In a 62-yr-old woman who complained of recurrent rectal bleeding, hemorrhoids with mucosal prolapse were found. Virus-related cirrhosis also was present. Colonoscopy revealed spontaneous bleeding from two rectal ectasias (portal hypertensive colopathy) located 9 cm from the anus. Endoscopic hemostasis was achieved with a heater probe, and there has been no recurrent hemorrhage. Colonoscopy is important in ruling out hemorrhage from portal hypertensive colopathy when rectal bleeding occurs in the presence of portal hypertension.