Anal warts are caused by infection with the human papillomavirus, often with a history of impure sexual intercourse. They appear as new organisms in the skin or skin folds around the anus, ranging from the size of a pinpoint to the size of a peanut meter. The warts are off-white or grayish-red in color, have a tip or a wide base, have an uneven, granular or papillary surface, are moist, and are usually asymptomatic. Hemorrhoids, on the other hand, are caused by dilated or ruptured bleeding blood vessels in the perianal skin or submucosa, often without a history of impure sexual intercourse, and usually combined with constipation. They appear as localized elevations of the skin or mucous membrane around the anus, with smooth, normal skin, and are usually associated with pain or blood on the surface of the stool during defecation or dripping blood from the anus after defecation.