So, you’ve been diagnosed with hemorrhoids, and your doctor advises rubber band ligation. What next? We will answer your questions about hemorrhoid banding here.

By: Gregory M Lam, DO

There’s a reason rubber band ligation is one of the most commonly used and effective procedures in hemorrhoid treatment. While physicians have been performing the procedure on patients since the 1950s, the concept behind “ligation” dates to ancient medicine, with medical writings attributed to Hippocrates, who described tying off hemorrhoids with thread.

Physicians have advanced this pioneering procedure over the centuries, but the concept is remarkably consistent: close off the blood supply to the hemorrhoidal tissue so it shrinks and falls off. Many patients have undergone the procedure, and some studies report symptom improvement rates as high as 89%.

Read up on all of the procedures Cincinnati GI offers.

Why does it work?

Hemorrhoid banding is a minimally invasive, office-based procedure. A hemorrhoid is a swollen vein cushion near the anus, worsened by straining. Think of them as varicose veins in the bottom. Many people call them “piles.”

Still, hemorrhoids can bleed and be acutely painful. They can make it challenging to ride a bike, a motorcycle, or a horse, to sit through a long movie, or even have intimate relations. Of the estimated 10 million people diagnosed with hemorrhoids, one-third seek relief.

For many of those patients, that relief is provided by rubber band ligation. If you are among them, you might have questions about the procedure, such as: Exactly what is hemorrhoid banding?

We’re here to answer your questions

Answers to the Big Questions About Hemorrhoid Banding

Researchers believe many people do not seek hemorrhoid treatment, such as banding, due to embarrassment. A good way to overcome that awkwardness is through knowledge. So here are the answers to our patients’ common banding questions.

Question: Why do hemorrhoids occur?

Answer: Anything that applies pressure to the veins near your anus can cause them to swell and protrude. This includes repeatedly straining to move your bowels, sitting on the toilet for long periods, or regularly lifting heavy objects. Two forms of hemorrhoids can occur: Internal or external.

Q: What are the differences between internal and external hemorrhoids?

A: Internal hemorrhoids develop inside the lining of the anus and lower rectum. They might bleed and push out while taking a bowel movement, but they are often painless. External hemorrhoids form just under the skin surrounding the anus, closer to sensitive nerves, making them tender and painful. They can bleed and itch.

Q: Is banding an option for all hemorrhoids?

A: Rubber band ligation is performed to treat only internal hemorrhoids, typically grades 1-3, including those that have prolapsed, or pushed outside the anus. Doctors avoid banding for external hemorrhoids because their location near pain-sensitive nerves can cause acute postoperative discomfort and potential complications.

Q: Who is a candidate for hemorrhoid banding?

A: Your doctor might recommend banding if your internal hemorrhoids cause discomfort, bleeding, or itching, and if home-based treatments such as medications and/or eating more fiber and not straining on the toilet do not improve symptoms.

Q: What happens during a rubber band ligation?

A: The word “ligation” describes a medical procedure in which a vein or vessel is closed off from its blood supply with a clip or other ligature. For hemorrhoids, that ligature is a tiny rubber band or ring placed around the base of the mass, cutting off the blood supply. This can be applied in the office or for more severe cases endoscopically.

Q: How long does the banding procedure take?

A: This outpatient operation can take less than five minutes or up to 30 minutes, depending on the number of hemorrhoids being banded.

Q: Is hemorrhoid banding painful?

A: The rubber band ligation procedure is typically not painful because of the hemorrhoids’ location inside the anus, away from nerves. Following the procedure, you could feel some pressure and discomfort in the rectum or a sense of fullness in the lower abdomen. Some patients do experience moderate or even severe pain, depending on the placement of the band. These symptoms typically improve within a day or two, and the banded tissue usually falls off within several days. Your doctor might give you a local anesthetic or relaxing medication, if necessary.

Q: What should I expect after rubber band ligation?

A: You might notice mild bleeding as the hemorrhoids fall off. The advantage of endoscopic and in-office banding is that recovery is typically quick.

Q: What are the complications of hemorrhoids if I don’t treat them?

A: While uncommon, complications from untreated hemorrhoids can cause severe pain. These complications include strangulated hemorrhoids, when blood supply to an internal hemorrhoid is cut off; anemia, from sustained blood loss; and blood clotting (thrombosis), which can form a painful lump in the hemorrhoidal veins.

Q: How permanent is rubber band ligation?

A: Many studies assign a 70% to 80% effective rate to hemorrhoid banding. However, hemorrhoids can recur without lifestyle changes. Follow the recommended diet, bathroom practices, and hydration guidelines your doctor prescribes to reduce the risk of recurrence.

Q: What alternatives can patients consider to banding?

A: Other options include sclerotherapy, infrared/electrical coagulation, or even surgery for more severe cases.

Q: How do I prepare for a banding procedure?

A: For in-office banding, very little preparation is required, but multiple visits might be necessary to treat each hemorrhoid column. If banding is performed during an endoscopic procedure such as a sigmoidoscopy, a bowel prep may be necessary, but it can often be completed in a single visit.

Ready to Learn More About Hemorrhoid Banding Treatment?

Rubber band ligation has helped many patients find relief. It is generally low risk, requires minimal preparation, and has a strong safety record when performed by an experienced clinician.

If you think hemorrhoid banding might be for you, schedule an appointment with one of our providers to review your symptoms and options.

Still have questions? You can learn more about our other hemorrhoid treatments on our website, or read about hemorrhoid banding here.

Or, schedule an appointment with one of our providers.