Hemorrhoids are a common issue in the anal canal, often causing discomfort, bleeding, or protrusion. When conservative measures like dietary changes and fiber supplements fail to resolve symptoms, medical intervention is necessary. Rubber band ligation (RBL) is a widely accepted, minimally invasive procedure performed in a doctor’s office to treat problematic internal hemorrhoids. RBL offers an effective and quick solution for patients experiencing persistent symptoms.
Mechanism of Rubber Band Ligation
The effectiveness of rubber band ligation relies on mechanical strangulation, which leads to tissue death and expulsion. A small rubber band is placed around the base, or “neck,” of the internal hemorrhoid mass. This placement occurs above the dentate line in the anal canal, an area that lacks pain receptors. By constricting the base, the band cuts off the blood supply to the tissue, initiating localized ischemia.
Deprived of oxygen and nutrients, the ligated tissue shrinks and withers over several days. The non-viable tissue mass, along with the band, detaches from the anal wall and is naturally expelled, typically during a bowel movement. This usually occurs within three to seven days after the procedure. The resulting wound heals by forming scar tissue, which helps anchor the surrounding tissue and reduces the chance of future prolapse.
Determining Patient Eligibility
Rubber band ligation is primarily indicated for symptomatic internal hemorrhoids that have not responded to conservative treatments. Eligibility is determined by the hemorrhoid’s location and severity, which are classified into grades. RBL is the standard treatment for Grade I hemorrhoids (bleeding without prolapse) and Grade II hemorrhoids (prolapse during bowel movement but spontaneous retraction).
The procedure is also used for Grade III hemorrhoids, which prolapse and require manual reduction, though these may need multiple sessions. RBL is contraindicated for external hemorrhoids because the tissue below the dentate line contains pain-sensitive nerves, making ligation painful. It is also avoided for large, irreducible Grade IV hemorrhoids, which usually require surgery.
What Happens During the Banding Procedure
The procedure is quick and performed in an outpatient setting without general anesthesia. The patient is typically positioned on their side with knees drawn up. A specialized viewing instrument, such as an anoscope, is gently inserted into the anal canal so the physician can visualize the internal hemorrhoids.
Once the target hemorrhoid is identified, a ligator device is introduced through the anoscope. This device uses gentle suction or forceps to grasp the hemorrhoidal tissue and draw it into the cylinder. The physician then deploys one or two small rubber bands, securing them firmly around the tissue’s base above the dentate line. Treating multiple hemorrhoids requires repeat sessions spaced several weeks apart, as only one or two masses are banded per visit to limit discomfort.
Post-Procedure Care and Recovery Timeline
Following the procedure, patients commonly experience a feeling of fullness or a dull ache in the rectal area, often described as a persistent urge to have a bowel movement. This discomfort is usually manageable with over-the-counter pain relievers. Patients should avoid non-steroidal anti-inflammatory drugs (NSAIDs) if they increase the risk of bleeding.
Minor spotting or light bleeding is common, especially when the ligated tissue sloughs off, typically between three and ten days after banding. Care instructions focus on preventing constipation and straining, which can disrupt the healing site. Patients are advised to increase fiber intake, drink plenty of fluids, and may be prescribed stool softeners.
Warm sitz baths, involving soaking the anal area in warm water for 15 to 20 minutes several times a day, can help soothe discomfort and keep the area clean. Patients should seek immediate medical attention if they experience severe, unrelenting pain, heavy rectal bleeding, fever, or an inability to urinate.