What is a rubber band ligation?
The band causes the hemorrhoids to shrink, holding the hemorrhoids in place. The physician removes hemorrhoids in two-four settings, done six-eight weeks apart.
A rubber band ligation is a simple, painless, and highly effective procedure that involves placing a rubber band around hemorrhoids to cut off its blood supply. Hemorrhoids, commonly known as piles, are swollen veins located around the anus or in the lower rectum.
Hemorrhoids are either internal or external, depending on the location. Internal hemorrhoids are covered with a lining called mucosa that is resistant to touch, pain, stretch, or temperature, whereas external hemorrhoids are covered by very sensitive skin.
Internal hemorrhoids may be graded as follows:
- Grade I (primary): These slide below the toothed or jagged line present above the anal canal (dentate line) while straining but retract when strain is gone. Treatment includes increasing fiber intake.
- Grade II (secondary): These protrude below the anal opening but reduce spontaneously. Treatments include sclerotherapy and rubber band ligation.
- Grade III (tertiary): These protrude below the anal opening and need to be reduced manually. Treatments include sclerotherapy, rubber band ligation, or surgery.
- Grade IV (quarternary): These protrude below the anal opening and are not reducible. Surgical removal of hemorrhoids (hemorrhoidectomy) is indicated.
Who should have a rubber band ligation?
A rubber band ligation is indicated in
- Patients in whom other therapies have failed.
- Patients who are intolerant to the risk of anesthesia administered during the surgery.
- Patients with cirrhosis or uremia (a high blood urea level) as an alternative therapy.
Who should not have a rubber band ligation?
A rubber band ligation is avoided in the following conditions:
- Take anticoagulant medications
- Bleeding disorder
- Latex allergy
- Significant protruding of the rectum
- Rectal cancer
- Inflammatory bowel disease such as colitis
- Acute thrombosis (local blood clots)
- Suppressed immunity
- A perirectal abscess (pus formation near the anus)
- Large grade intravenous hemorrhoids
How is a rubber band ligation performed?
Before the procedure
- You may have to stop taking blood thinners such as Coumadin (warfarin) and Aggrenox (aspirin and dipyridamole), four-five days before the procedure.
- You may be asked to sign an informed consent form that consists of the risk and benefits, alternatives, expectations, and length of the procedure.
- You may be given an enema on the previous night of the procedure.
- You may have to fast from midnight to the procedure.
During the procedure
- The physician performs a rubber band ligation either in a hospital or an office setting. Anesthesia may not be necessary while performing this procedure in an office setting.
- The physician inserts a small tool, known as a ligator, through a lighted tube (scope) in the anal canal and grabs hemorrhoids with forceps.
- The physician pushes the ligator’s cylinder to release the rubber band around the base of hemorrhoid.
After the procedure
- Bleeding may be observed for 7-10 days post the procedure.
- Avoid strenuous work for 24-48 hours after the procedure.
- Do not lift anything heavy for 24-48 hours.
- Avoid straining while defecating because it can lead to more hemorrhoids.
- Check out for the following symptoms:
How long does it take for banded hemorrhoids to fall off?
The band causes the hemorrhoids to shrink, holding the hemorrhoids in place. The physician removes hemorrhoids in two-four settings, done six-eight weeks apart. However, some bleeding will be observed when the rubber band falls off.
Can a rubber band ligation be used for external hemorrhoids?
A rubber band ligation mainly treats grades II and III internal hemorrhoids. It is not effective in treating external hemorrhoids or significantly protruding hemorrhoids.