Rubber band ligation for hemorrhoids

Treatment Overview

Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid.

To perform the procedure, a doctor inserts a viewing instrument (anoscope) into the anus. The hemorrhoid is grasped with an instrument, and a device places a rubber band around the base of the hemorrhoid. The hemorrhoid then shrinks and dies and, in about a week, falls off.

A scar will form in place of the hemorrhoid, holding nearby veins so they don't bulge into the anal canal.

The procedure is done in a doctor's office. You will be asked whether the rubber bands feel too tight. If the bands are extremely painful, a medicine may be injected into the banded hemorrhoids to numb them.

After the procedure, you may feel pain and have a sensation of fullness in the lower abdomen, or you may feel as if you need to have a bowel movement.

Treatment is limited to 1 to 2 hemorrhoids at a time if done in the doctor's office. Several hemorrhoids may be treated at once if the person has general anesthesia. Additional areas may be treated at 4- to 6-week intervals.

What To Expect After Treatment

People respond differently to this procedure. Some are able to return to regular activities (but avoid heavy lifting) almost immediately. Others may need 2 to 3 days of bed rest.

• Pain is likely for 24 to 48 hours after rubber band ligation. You may use mild pain relievers (analgesics) and sit in a shallow tub of warm water (sitz bath) for 15 minutes at a time to relieve discomfort.
• To reduce the risk of bleeding, avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) for 4 to 5 days both before and after rubber band ligation.
• Bleeding may occur 7 to 10 days after surgery, when the hemorrhoid falls off. Bleeding is usually slight and stops by itself.

Health professionals recommend that you take stool softeners containing fibre and drink more fluids to ensure smooth bowel movements. Straining during bowel movements can cause hemorrhoids to recur.

Why It Is Done

Rubber band ligation is the most widely used treatment for internal hemorrhoids. If symptoms persist after three or four treatments, surgery should be considered.

Rubber band ligation cannot be used if there is not enough tissue to pull into the banding device. This procedure is almost never appropriate for fourth-degree hemorrhoids.¹

How Well It Works

Up to 80% of people who had this procedure said their symptoms improved.²

• Rubber band ligation provides more rapid and longer-lasting relief than injection sclerotherapy or infrared photocoagulation therapy.
• Repeat treatment for recurring symptoms is rarely needed.
• This procedure is most useful for small- to medium-sized internal hemorrhoids.
• The procedure is less likely to be successful for large hemorrhoids.

Risks

Side effects are rare but include:

• Severe pain that does not respond to the methods of pain relief used after this procedure. The bands may be too close to the area in the anal canal that contains pain sensors.
• Bleeding from the anus.
• Inability to pass urine (urinary retention).
• Infection in the anal area.

What To Think About

Rubber band ligation is one of the least expensive treatments and also one of the most effective.

Surgical removal of hemorrhoids (hemorrhoidectomy) may provide better long-term results than fixative procedures such as rubber band ligation. However, surgery is more expensive, requires longer recovery times, and has a greater risk of complications.

Rubber band ligation is considered to be the most effective non-surgical treatment for internal hemorrhoids over the long term. Because this treatment can be painful, some people might not choose it. Although a different treatment might be less painful, it may not be as effective, and it may need to be repeated to treat recurring hemorrhoids.

Not all doctors have the experience or the necessary equipment to do rubber band ligation. This may help you decide which procedure to choose. Ask your doctor which procedure he or she has done the most, how many times he or she has done the procedure, and how satisfied patients have been with the outcome.

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Author:	Carrie Henley Monica Rhodes	Last Updated: November 30, 2006
Medical Review:	Adam Husney, MD - Family Medicine Brent Shoji, MD - General Surgery Andrew Swan, MD, CCFP, FCFP - Family Medicine
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