommended to maintain regular bowel habits and avoid prolonged squatting, sitting, or standing. Attention should also be given to dietary regulation, increasing dietary fiber intake, and reducing consumption of spicy and greasy foods to prevent constipation and diarrhea.
