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Office Treatment of Hemorrhoids

(Hemorrhoid Ligation; Rubber Band Ligation for Hemorrhoids)
Definition

Hemorrhoids are enlarged and bulging blood vessels in the anus and lower rectum. Hemorrhoid banding is a procedure to remove them. It is most commonly done in the office and does not require anesthesia.

Most colorectal surgeons believe hemorrhoid banding is more effective than infra-red coagulation (IRC).

Reasons for Procedure

Banding is used to treat internal hemorrhoids. The procedure is most often done for the following reasons:

  • Severely bleeding hemorrhoids
  • Severely painful hemorrhoids
  • Hemorrhoids that protrude through the anus (called prolapsed hemorrhoids)
Possible Complications:

Complications are rare but no procedure is completely free of risk. If you are planning to have hemorrhoid banding, your doctor will review a list of possible complications which may include:

  • Infection
  • Bleeding
  • Recurrence of hemorrhoids
  • Swelling and pain from remaining hemorrhoids
  • Adverse reaction to the local anesthetic (if used)
What to Expect
Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Rectal exam
  • Anoscopy—the visual examination of the inside of the anus using a short tube (anoscope) to help keep the sphincter open
  • Sigmoidoscopy/Colonoscopy —the use of a specialized endoscope (a tube attached to a viewing device) to examine the inside of the anus, rectum, and lower intestine
Anesthesia

The advantage of hemorrhoid banding is that it is done above the area where pain nerves are and therefore it does not require anesthesia.

Description of the Procedure

An anoscope will be inserted through the anus. The doctor will look through the tube see inside the rectum and locate the hemorrhoid. The doctor will then use a special banding tool. The tool will place a small rubber band around the hemorrhoid. The band cuts off the blood supply. This will make the hemorrhoid fall off. More than one hemorrhoid may be banded. The band and the hemorrhoid will fall off in a few days.

Hemorrhoid Banding

How Long Will It Take?

This is a relatively quick procedure. The length of time depends on how many hemorrhoids need treatment.  Some patients need banding repeated.

Will It Hurt?

Patients often report some discomfort during and after this procedure. If you feel sharp or severe pain, tell the doctor immediately. Mild pain medicine will help you manage discomfort during recovery.

Post-procedure Care

For a few days, you may have difficulty controlling passage of gas and bowel movements. When you return home after the procedure, do the following to help ensure a smooth recovery:

  • Take sitz baths as recommended. Sitz baths will help relieve discomfort and clean the area. For a sitz bath, sit in warm water for 10-15 minutes. Pat the area dry. Do not wipe or rub vigorously. You may be advised to take a sitz bath every four hours and after every bowel movement. Devices are available to place on top of the toilet to make this process easier.
  • Move your bowels as soon as you feel the urge.
  • Do not strain, bear down, or hold your breath during a bowel movement.
  • Do not sit on the toilet for long periods of time.
  • To prevent constipation and straining during bowel movements: drink plenty of fluids, and eat plenty of high-fiber foods ( fruits, vegetables , beans, and whole grain )
  • Avoid heavy lifting for two or three weeks.
  • Be sure to follow your doctor’s instructions.

Expect some bleeding when the hemorrhoid falls off. See your doctor for a follow-up 3-4 weeks after the procedure.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Passing large amounts of blood
  • Signs of infection, including fever and chills
  • Pain that you can’t control with the medications you’ve been given
  • Constipation or trouble urinating
  • An aching feeling develops in the area between the rectum and the genitals

In case of emergency, call 911 or our office.

These are internal hemorrhoids. This picture was taken with a colonoscope (the black tube in the picture) looking back on itself. Banding would be an effective treatment for hemorrhoids such as these. Internal hemorrhoids such as these can cause bleeding and can prolapse when one has a bowel movement.