What Is a Rubber Band Ligation?

Rubber band ligation is a medical procedure for the treatment of internal hemorrhoids, also called piles. It is frequently performed in the clinics of gastroenterology surgeons who perform surgical operations and medical procedures on patients with disorders related to the gastrointestinal tract (GIT). The rubber band ligation procedure for internal hemorrhoids is often a short procedure which does not require anesthesia. Patients can usually go home after it is done.

Internal hemorrhoids are swollen and inflamed small veins and arteries inside the anal canal. When they develop in the skin around the anus, they are known as external hemorrhoids. Factors associated with the development of hemorrhoids are increased straining during defecation or bowel movement, chronic constipation, lack of dietary fiber and childbirth, among many others. Symptoms of hemorrhoids may include bleeding, pain, itching,irritation and having a lump or bulge around the anus.

The decision to use rubber band ligation often depends on the extent or degree of internal hemorrhoids as determined by surgeons. First and second degree internal hemorrhoids, which bleed persistently, may benefit from the procedure. First degree hemorrhoids are those which usually bleed but do not bulge outside the anus, while second degree hemorrhoids often bulge out of the anus during straining, but resolve spontaneously.

Before the rubber band ligation is performed, patients usually have an enema to empty the rectum. They are then instructed to lie on their left side with their knees drawn to the chest. The surgeon then inserts a proctoscope, an instrument to view the anus and the rectum, which enables him to locate the hemorrhoids and place a small rubber band around the base using a ligator. The rubber band around the hemorrhoids will generally cut off the blood flow, resulting in tissue death and causing them to eventually fall off, usually after a week.

There are some possible complications which may arise after the procedure. These include bleeding, pain and anal fissures or cuts in the skin of the anus. Pain is usually minimal, however, if the rubber band is placed very low around the base of the hemorrhoids. Severe pain may be felt, in which case immediate removal of the ligation is often required. Once removed, doctors may reposition it further above the base. Some bleeding is expected after the procedure, and again after the hemorrhoids fall off. A small number of patients acquire anal fissures, which may become painful, and are usually treated with pain medications.