Pain and Complications After Hemorrhoid Banding Surgery

Hemorrhoid ligation

I have undergone rubber band ligation for external hemorrhoids, which has caused my anal sphincter to tighten intermittently, resulting in significant pain.
I also experience a sensation of a foreign body in the anal area, along with the discharge of foul-smelling fluid mixed with blood.
I have already had five ligation procedures; the first two were for internal hemorrhoids and went well.
However, after the third procedure for external hemorrhoids, I began to experience poor sleep, pain, and bleeding along with discharge, which even led to the prolapse of internal hemorrhoids.
During the fourth and fifth procedures, I had treatment for the prolapsed internal hemorrhoids, both involving rubber band ligation.
The pain after these procedures has been severe, and I still feel a foreign body sensation in my anal area, with intermittent tightening of the sphincter, which is quite painful.
Although the rubber band for the prolapsed internal hemorrhoid has fallen off, I continue to experience these symptoms.
I would like to ask the doctor why this is happening...

Yu Daming, 30~39 year old female. Ask Date: 2019/01/05

Dr. Ke Fangxu reply Surgery

According to health insurance regulations, rubber band ligation for hemorrhoids should not exceed four times a year.
It is generally believed that if multiple ligations do not effectively improve symptoms, hemorrhoidectomy may be recommended.
If the hemorrhoids are large and multiple ligations are performed in a short period, it may lead to an increased risk of wound inflammation.
It is advisable to first use topical medications along with warm sitz baths and to avoid further ligation in the short term.

Reply Date: 2019/01/05

More Info

After undergoing hemorrhoid banding surgery, it is not uncommon for patients to experience pain and complications, especially if multiple procedures have been performed. Hemorrhoid banding, or rubber band ligation, is a minimally invasive procedure used to treat hemorrhoids, particularly internal hemorrhoids. However, when complications arise, they can significantly affect a patient's quality of life.

In your case, the persistent pain, the sensation of a foreign body, and the discharge of foul-smelling fluid and blood are concerning symptoms that warrant further investigation. Here are some possible explanations for your symptoms:
1. Post-Operative Pain: After hemorrhoid banding, it is typical to experience some pain and discomfort. However, if the pain is severe and persistent, it may indicate complications such as infection, thrombosis (clot formation), or necrosis (tissue death) of the hemorrhoidal tissue.

2. Infection: The presence of foul-smelling discharge and blood could suggest an infection at the site of the surgery. Infections can occur post-operatively and may require antibiotic treatment. Signs of infection include increased pain, swelling, redness, and discharge.

3. Thrombosed External Hemorrhoids: If you have undergone banding of external hemorrhoids, there is a risk of thrombosis, which can lead to significant pain and swelling. This condition may require additional treatment, such as incision and drainage.

4. Incomplete Resolution of Hemorrhoids: If the internal hemorrhoids have not been fully resolved, or if new hemorrhoids have developed, this could lead to ongoing symptoms. The sensation of a foreign body and the feeling of tightness could be due to residual or newly formed hemorrhoids.

5. Scar Tissue Formation: Repeated surgeries can lead to the formation of scar tissue, which may contribute to discomfort and a sensation of tightness or pressure in the anal area.

6. Psychological Factors: Chronic pain can lead to anxiety and stress, which may exacerbate the perception of pain. Sleep disturbances can also be a result of ongoing discomfort, creating a cycle of pain and anxiety.

Given that you have undergone multiple procedures, it is crucial to consult with a healthcare provider who specializes in colorectal surgery or gastroenterology. They may recommend further diagnostic tests, such as a physical examination, anoscopy, or imaging studies, to assess the condition of the anal canal and surrounding tissues.

Recommendations:
1. Consult a Specialist: Seek a consultation with a colorectal surgeon or a gastroenterologist who can evaluate your symptoms and recommend appropriate treatment options.

2. Pain Management: Discuss your pain management options with your doctor. They may suggest stronger analgesics or alternative pain relief methods, such as topical anesthetics or nerve blocks.

3. Monitor for Infection: Keep an eye on your symptoms. If you notice increased redness, swelling, or discharge, seek medical attention promptly.

4. Consider Dietary Changes: A high-fiber diet and adequate hydration can help prevent constipation and reduce straining during bowel movements, which may alleviate some pressure on the hemorrhoidal tissue.

5. Follow-Up Care: Ensure that you have regular follow-up appointments with your healthcare provider to monitor your condition and adjust treatment as necessary.

6. Psychological Support: If you are experiencing anxiety or depression related to your chronic pain, consider speaking with a mental health professional for support.

In summary, while hemorrhoid banding is generally effective, complications can arise, especially with multiple procedures. It is essential to address these issues with a healthcare professional to find a suitable treatment plan that alleviates your symptoms and improves your quality of life.

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