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Abscess vs haemorrhoid: how to tell

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

A painful lump near the anus could be several things. Two of the most common are a perianal abscess and a haemorrhoid — particularly a thrombosed (clotted) haemorrhoid. They can feel similar, but they are very different conditions that require different treatment. Knowing the key differences can help you decide how urgently to seek assessment.

This guide compares the two conditions and explains when to act.

The key differences

Pain character

Abscess:

Intense, throbbing pain that worsens steadily over hours to days
Pain that does not respond well to over-the-counter pain relief
Pain that increases when sitting or with any pressure on the area
Pain that may be accompanied by a general feeling of being unwell

Haemorrhoid:

Pain that can be significant but tends to be more constant rather than escalating
Thrombosed haemorrhoids are most painful in the first 24 to 72 hours and then gradually improve
Pain is usually localised to the lump
Not typically accompanied by feeling generally unwell

Appearance

Abscess:

A firm, swollen lump that may be red and warm to touch
The surrounding skin often appears red and inflamed
May appear to be growing over hours or days
May eventually develop a point or a head if it is close to the surface

Haemorrhoid:

A softer lump, often bluish or purplish if thrombosed
The surrounding skin may be swollen but typically less red
Usually does not continue to grow rapidly
External haemorrhoids are often visible at the anal margin

Systemic symptoms

Abscess:

Fever is common and is one of the most distinguishing features
Feeling generally unwell — fatigue, chills, malaise
These symptoms reflect the body fighting infection

Haemorrhoid:

Fever is not typical with haemorrhoids
No systemic illness
The problem is localised to the lump

Timeline

Abscess:

Develops over days, often with rapid worsening
Gets worse without treatment
Will not resolve on its own — needs drainage

Haemorrhoid:

Thrombosed haemorrhoids are most severe in the first few days and then gradually improve
Many resolve with conservative treatment over one to two weeks
Do not typically require emergency drainage (though excision within 72 hours is sometimes beneficial)

When it is hard to tell

In the early stages, a small abscess and a thrombosed haemorrhoid can feel very similar — both present as painful lumps. Features that should prompt prompt assessment:

A lump that is getting larger rather than staying stable
Fever or chills
Warmth and redness spreading beyond the lump itself
Pain that is escalating rather than stable
Feeling generally unwell

These features are more suggestive of an abscess and warrant urgent assessment.

Why accurate diagnosis matters

The treatment is fundamentally different:

Abscess treatment

Usually requires drainage — a minor procedure to release the infected fluid
May require antibiotics
An undrained abscess will not resolve on its own and can lead to complications including fistula formation
Prompt treatment leads to rapid improvement

Haemorrhoid treatment

Often managed conservatively — sitz baths, stool management, topical treatments
Thrombosed haemorrhoids may benefit from excision within the first 72 hours if symptoms are severe
Most improve within one to two weeks with conservative care
Rarely requires emergency treatment

Treating an abscess like a haemorrhoid — with conservative measures and waiting — delays necessary treatment and can allow the abscess to worsen.

Self-assessment limitations

While the differences described above can help guide your thinking, self-diagnosis in this area is unreliable. The conditions can look and feel similar, and other conditions (fissures, fistulas, skin conditions) can also present as perianal lumps.

The safest approach: if you have a new, painful lump in the perianal area, particularly one that is growing or accompanied by fever, seek clinical assessment.

When to seek care

Contact your doctor or attend urgent care if you notice:

A painful, swollen lump near the anus that is getting larger
Fever or chills
Increasing redness and warmth around the lump
Pain that is severe and escalating
Any lump that you are unsure about — assessment provides clarity

Common questions

How can I tell if my lump is an abscess or a haemorrhoid?

The key differences: an abscess tends to be more painful, feels warm to touch, increases in size over days, and may be accompanied by fever. A haemorrhoid is typically softer, may be bluish in colour if thrombosed, and while painful, does not usually cause fever or systemic illness. However, distinguishing between them can be difficult without a clinical examination — if you are unsure, getting it assessed is the safest approach.

Can an abscess be mistaken for a haemorrhoid?

Yes, particularly in the early stages when an abscess is small. People describe initially assuming a painful perianal lump was a haemorrhoid, only to discover it was an abscess when it continued to grow and became accompanied by fever or increasing pain. This is one of the reasons any new, painful, and growing lump in the area should be assessed promptly.

Do abscesses need different treatment than haemorrhoids?

Yes. Haemorrhoids are often managed conservatively — sitz baths, dietary changes, topical treatments. Abscesses typically need to be drained. An undrained abscess can worsen and potentially lead to serious complications. This is why accurate diagnosis matters — the treatment approach is fundamentally different.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

Emergency
Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

Call 911 or go to the ER.
Today
Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

Call your doctor or go to urgent care.
Soon
Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

A painful, swollen lump near the anus that is getting larger
Fever or chills
Increasing redness and warmth around a lump
Pain that is severe and not improving

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
fainting, a racing heart or trouble breathing
confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
pain that is getting worse over days, or severe pain that stops you sitting or sleeping
a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
trouble urinating
bleeding that is getting heavier or more frequent, or blood mixed into your stool
feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

you have never had these symptoms checked by a doctor or nurse — whatever your age
you have had rectal bleeding for more than 3 weeks
your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
symptoms have not settled after a week or so, or keep coming back
you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
you have new leakage or trouble controlling your bowels
you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Related symptoms

Pain during bowel movements Pain after bowel movements Swelling or lump Discharge Pain while sitting

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