Hemorrhoids are swollen veins located in the rectum or anus that can cause symptoms like bleeding, discomfort, and itching. When conservative treatments such as dietary changes and over-the-counter creams fail, a common and minimally invasive procedure known as Rubber Band Ligation (RBL) is often recommended. RBL is highly effective for addressing internal hemorrhoids. Understanding the process and the expected timeline after this procedure is important for patients.
Understanding Rubber Band Ligation
Rubber Band Ligation treats internal hemorrhoids by cutting off their blood supply. During the procedure, a small, specialized device places a tiny elastic band around the base of the internal hemorrhoid tissue. This band is intentionally placed just above the dentate line, where few pain-sensing nerves exist, to minimize discomfort during and immediately after the procedure.
The immediate effect of placing the band is a restriction of blood flow, which causes the hemorrhoid to become ischemic. Over a period of several days, the lack of oxygen and nutrients causes the ligated tissue to wither and die. The shriveled hemorrhoid, along with the elastic band, will eventually detach from the rectal wall, leaving a small scar that helps prevent recurrence.
The Typical Detachment Timeline
Generally, the banded hemorrhoid will detach and pass out of the body within a range of seven to fourteen days after the RBL procedure. Many patients experience this detachment around the seven to ten-day mark, though the exact timing can vary based on the size of the hemorrhoid and individual healing characteristics.
The ligated tissue slowly shrinks and hardens over the course of the first week. The exact moment of detachment frequently occurs during a normal bowel movement, which means many patients do not notice the hemorrhoid passing at all. It may look like a small piece of tissue or clot in the toilet bowl or on toilet paper, or it may be passed unnoticed with the stool.
Seeing a small amount of fresh, bright red blood when the tissue finally separates is a normal occurrence signifying the healing process. Any tissue that remains after the initial procedure can often be addressed in a subsequent banding session, typically scheduled a few weeks later.
Managing Symptoms During Healing
Patients should expect to experience some sensations immediately following the procedure. A feeling of fullness in the rectum or a persistent urge to have a bowel movement is common for the first few days. This sensation occurs because the ligated tissue temporarily mimics the presence of stool in the lower rectum.
Mild discomfort or a dull ache is also a frequent experience, which can usually be managed effectively with over-the-counter pain relievers. Healthcare providers often recommend taking a sitz bath, which involves soaking the anal area in a few inches of warm water for fifteen to twenty minutes multiple times a day. This practice can help soothe the area and relax the anal sphincter muscles.
Preventing constipation and straining during bowel movements is an important part of the healing process. Patients are routinely advised to increase their dietary fiber intake and maintain good hydration to keep stools soft and easy to pass. Stool softeners are often recommended for the first week or two to ensure the smooth passage of stool, which helps protect the treated area until it fully heals. Avoiding heavy lifting for a few weeks is also suggested, as straining from physical exertion can increase pressure in the rectal veins.
Recognizing Complications
Patients need to be aware of signs that indicate a possible complication requiring medical attention. Severe, unrelenting pain that is not relieved by prescribed or over-the-counter pain medication is a sign that the band may have been placed too close to the sensitive anal area. This type of pain should prompt a call to the healthcare provider immediately.
Signs of infection, although rare, must be taken seriously, and these include developing a fever, experiencing chills, or noticing a purulent discharge from the rectum. Another concerning symptom is heavy rectal bleeding. If bleeding fills the toilet bowl or continues steadily, it is considered a medical emergency. Difficulty passing urine after the procedure can also occur in a small number of cases and requires prompt evaluation.