OBJECTIVE Little is known about the colon in patients with portal hypertension. The present study was carried out in order to assess the prevalence of, and factors influencing, hemorrhoids, anorectal varices, and colopathy in these patients. METHODS Seventy patients with cirrhosis and portal hypertension, and seventy controls, were prospectively studied. Full-length colonoscopy was carried out in all cases, and the presence of hemorrhoids, anorectal varices, and colopathy was noted. RESULTS Hemorrhoids and anorectal varices were seen in 36% and 40% of patients, compared to 40% and 0% in the controls. The difference was statistically significant only for anorectal varices (p < 0.001). Neither hemorrhoids nor anorectal varices were associated with the Child's grade of cirrhosis, the grade of esophageal varices, the presence of gastric varices, portal hypertensive gastropathy, or whether or not patients received sclerotherapy. Nor were they associated with each other. Colopathy was seen in 48.5% of the patients and 3% of the controls (p < 0.001). It was seen more frequently in patients with large esophageal varices compared to those with small varices (87% vs. 28.5%; p < 0.001), and more often in those with gastric varices than those without (71% vs. 28.5%; p < 0.001). It had no association with the severity of liver disease, the presence of hemorrhoids, portal hypertensive gastropathy, or whether or not patients received sclerotherapy. CONCLUSIONS It is concluded that the prevalence of hemorrhoids is not increased in patients with portal hypertension. However, the prevalence of anorectal varices and colopathy is higher in these patients. Portal colopathy occurs more commonly in patients with large esophageal varices, those with gastric varices, and those who do not have anorectal varices.