Hemorrhoid Ligation: Questions and Concerns After Treatment

Issues related to hemorrhoid ligation?

Hello, I previously inquired about https://adoctor.tw/article/138603.
Last Thursday, I had a follow-up appointment where the doctor examined me again and performed a rubber band ligation for my internal hemorrhoids.
He mentioned that I had a slight anal fissure and stated that under health insurance regulations, I can have this procedure done four times a year, with ligation performed in four directions.
Additionally, I had to return to work the day after the procedure, and I was unsure about the potency of the laxative he prescribed, so I did not take it that night, planning to take it the following Friday instead.
However, on Friday afternoon, I noticed a small black ring that had fallen off during a bowel movement, which I believe had already detached.
There was also noticeable blood on the toilet paper.
I have a few questions:
1.
Regarding the anal fissure, it seems the doctor did not provide any treatment or medication for it.
Will it heal on its own? How can I tell if the wound has healed?
2.
Shouldn't the ligation procedure be based on the number of internal hemorrhoids present? Why was it done according to direction rather than quantity?
3.
Is it too soon for the ligation to have fallen off the next day? Could it be because I did not take the laxative that night, making it easier for it to detach? Or could it be due to the doctor's technique or the hemorrhoids being too small to ligate effectively?
4.
Since it fell off the next day, I have not taken any of the medication prescribed.
Does this detachment indicate success or failure? I cannot tell if any internal hemorrhoids have fallen off; I only saw the stool and a black ring.
Thank you.

a, 30~39 year old female. Ask Date: 2018/09/09

Dr. Ke Fangxu reply Surgery

1.
If the anal fissure is not severe, it may indeed heal on its own.
The key is to maintain good bowel habits.
If there is no pain or bleeding, it can be left alone.

2.
The location of hemorrhoids is described in terms of direction, and the physician's explanation is accurate; however, it can be difficult for the general public to understand.
The decision to ligate is based on severity and symptoms rather than the number of ligations.

3.
Small hemorrhoids can indeed fall off easily after ligation, and if the ligation is too shallow, it may also detach prematurely.
However, as long as there is no pain or bleeding, it is more important to focus on the effectiveness of the treatment rather than when it falls off.

4.
If there is no further bleeding, it is considered a successful treatment.
If there is still bleeding or discomfort, why not take medication?

Reply Date: 2018/09/09

More Info

Hemorrhoid ligation, particularly for internal hemorrhoids, is a common procedure aimed at reducing symptoms such as bleeding and discomfort. It is understandable to have concerns following the treatment, especially regarding the healing process and the effectiveness of the procedure. Let’s address your questions one by one.

1. Regarding the anal fissure: Anal fissures can often heal on their own, especially if you maintain a soft stool and avoid straining during bowel movements. However, it is crucial to monitor the fissure for signs of healing, such as a reduction in pain and bleeding. If the fissure persists or worsens, it may require further treatment, such as topical medications or even surgical intervention in more severe cases. Keeping the area clean and using stool softeners can aid in the healing process.

2. Ligation technique: The decision to ligate based on direction rather than the number of hemorrhoids can be attributed to the anatomical positioning of the hemorrhoids. The ligation technique often involves placing bands in various directions to ensure that all potential areas of hemorrhoidal tissue are addressed. This approach can help prevent future occurrences by targeting the underlying vascular supply to the hemorrhoids.

3. Premature detachment of the ligation: It is not uncommon for a ligation to detach sooner than expected, especially if the hemorrhoid was small or if there was insufficient tissue to hold the band securely. Not taking the stool softeners as prescribed may have contributed to this, as straining during bowel movements can increase the risk of detachment. However, it is also possible that the ligation was not adequately secured due to technical factors. If you notice significant bleeding or discomfort, it is advisable to contact your healthcare provider.

4. Assessment of success: The success of the ligation can be somewhat subjective, especially if you are unsure whether the hemorrhoid has detached. The presence of a black circle could indicate that the tissue has necrosed and fallen off, which is a normal part of the healing process. However, if you are experiencing ongoing symptoms or have concerns about whether the procedure was effective, it is essential to follow up with your doctor. They can perform an examination to determine if the hemorrhoid has been successfully treated.

In summary, while some discomfort and bleeding can be expected after hemorrhoid ligation, it is essential to monitor your symptoms closely. If you experience significant pain, persistent bleeding, or any other concerning symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. They can provide guidance on managing your recovery and ensuring that any complications are addressed promptly. Additionally, maintaining a high-fiber diet, staying hydrated, and using stool softeners can significantly aid in your recovery process.

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