Hemorrhoids are swollen and inflamed veins in the lower rectum or around the anus. These are normal anatomical structures that become symptomatic when enlarged, leading to discomfort, itching, or bleeding. This condition is widespread, impacting approximately 1 in 20 Americans and about half of adults over the age of 50.
Understanding Hemorrhoids
Hemorrhoids are categorized into two primary types based on their location relative to the dentate line, a distinct anatomical boundary within the anal canal. Internal hemorrhoids form above this line, deep within the rectum. This area has fewer pain-sensing nerve endings, which often means internal hemorrhoids may cause painless bleeding, typically bright red blood. Internal hemorrhoids can also prolapse, meaning they protrude through the anal opening, sometimes requiring manual reduction.
In contrast, external hemorrhoids develop below the dentate line, under the skin surrounding the anus. This region is richly supplied with pain-sensitive nerves, making external hemorrhoids prone to significant discomfort, pain, itching, and swelling. If a blood clot forms within an external hemorrhoid, known as a thrombosed external hemorrhoid, it can cause sudden and intense pain.
What is Hemorrhoid Banding
Hemorrhoid banding (RBL) is a common, minimally invasive procedure used to treat symptomatic internal hemorrhoids. During this outpatient procedure, a small rubber band is placed around the base of an internal hemorrhoid. This band works by cutting off the blood supply, leading to its gradual shrinking and eventual detachment.
The procedure typically involves a healthcare provider inserting a ligator through a scope into the anal canal to grasp the hemorrhoid. The rubber band is then released around the base of the tissue, causing it to wither and fall off within a few days to a week. The success of RBL for internal hemorrhoids is largely attributed to their location above the dentate line, an area with limited pain sensitivity.
Banding for External Hemorrhoids
Rubber band ligation is generally not recommended for external hemorrhoids. The primary reason is the presence of numerous pain-sensitive nerve endings in the anoderm, the skin around the anus where external hemorrhoids are located. Applying a rubber band would cause intense pain and significant discomfort.
Internal hemorrhoids, conversely, are located in an area that lacks these pain-sensitive nerves, making the banding procedure tolerable. Beyond the pain, external hemorrhoids are covered by skin and are often flatter, making them structurally unsuitable for banding. Attempting to band an external hemorrhoid could also lead to complications such as blood clots, severe pain, and potential infection.
Alternative Treatments for External Hemorrhoids
Since banding is not a suitable treatment for external hemorrhoids, alternative approaches focus on managing symptoms and, in some cases, surgical intervention. Home remedies often include increasing dietary fiber intake and ensuring adequate hydration to soften stools and prevent straining. Sitz baths, which involve soaking the anal area in warm water for 15-20 minutes, can help reduce swelling and pain.
Over-the-counter creams, ointments, and suppositories containing ingredients like hydrocortisone or witch hazel can provide relief from itching and discomfort. For persistent or severe external hemorrhoids, medical interventions may be necessary. If a thrombosed external hemorrhoid causes significant pain, an excisional thrombectomy can be performed to remove the blood clot. In rare and severe cases, surgical removal, known as an excisional hemorrhoidectomy, might be considered.