Rectal Varicose Veins vs Hemorrhoids: Symptoms, Causes, Treatment

The terms “hemorrhoids” and “rectal varices” are often used interchangeably, but they are 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, itching, and difficulty sitting down.

Rectal varices are bulging blood vessels inside your rectum, which are the last few inches of your large intestine. They develop from a backflow of blood into your rectum due to high 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 the differences between hemorrhoids and rectal varices, including differences in symptoms, causes, and treatment.

Here is an overview of the symptoms of hemorrhoids and rectal varicose veins:

Symptoms of hemorrhoids

External hemorrhoids can cause:

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

Internal hemorrhoids are often not painful. They can cause bleeding from the rectum after bowel movements. They can also fall through your anal opening. When this happens, they are called prolapsed hemorrhoids.

Prolapsed hemorrhoids can cause similar symptoms to external hemorrhoids.

Symptoms of rectal varices

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

Medical emergency

Until 38% cases, rectal varices can bleed. Bleeding requires prompt medical attention. It can be fatal without proper treatment.

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

Hemorrhoids and rectal varices have different underlying causes.


Hemorrhoids develop from increased pressure around your anus and rectum. They are no link to portal hypertension.

Risk factors to develop hemorrhoids include:

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

Rectal varices

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

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

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

People most likely to get hemorrhoids are those who:

  • have a family history of hemorrhoids
  • have obesity
  • are pregnant
  • are over 50 years old

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

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

Rectal varices and hemorrhoids are treated differently.

Rectal varices

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

Several techniques can be used, including:

  • Sclerotherapy by endoscopic injection: an injection is used to narrow the blood vessels
  • Litigation of endoscopic rings: elastic bands are placed around the blood vessels to prevent bleeding
  • Injection of cyanoacrylate: a substance is injected that acts as a plug to cover the varicose veins

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

To research suggests that endoscopic injection sclerotherapy is more effective than endoscopic ring litigation in controlling active bleeding. Bleeding only occurs in about 0.5% to 5% 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.

Home remedies for hemorrhoids include:

  • eat a high fiber diet
  • take a stool softener or fiber supplement
  • to drink a lot of water
  • avoid straining during bowel movements
  • avoiding staying on the toilet for long periods of time
  • relieve pain by sitting in a warm bath
  • taking over-the-counter 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 see a doctor any time you develop rectal bleeding, regardless of the cause. In some cases, rectal bleeding can be a sign of serious diseases like colon cancer.

Treating hemorrhoids early can help you get relief fast. See a doctor any time you develop a prolapsed hemorrhoid, as it can cause significant irritation, itching, or pain.

Most doctors recommend using over-the-counter products to 1 week. If your symptoms do not go away by then or if you have side effects, see your doctor.

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

Here are some frequently asked questions 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 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 of time, chronic constipation, and straining during bowel movements can cause this.

Rectal varices are caused by high blood pressure in the veins that lead to the liver. Cirrhosis is often the cause.

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

It’s a good idea to see a doctor if you notice blood in your stool. Also see a doctor if you have pain around your anus that does not improve after about a week of taking over-the-counter medications or using home remedies.

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