Hemorrhoid banding, also called rubber band ligation, is a quick office procedure that treats internal hemorrhoids by placing a tiny elastic band around the base of the swollen tissue. The band cuts off blood supply to the hemorrhoid, causing it to shrivel and fall off within about a week. It’s the most common non-surgical treatment for hemorrhoids that bleed or prolapse, and most people return to normal activities the same day.
How the Procedure Works
During banding, a doctor inserts a small viewing scope into the anus to see the hemorrhoid clearly. Using either suction or a grasping tool, the hemorrhoid is pulled into a banding device, and a small rubber band is released around its base. The band is tight enough to completely cut off blood flow to the tissue below it.
Without blood supply, the hemorrhoid tissue dies over the next several days. It shrinks, detaches, and passes out of the body during a bowel movement, often without you noticing. A small scar forms where the hemorrhoid was, which helps anchor the remaining tissue in place and prevents it from bulging again.
When performed correctly, the procedure requires no anesthesia because the band is placed in an area of the rectum that has very few pain-sensing nerves. The whole process typically takes around 30 minutes, and in many cases the actual banding itself is finished in just a few minutes. If you have multiple hemorrhoids, your doctor may band one or two per session and schedule follow-up visits a few weeks apart.
Who Is a Good Candidate
Banding works best for internal hemorrhoids, the type that form inside the rectum. These are graded on a scale of one to four based on how much they bulge. Grade 1 hemorrhoids bleed but don’t protrude. Grade 2 protrude during a bowel movement but pull back in on their own. Grade 3 protrude and need to be pushed back manually. Grade 4 are permanently prolapsed and can’t be pushed back in.
Banding is typically recommended for grades 1 through 3, particularly when symptoms like bleeding or prolapse haven’t responded to dietary changes, fiber supplements, or other conservative measures. Grade 4 hemorrhoids usually require surgery. External hemorrhoids, which form under the skin around the outside of the anus, are not treated with banding because that area is rich in pain-sensing nerves, and placing a band there would be extremely painful.
What Recovery Looks Like
Most people go back to their usual routine right after the procedure. Some need to take it easy for a day or two. You can expect a dull ache or a feeling of fullness in the rectum for the first 24 to 48 hours, which over-the-counter pain relievers and a warm sitz bath can help with. A small amount of bleeding when the hemorrhoid falls off is normal and usually stops on its own.
Doctors generally recommend eating high-fiber foods, drinking plenty of water, and avoiding straining during bowel movements in the days following the procedure. These steps help prevent irritation at the treatment site and reduce the chance of new hemorrhoids forming. Stool softeners are sometimes suggested for the first week or so.
Success Rates and Recurrence
Banding is highly effective. In a large study published in the World Journal of Gastroenterology, bleeding was controlled in 98% of patients, and more than 82% saw their hemorrhoids reduced by at least one grade after a single session.
Recurrence does happen, though, especially over longer time frames. For patients treated for bleeding, recurrence rates were about 3.7% at one year, 6.6% at two years, and 13% at five years. For hemorrhoids that prolapsed, the pattern was similar: 3% at one year, roughly 10% at two years, and about 17% at five years. When hemorrhoids do come back, a repeat banding session is usually an option.
How Banding Compares to Surgery
Surgical removal of hemorrhoids (hemorrhoidectomy) is generally reserved for more severe cases or when banding has failed. The tradeoff between the two comes down to effectiveness versus recovery burden.
Surgery has a lower recurrence rate, but it comes with significantly more pain and downtime. A Cochrane systematic review found that patients who had surgical removal were nearly twice as likely to experience substantial postoperative pain compared to those who had banding. The difference in recovery time was even more striking: patients who had banding returned to work roughly 29 days sooner than those who had surgery. For most people with grade 1 to 3 hemorrhoids, banding offers a strong balance of effectiveness and minimal disruption to daily life.
Possible Risks
Banding is considered low-risk, but no procedure is entirely without complications. The most common issues are mild pain, a sensation of pressure in the rectum, and minor bleeding when the banded tissue falls off. These are expected parts of the healing process rather than true complications.
Less commonly, some people experience heavier bleeding that requires medical attention, difficulty urinating in the hours after the procedure, or, very rarely, infection at the banding site. Signs of a serious complication include fever, severe pain that worsens instead of improving, heavy rectal bleeding, or an inability to urinate. These are uncommon but worth knowing about so you can seek prompt care if needed.