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What s the Difference Between Hemorrhoids and Rectal Varices

Medically reviewed by Saurabh Sethi, M.D., MPH — By Daniel Yetman on September 19, 2022The 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.

What are the symptoms of hemorrhoids vs rectal varices

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

Symptoms of hemorrhoids

External hemorrhoids can cause:anal itchingone or more hard and tender lumps near your anusanal 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:gastrointestinal bleedingascites, a buildup of fluid in your bellycrampsbloatingshortness of breathMedical 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.

What causes hemorrhoids vs rectal varices

Hemorrhoids and rectal varices have different underlying causes.

Hemorrhoids

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 movementssitting for prolonged periodschronic constipation or diarrheaheavy 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:long-term heavy alcohol usehepatitis Chepatitis Bnonalcoholic fatty liver disease

Who gets hemorrhoids vs rectal varices

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 hemorrhoidshave obesityare pregnantare over the age of 50

How are the two conditions diagnosed

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.

Treatment of rectal varices vs hemorrhoids

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 vesselsEndoscopic band litigation: elastic bands are placed around blood vessels to prevent bleedingCyanoacrylate 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.

Hemorrhoids

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 diettaking a stool softener or fiber supplementdrinking plenty of wateravoiding straining during bowel movementsavoiding staying on the toilet for prolonged periodsrelieving pain by sitting in a warm bathtaking OTC pain relievers, such as ibuprofen (Advil) If home treatments don’t help, a doctor may recommend rubber band ligation or another surgical technique.

When to contact a doctor

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:jaundiceabdominal pain and swellingdark urinenausea and vomiting

Frequently asked questions

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.

Takeaway

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. Last medically reviewed on September 19, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Al Khalloufi K, et al. (2015). Management of rectal varices in portal hypertension.
ncbi.nlm.nih.gov/pmc/articles/PMC4691702/Garrido M, et al. (2019). Treating untreatable rectal varices.
ncbi.nlm.nih.gov/pmc/articles/PMC6876591/Malik A, et al. (2022). Portal vein obstruction.
ncbi.nlm.nih.gov/books/NBK541134/Piles (haemorrhoids). (2022).
nhs.uk/conditions/piles-haemorrhoids/Robertson M, et al. (2017). The management of bleeding from anorectal varices.
link.springer.com/article/10.1007/s11901-017-0382-6Symptoms & causes of hemorrhoids. (2016).
niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/symptoms-causesOur experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 19, 2022 By Daniel Yetman Edited By Roman Gokhman Medically Reviewed By Saurabh Sethi, MD, MPH Copy Edited By Sara Giusti Share this articleMedically reviewed by Saurabh Sethi, M.D., MPH — By Daniel Yetman on September 19, 2022

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