Severe Rectal Bleeding After Rubber Band Ligation for Internal Hemorrhoids

Massive bleeding from the anus after hemorrhoid ligation?

Hello Dr.
Ke,
Two weeks ago, I went to the clinic for a rubber band ligation of my internal hemorrhoid.
Initially, I visited because I had a round lump (external hemorrhoid) at my anus, and it was discovered that I had both an external and an internal hemorrhoid.
I had no rectal bleeding at all, so I was unaware of the internal hemorrhoid.
The doctor at the clinic performed the rubber band ligation on the internal hemorrhoid right away.
During this period, my bowel movements have been relatively soft, and I have been cautious not to strain.
However, today (July 6), my stool was a bit hard, and I had to exert some effort to pass it.
As a result, I experienced significant rectal bleeding, with an alarming amount of bright red blood filling the toilet and bathroom.
By the evening, even passing gas caused my underwear to be stained red.

I would like to ask the doctor:
1.
Could this bleeding be from the internal hemorrhoid? (Previously, before the ligation, the internal hemorrhoid did not bleed.) Shouldn't the internal hemorrhoid have improved significantly after the ligation, especially since it has been two weeks and the rubber band should have fallen off? Why would such a large amount of bleeding occur?
2.
If this is not bleeding from the internal hemorrhoid, could there be a possibility of an anal fissure? How can one differentiate between bleeding from an anal fissure and bleeding from an internal hemorrhoid?
P.S.
Although the bleeding is quite severe today, I do not have intense pain; only a very mild discomfort.
Thank you for your patience in answering my questions!

Xiao Wu, 20~29 year old female. Ask Date: 2019/07/06

Dr. Ke Fangxu reply Surgery

1.
Bleeding after hemorrhoid ligation typically occurs within a week; however, it is less common for bleeding to happen two weeks post-ligation, but it is still possible.
2.
Anal fissures usually result in a small amount of bleeding and are accompanied by pain during bowel movements.
Therefore, your situation is more indicative of bleeding from internal hemorrhoids or the ligation site.
As long as there is no further bleeding, it should not be a concern; otherwise, you should seek medical attention promptly.

Reply Date: 2019/07/06

More Info

Severe rectal bleeding after rubber band ligation for internal hemorrhoids can be alarming and requires careful evaluation. Based on your description, it seems that you experienced significant bleeding following a bowel movement, which raises several important considerations.

1. Is the bleeding from the internal hemorrhoid? After rubber band ligation, the internal hemorrhoid is expected to undergo necrosis and eventually fall off, which usually occurs within a week or two. However, it is possible that the ligation did not fully resolve the issue, or that there is another underlying problem. The fact that you had no prior bleeding before the procedure suggests that the ligation might have exacerbated an existing condition or caused a new one. The large volume of bright red blood you described is concerning and could indicate that the ligation site has become irritated or that there is still active bleeding from the hemorrhoid.

2. Could this be a fissure? Anal fissures can occur due to hard stools or straining during bowel movements. They can cause sharp pain and bleeding, often described as a "tearing" sensation. In your case, since you mentioned that the bleeding occurred after passing a hard stool, it is plausible that you may have developed a fissure. The key differences between bleeding from a hemorrhoid and a fissure are the nature of the pain and the appearance of the blood. Hemorrhoidal bleeding is typically painless and bright red, while fissures often cause severe pain during and after bowel movements, and the blood may appear on the surface of the stool or on toilet paper.

3. What should you do next? Given the severity of your bleeding, it is crucial to seek medical attention promptly. You should contact your healthcare provider or go to the emergency room, especially if the bleeding does not stop or if you experience symptoms such as dizziness, weakness, or significant pain. Your doctor may perform a physical examination, possibly including a digital rectal exam or anoscopy, to determine the source of the bleeding.

4. Management and prevention: If the bleeding is indeed from the hemorrhoid or a fissure, your doctor may recommend treatments such as topical anesthetics, stool softeners, increased fiber intake, and sitz baths to promote healing and relieve discomfort. If a fissure is diagnosed, additional treatments may include topical nitroglycerin or calcium channel blockers to promote healing. In some cases, surgical intervention may be necessary if conservative measures fail.

5. Monitoring and follow-up: After your initial evaluation and treatment, it is important to monitor your symptoms closely. If you continue to experience bleeding, changes in bowel habits, or worsening pain, follow up with your healthcare provider. They may need to reassess your condition and consider further interventions.

In summary, significant rectal bleeding after rubber band ligation warrants immediate medical evaluation to determine the cause and appropriate treatment. Whether the bleeding is from the internal hemorrhoid or a new issue such as a fissure, timely intervention can help prevent complications and promote healing.

Similar Q&A

Understanding Complications After Hemorrhoid Banding Surgery

Dear Dr. Ke, I underwent three rubber band ligation procedures for internal hemorrhoids at a clinic in Taipei from January to March 2014. After the procedures, I experienced occasional bleeding during bowel movements in April. The clinic physician administered two additional inj...

Dr. Ke Fangxu reply Surgery
1. In medical terminology, there is no such term as "anal membrane." The website refers to the mucosal tissue above the anal dentate line, which is the lower rectal mucosa. This mucosal tissue typically heals within about a week unless subjected to high doses of radiati...

Understanding Rubber Band Ligation for Internal Hemorrhoids: FAQs

Hello, doctor. I have internal hemorrhoids and do not experience bleeding after bowel movements, but I have occasionally had anal fissures and often feel pain in my buttocks from sitting too long. A doctor at the hospital used rubber band ligation on my hemorrhoids. I have a ques...

Dr. Yu Mingchang reply Surgery
Hello: Please do not use suppositories. When you have time, visit the colorectal department at Changhua Hospital, Ministry of Health and Welfare, to discuss your concerns.

Managing Post-Procedure Bleeding After Rubber Band Ligation for Internal Hemorrhoids

Hello Doctor, I underwent rubber band ligation for internal hemorrhoids two days ago. My stools have not been hard, but I have noticed a bit more bleeding than before the procedure. The doctor advised me to apply the ointment externally and to insert it about one centimeter deep,...

Dr. Cai Xingzhi reply Surgery
Hello: Regarding what you mentioned, it is normal to experience slight bleeding after a vasectomy, which may be due to the shedding of scabs or bleeding from any remaining unligated vessels or other causes. The physician should schedule a follow-up appointment, so please make sur...

Is Bleeding Normal After Rubber Band Ligation for Internal Hemorrhoids?

Hello, I underwent rubber band ligation for internal hemorrhoids on October 12, 2023. On October 13, I noticed bright red blood during bowel movements, and on October 14, there was both dark red and bright red blood. I would like to know if this is normal, as seeing dark red bloo...

Dr. Zhang Shuhao reply Surgery
After hemorrhoid ligation, it is common to experience a small amount of bleeding for a few days, which is considered normal. You can return for your scheduled follow-up appointment. However, if you experience heavy bleeding, passage of blood clots, feelings of dizziness or palpit...