How do I know if it is hemorrhoids or something else?

Hemorrhoids are the most common cause of bright red rectal bleeding and perianal lumps, but they are not the only cause. Other conditions — fissures, fistulas, skin tags, and less commonly polyps or other growths — can cause similar symptoms. A proper assessment by a clinician provides clarity. Self-diagnosis is reasonable for mild, typical symptoms, but any uncertainty or concerning features warrant professional evaluation.

Can I see hemorrhoids?

External hemorrhoids and prolapsed internal hemorrhoids may be visible or felt as lumps near the anus. Internal hemorrhoids that have not prolapsed cannot be seen without a medical examination using a proctoscope. If you can feel a lump, noting its characteristics (soft or hard, painful or painless, colour) is useful information for a clinician.

Do hemorrhoids always hurt?

No. Internal hemorrhoids often cause painless bleeding with no pain at all. External hemorrhoids are more likely to be painful, particularly if thrombosed. The level of pain is not a reliable indicator of severity — a painless but persistently bleeding hemorrhoid can be more significant than a painful but temporary one.

Should I see a doctor for suspected hemorrhoids?

If this is your first experience of rectal symptoms, yes. Getting a proper diagnosis is important both for appropriate treatment and for ruling out other causes. For people with known hemorrhoids experiencing a familiar flare, self-management with conservative care is reasonable, with a clinician visit if symptoms are not improving.

How to tell if you have hemorrhoids

At a glance

Suspecting you have hemorrhoids but not being sure is a common and anxious experience. The symptoms overlap with other conditions, the area is difficult to examine yourself, and the embarrassment of the location can delay seeking a professional opinion.

This guide describes the common signs and symptoms of hemorrhoids, what they typically look and feel like, and when getting a proper assessment is important.

Common symptoms

Bleeding

The most common hemorrhoid symptom:

Bright red blood — typically on the toilet paper, on the surface of the stool, or dripping into the toilet
Painless — internal hemorrhoids often bleed without any pain
Associated with bowel movements — occurs during or immediately after
Intermittent — may come and go, often worse during flares or with hard stools

Lumps and swelling

External hemorrhoid — a soft, sometimes tender swelling near the anus
Thrombosed hemorrhoid — a firm, hard, painful lump that appears suddenly (a blood clot within the hemorrhoid)
Prolapsed internal hemorrhoid — soft tissue that protrudes from the anus, usually during a bowel movement

Itching

Perianal itching is common with hemorrhoids
Often caused by mucous discharge from prolapsed internal hemorrhoids
Can also result from difficulty keeping the area clean

Discomfort and pain

Heaviness or fullness — a feeling of something being there
Discomfort with sitting — particularly on hard surfaces
Pain during bowel movements — more common with external hemorrhoids or if there is also a fissure
Throbbing pain — characteristic of a thrombosed hemorrhoid

Discharge

Mucous discharge — from prolapsed internal hemorrhoids
Soiling — difficulty keeping the area clean
Moisture — persistent dampness in the perianal area

What hemorrhoids feel like

External hemorrhoids

If you feel the area, an external hemorrhoid is typically:

A soft, rounded swelling near the anus
May be tender to touch during a flare
Covered by skin (not the red mucosa of the rectal lining)
May swell up and then reduce over days to weeks

Thrombosed hemorrhoid

Firm and hard — the blood clot makes it feel solid
Very painful, especially in the first 48 to 72 hours
May appear dark blue or purple under the skin
Does not reduce with gentle pressure

Prolapsing internal hemorrhoid

Soft, spongy tissue that protrudes during bowel movements
May feel like something falling out of the anus
Can usually be gently pushed back in (grade 2 or 3)
Pinkish or reddish — mucosal tissue rather than skin

What hemorrhoids are not

Symptoms that are less typical of hemorrhoids and warrant prompt assessment:

Dark blood mixed into the stool (rather than bright red on the surface)
Unexplained weight loss with bowel symptoms
Persistent change in bowel habits — new constipation, diarrhoea, or narrower stools
Pain that is constant rather than associated with bowel movements
A hard, fixed lump that does not change with time
Anal discharge that is not mucous — pus suggests infection

Getting a diagnosis

What a GP will do

Ask about your symptoms — duration, character, triggers
Examine the area — external examination and usually a digital rectal examination
May use a proctoscope — a small tube with a light to visualise internal hemorrhoids
Discuss management based on their findings
Refer to a specialist if needed

Why professional assessment matters

Self-diagnosis is tempting but has limitations:

You cannot examine internal hemorrhoids yourself
Other conditions (fissures, fistulas, skin tags) can coexist with or mimic hemorrhoids
Rectal bleeding should always be assessed at least once to confirm the cause
A proper diagnosis directs appropriate treatment

The appointment is brief, routine, and much less uncomfortable than most people expect.