Rubber Band Ligation

Introduction
FAQ

Rubber band ligation is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. Rubber band ligation works very well for prolapsed hemorrhoids, such as the advanced grade 2 and grade 3 hemorrhoids. It cannot be performed if there is not enough tissue to pull into the banding device. This procedure is almost never appropriate for grade 1 or mild grade 2 hemorrhoids, or most severe (grade 4) hemorrhoids.

The process involves a doctor inserting an anoscope into the anus and indentifying and grasping the prolapsed hemorrhoid with an instrument to place a rubber band around its base. With the rubber band in place, the hemorrhoid shrinks and recedes, dying off in a few days or a week. The reduced volume of venous tissue with the scar formation prevents hemorrhoid tissue bulging into the anal canal. The procedure is done in a doctor's office and only a couple of minutes. Treatment is limited to 1 to 2 hemorrhoids each office visit and additional areas may be treated at 2 week intervals.

What to expect after treatment?

After the procedure, you don't feel much discomfort; some patients may feel tightness and mild pain or feel as if you need to have bowel movement. People respond differently to this procedure. Most patients are able to return to regular activities (but avoid heavy lifting) almost immediately. Others may need a few hours or a day of rest. If you feel some pain after banding, you may use Tylenol or Ibuprofen as needed and do a lot of sitz bath for 15-30 minutes at a time to relieve discomfort. Some patients may have slight rectal bleeding in a week, when the hemorrhoid dies off. The bleeding usually stops by itself; however, if you notice significant rectal bleeding, then you should call your doctor's office. It is also very important to make sure that your stool is soft by taking stool softeners containing fiber and drink more fluids to help prevent hemorrhoids in the future.

What is Rubber Band Ligation?

How is the Rubber Band Ligation performed?

The process involves a doctor inserting an anoscope into the anus and grasping the prolapsed hemorrhoid with an instrument to place a rubber band around its base. The procedure is done in a doctor's office and only a couple of minutes. Treatment is usually limited to 1 hemorrhoid each office visit and additional areas may be treated at 2 week intervals.

Is the Rubber Band Ligation performed under local anesthesia?

No. The nerves that are located higher up the anal canal (above the dentate line) do not sense pain, though they do feel pressure. The internal hemorrhoids located above the dentate line will be associated with these visceral nerves, so the rubber band ligation is usually a painless procedure.

Why is it done?

Rubber band ligation is one of the most popular treatments for internal hemorrhoids. If symptoms continue after three or four treatments, surgery may be the next option.

What to expect after treatment?

Some patients may feel tightness and mild pain or feel as if you need to have bowel movement. People respond differently to this procedure. Most patients are able to return to regular activities (but avoid heavy lifting) almost immediately. A few patients may need a few hours or a day of rest. You may use Tylenol or Ibuprofen as needed and do a lot of sitz bath for 15-30 minutes at a time to relieve discomfort. Some patients may have slight rectal bleeding in a week, when the hemorrhoid dies off, however, if you notice significant rectal bleeding, then you should call your doctor's office.

How well does it work?

Up to 80% of people who have gone through the procedure said their symptoms improved.

Side effects are rare, but may include:

Severe pain that won't go away even after various methods of pain relief are used. The bands may be too close to the area in the anal canal that contains pain sensors.

Anorectal Care