Hemorrhoid Ligation: Pain, Recovery, and Treatment Options

Regarding hemorrhoid ligation surgery?

After each bowel movement, a large mass protrudes from my anus, which gradually retracts.
Additionally, there is blood when I wipe with toilet paper.
This condition has persisted for several months.
On June 2, I visited a colorectal surgeon at a major hospital, and the doctor diagnosed me with both internal and external hemorrhoids.
There are two large internal hemorrhoids, and one was ligated on the spot, while the other will be addressed later.
However, I have been experiencing ongoing pain after the ligation.
The doctor prescribed anti-inflammatory pain medication and recommended sitz baths, but I still feel uncomfortable, and there is itching inside my anus.
I have previously undergone ligation for internal hemorrhoids twice without pain or the need for pain medication, so I am unsure why this time it is so uncomfortable.
I would like to ask the doctor:
1.
Can the pain from ligating internal hemorrhoids be due to differences in the doctor's technique?
2.
I have heard that some doctors may not ligate properly, leading to the rubber band falling off, making the procedure ineffective.
Is this true?
3.
If I do not ligate the internal hemorrhoid, will applying medication help, especially since I still have one large internal hemorrhoid?
4.
If internal hemorrhoids recur, can they be ligated repeatedly?
5.
In the past, I often experienced constipation without any protrusion from my anus.
Why does a large mass protrude now after having normal bowel movements?
6.
What can I do about the itching in my anus?

Niming, 40~49 year old female. Ask Date: 2016/06/03

Dr. Ke Fangxu reply Surgery

1.
The pain associated with hemorrhoid ligation can indeed vary among physicians; if the ligation is performed too superficially, it is more likely to cause pain.

2.
Regardless of who performs the procedure, there will always be instances where the rubber band falls off, and the treatment outcomes cannot be guaranteed to be satisfactory.
If the hemorrhoids are severely prolapsed, surgical excision is generally more effective than rubber band ligation.

3.
If hemorrhoids are not bleeding or painful, treatment may not be necessary; however, if there is significant prolapse, topical medications usually have limited effectiveness.

4.
If continuous ligation does not yield satisfactory treatment results, what is the point of ongoing ligation? Surgical excision is recommended as a more definitive solution.

5.
The prolapse of hemorrhoids is related to straining during bowel movements and the duration of those movements.
Additionally, how long ago is "previously"? A month ago or twenty years ago? If bowel habits are poor, the problem of hemorrhoidal prolapse will only worsen.

6.
Topical ointment.

Reply Date: 2016/06/03

More Info

Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. They can be classified into two main types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. The symptoms you describe, such as the protrusion of tissue after bowel movements, bleeding, and itching, are common indicators of hemorrhoids.

Understanding Hemorrhoid Ligation
Hemorrhoid ligation, specifically rubber band ligation, is a common procedure used to treat symptomatic internal hemorrhoids. During this procedure, a rubber band is placed around the base of the hemorrhoid to cut off its blood supply. The hemorrhoid then shrinks and eventually falls off within a week or so. While this procedure is generally effective and minimally invasive, it can lead to discomfort and pain post-operation.

1. Pain and Discomfort: It is not uncommon to experience pain after hemorrhoid ligation. The level of pain can vary based on several factors, including the size of the hemorrhoid, the technique used by the surgeon, and individual pain tolerance. If the pain persists or worsens, it is essential to consult your healthcare provider, as they may need to evaluate for complications such as infection or improper ligation.

2. Technical Variability: The skill and experience of the surgeon can influence the outcome of the procedure. While complications such as the rubber band falling off are rare, they can occur. If the band does not remain in place, the hemorrhoid may not shrink as expected, leading to continued symptoms.

3. Non-surgical Management: If you choose not to undergo ligation for the remaining hemorrhoid, topical treatments, such as creams or ointments containing hydrocortisone, may provide relief. However, these treatments do not eliminate the hemorrhoid; they only help manage symptoms. Dietary changes, increased fiber intake, and proper hydration can also help alleviate symptoms and prevent future occurrences.

4. Recurrent Hemorrhoids: It is possible to undergo rubber band ligation multiple times if necessary. However, if you find yourself needing repeated procedures, it may be worth discussing long-term management strategies with your doctor, including lifestyle modifications or other surgical options.

5. Bowel Habits and Hemorrhoids: The development of hemorrhoids can be influenced by various factors, including bowel habits. Chronic constipation can lead to straining during bowel movements, which increases pressure on the veins in the rectal area. Conversely, diarrhea can also contribute to hemorrhoid formation. It is crucial to maintain regular bowel habits and avoid straining.

6. Itching and Irritation: Anal itching can be caused by several factors, including hemorrhoids, skin irritation, or hygiene issues. To alleviate itching, keep the area clean and dry, avoid harsh soaps, and consider using over-the-counter creams designed for anal itching. If the itching persists, consult your healthcare provider for further evaluation and treatment options.

Recovery and Treatment Options
Post-procedure, it is essential to follow your doctor's recommendations for recovery, which may include:
- Pain Management: Use prescribed pain relievers as directed. Over-the-counter medications like acetaminophen or ibuprofen may also help.

- Sitz Baths: Taking warm sitz baths can soothe the area and promote healing.

- Dietary Changes: Increase fiber intake to soften stools and reduce straining during bowel movements. Consider fiber supplements if necessary.

- Hydration: Drink plenty of fluids to help prevent constipation.

- Follow-up Appointments: Attend follow-up visits with your healthcare provider to monitor your recovery and address any ongoing symptoms.

In conclusion, while hemorrhoid ligation is a common and generally safe procedure, it can lead to discomfort and requires proper post-operative care. If you have ongoing concerns or symptoms, do not hesitate to reach out to your healthcare provider for personalized advice and treatment options.

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