Post-Banding Bleeding After Hemorrhoid Surgery: What to Expect

Bleeding after rubber band ligation for internal hemorrhoids?

Hello Dr.
Ke, on November 26 (Tuesday), I experienced continuous diarrhea and passed bloody stools (the stool was golden yellow with some bright red streaks).
I visited a clinic where the doctor diagnosed me with second to third-degree internal hemorrhoids with skin breakdown and bleeding.
An immediate rubber band ligation was performed, and I was prescribed suppositories for hemorrhoids along with anti-inflammatory medication and two days' worth of anti-diarrheal medication.

In the days following the procedure, I experienced some constipation, likely due to the anti-diarrheal medication, and I had to exert some effort to pass stools.
I also expelled a pink, cloudy liquid that seemed to mix with the suppository.
During a follow-up visit, the doctor examined me with an anoscope and confirmed that the rubber band had fallen off, and continued to prescribe the hemorrhoid suppositories.
However, from the ligation until today, December 10 (Tuesday), it has been 14 days, and I still notice a small amount of bleeding every morning, which appears as a pink, cloudy liquid along with slight blood stains on the surface of the stool.
My bowel movements have gradually shifted from constipation to somewhat unformed soft stools, and these symptoms mainly occur during the first morning bowel movement.
If I have a second bowel movement in the afternoon or evening, the bleeding is significantly reduced, and there is almost no bleeding.
1.
Is it normal to have bleeding for so many days?
2.
I use the hemorrhoid suppositories every night before bed since the ligation; could the suppositories be affecting this?
3.
I had a colonoscopy at the end of August last year, but I only fasted and drank water the day before the exam and took laxatives the morning of the exam.
The doctor said my intestines were normal and did not mention any need for a repeat exam.
Is it necessary to repeat the colonoscopy now?
Thank you for your assistance.

kuàngquánshuǐ, 20~29 year old female. Ask Date: 2019/12/10

Dr. Ke Fangxu reply Surgery

1.
It's not entirely normal, but as long as there is no significant bleeding, it's not a concern.

2.
The suppository itself should not have hemostatic effects.

3.
If a colonoscopy was performed last year, there is currently no need to repeat the procedure.

Reply Date: 2019/12/10

More Info

Post-banding bleeding after hemorrhoid surgery can be a concerning issue for many patients. It's important to understand what to expect during the recovery process, especially after undergoing a rubber band ligation for hemorrhoids.
1. Is it normal to have bleeding for so many days?
After a rubber band ligation, some bleeding is expected, especially in the first few days following the procedure. However, if you are experiencing bleeding that persists for 14 days, even if it is minimal, it is advisable to consult your healthcare provider. While some patients may have slight bleeding for a week or so, prolonged bleeding could indicate complications such as infection, inadequate ligation, or other issues. It’s essential to monitor the amount and color of the blood. Bright red blood mixed with stool can be a sign of ongoing irritation or injury to the rectal area.

2. Could the use of suppositories be affecting the bleeding?
The use of hemorrhoid suppositories, such as the one you mentioned (宜痔平), can sometimes cause irritation or a reaction in the rectal area, especially if used frequently. If the suppository contains ingredients that may irritate the mucosa or if it is not being tolerated well, it could contribute to ongoing bleeding. It’s important to discuss with your doctor whether to continue using the suppository or if an alternative treatment might be more suitable.

3. Is it necessary to repeat a colonoscopy?
Given that you had a colonoscopy in August and it was reported as normal, it may not be necessary to repeat the procedure unless there are new symptoms or concerns. However, if you are experiencing ongoing issues such as significant changes in bowel habits, persistent bleeding, or if your doctor feels that there may be an underlying condition that needs to be evaluated, they may recommend a follow-up colonoscopy. It’s always best to discuss your symptoms and concerns with your healthcare provider to determine the most appropriate course of action.

Additional Considerations for Recovery:
- Diet and Hydration: Ensure you are consuming a high-fiber diet and staying well-hydrated to prevent constipation, which can exacerbate hemorrhoid symptoms. Soft, well-formed stools are easier to pass and can help reduce strain during bowel movements.

- Avoid Straining: If you find yourself straining during bowel movements, consider using a stool softener or laxative as recommended by your doctor. Avoiding straining is crucial to prevent further irritation or injury to the surgical site.

- Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor your recovery. If you notice any significant changes in your symptoms, such as increased pain, swelling, or changes in the nature of the bleeding, seek medical attention promptly.

- Activity Level: While it’s important to remain active, avoid heavy lifting or strenuous activities that could put pressure on the pelvic area during your recovery.

In conclusion, while some bleeding after hemorrhoid banding is normal, prolonged bleeding should be evaluated by a healthcare professional. Discussing your symptoms and treatment options with your doctor will help ensure a smooth recovery and address any concerns you may have.

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