The terms “hemorrhoids” and “rectal varices” are often used interchangeably, but they’re separate conditions with different causes and treatments.

Hemorrhoids, also called piles, are swollen veins in your rectum or around your anus. They can occur internally or externally. Symptoms include pain, itchiness, and trouble sitting.

Rectal varices are bulging blood vessels inside your rectum, which is the last several inches of your large intestine. They develop from a backflow of blood in your rectum from elevated blood pressure in the veins that drain blood from most of your intestines to your liver.

High blood pressure in these veins is known as portal hypertension. Portal hypertension is common in people with liver disease.

Read on to learn more about how the differences between hemorrhoids and rectal varices, including differences in symptoms, causes, and treatment.

Here’s a look at the symptoms of hemorrhoids and rectal varices:

Symptoms of hemorrhoids

External hemorrhoids can cause:

  • anal itching
  • one or more hard and tender lumps near your anus
  • anal pain that gets worse when sitting

Internal hemorrhoids often aren’t painful. They may cause bleeding from your rectum after bowel movements. They can also fall through your anal opening. When this happens, they’re called prolapsed hemorrhoids.

Prolapsed hemorrhoids can cause similar symptoms as external hemorrhoids.

Symptoms of rectal varices

Portal hypertension causes rectal varices. Symptoms of portal hypertension can include:

Medical emergency

In up to 38% of cases, rectal varices may bleed. Bleeding requires prompt medical attention. It can be fatal without proper treatment.

If you experience bleeding rectal varices, go to the nearest emergency medical clinic, especially if you have a cirrhosis diagnosis.

Hemorrhoids and rectal varices have different underlying causes.


Hemorrhoids develop from increased pressure around your anus and rectum. They’re not related to portal hypertension.

Risk factors for developing hemorrhoids include:

  • straining during bowel movements
  • sitting for prolonged periods
  • chronic constipation or diarrhea
  • heavy lifting

Rectal varices

The primary cause of portal hypertension in the Western hemisphere is cirrhosis, which is scarring of the liver. The most common causes of cirrhosis are:

Most people who get rectal varices have cirrhosis. Research suggests the rate of rectal varices in people with cirrhosis is between 38% and 56%.

Rectal varices also develop in up to 94% of people with obstruction of the extrahepatic portal vein. Portal vein obstruction most commonly occurs from blood clots. Occasionally it occurs from tumors.

People most likely to get hemorrhoids include those who:

  • have a family history of hemorrhoids
  • have obesity
  • are pregnant
  • are over the age of 50

Endoscopy is the primary method for diagnosing rectal varices. An endoscope is a long tube with a camera on the end that’s inserted into your anus. Endoscopic ultrasound may be able to detect varices not detectable with an endoscope.

A doctor can usually diagnose hemorrhoids by examining the area around your anus. They may use either an anoscope or a proctoscope to exam your anus and lower rectum.

Rectal varices and hemorrhoids are treated differently.

Rectal varices

Rectal varices can often be managed surgically using an endoscope. Doctors usually prescribe antibiotics to help prevent infection.

Several techniques may be used, including:

  • Endoscopic injection sclerotherapy: an injection is used to shrink blood vessels
  • Endoscopic band litigation: elastic bands are placed around blood vessels to prevent bleeding
  • Cyanoacrylate injection: a substance is injected that acts as a plug to cover the varices

More invasive surgery may be needed if these treatments don’t work.

Research suggests that endoscopic injection sclerotherapy is more effective than endoscopic band litigation for controlling active bleeding. Bleeding only occurs in about 0.5% to 5% of people but can be life threatening.


Home remedies can often treat hemorrhoids. Over-the-counter (OTC) creams and suppositories can help reduce pain, swelling, and itching.

Hemorrhoid home remedies include:

  • eating a high fiber diet
  • taking a stool softener or fiber supplement
  • drinking plenty of water
  • avoiding straining during bowel movements
  • avoiding staying on the toilet for prolonged periods
  • relieving pain by sitting in a warm bath
  • taking OTC pain relievers, such as ibuprofen (Advil)

If home treatments don’t help, a doctor may recommend rubber band ligation or another surgical technique.

It’s a good idea to visit a doctor anytime you develop rectal bleeding, no matter the cause. In some cases, rectal bleeding can be a sign of serious conditions like colon cancer.

Treating hemorrhoids early can help you get relief quickly. Visit a doctor anytime you develop a prolapsed hemorrhoid since it can cause significant irritation, itching, or pain.

Most doctors recommend using OTC products for 1 week. If your symptoms don’t clear up by then or you have side effects, follow up with your doctor.

It’s also important to talk with a doctor if you have any symptoms of liver disease, such as:

Here are some frequently asked questions people have about rectal varices and hemorrhoids.

What are rectal varices?

Rectal varices are swollen blood vessels in your rectum. They develop as a complication of high blood pressure in the veins that lead to your liver.

What are hemorrhoids?

Hemorrhoids are swollen veins in your anus or rectum. They can develop internally or externally. Internal hemorrhoids can prolapse outside of your anus.

Are hemorrhoids and rectal varices the same thing?

No. Hemorrhoids and rectal varices are different conditions.

Rectal varices are only found in people with high blood pressure in the veins that lead to the liver.

Hemorrhoids develop from increased pressure in the lower rectum. Things like sitting for long periods, chronic constipation, and strain during bowel movements can cause them.

Rectal varices are caused by high blood pressure in the veins that lead to your liver. Cirrhosis commonly causes them.

Hemorrhoids are more common. They develop from increased pressure around your anus.

It’s a good idea to visit a doctor if you notice blood in your bowel movements. Also visit a doctor if you have pain around your anus that doesn’t get better after about a week of taking OTC medications or using home remedies.