Figure 6: The direction of flow in rectal varices as shown in the figure is generally hepatofugal. The rectal varices are formed from these upper submucosal veins of intrinsic rectal venous plexus. From both the plexuses the portal hemorrhoidal blood works into systemic circulation through two portosystemic shunts (recto genital and inter rectal). The recto genital communication connect the rectal venous plexus with vesicoprostatic or vaginal venous plexus. The inter rectal communications occur between the three rectal veins. In rectal varices the banding should be done from above downwards.