Post-Surgery Concerns: Managing Pain and Follow-Up for Hemorrhoid Treatment

Hello, doctor?

Hello, doctor.
I would like to ask you about my situation.
I had a hemorrhoid ligation for a prolapsed internal hemorrhoid on April 27, and today marks the seventh day.
Since today is the first day of my menstrual period, I am unsure if the rubber band and the hemorrhoid have fallen off after using the restroom this morning.
I experienced pain in the previous days, but today the pain is almost gone.
My question is, regardless of how many days have passed, should I not worry about whether it has fallen off?
Additionally, my doctor scheduled a follow-up appointment in about three weeks.
I remember he mentioned that there are two more internal hemorrhoids that need to be ligated.
Can I skip the follow-up appointment, or is it necessary to return for the doctor to check after each ligation? I was thinking of resting for a month before having the second one ligated because the reason I had the first one ligated was that it was causing significant discomfort by constantly prolapsing.

Also, was the severe pain I experienced for about four days due to the severity of the prolapse of this internal hemorrhoid? The other two hemorrhoids are not prolapsed; are they located further inside? Would that make the ligation less painful? I apologize for asking you so many questions.
I am quite worried, and I really appreciate your help.

Xiao Mi, 30~39 year old female. Ask Date: 2020/05/04

Dr. Ke Fangxu reply Surgery

The purpose of hemorrhoid banding is to treat prolapsed or bleeding internal hemorrhoids.
If there are no such symptoms, there is no need for continuous banding with rubber bands.
Patients often worry about when the band will fall off; however, this is not a concern as long as there is no significant bleeding.
Pain from hemorrhoid banding is usually caused by either excessively large hemorrhoids or shallow banding.
Indeed, smaller hemorrhoids tend to be less painful when banded, but they are also less likely to require treatment.

Reply Date: 2020/05/04

More Info

After undergoing a hemorrhoid ligation procedure, it’s understandable to have concerns about pain management, recovery, and follow-up care. Your experience of pain decreasing significantly by the seventh day is a positive sign, indicating that your body is healing. However, it’s essential to address your questions regarding the ligation process and follow-up appointments.

Firstly, regarding whether you need to worry about the ligation falling off, it’s generally not necessary to monitor the ligation closely after the procedure. The rubber band used in the ligation is designed to cut off the blood supply to the hemorrhoid, causing it to shrink and eventually fall off within a week or two. If you are experiencing minimal pain and no significant bleeding, it is likely that the ligation is functioning as intended. However, if you notice any unusual symptoms, such as increased pain, bleeding, or signs of infection (like fever or pus), you should contact your healthcare provider immediately.

As for your follow-up appointment, it is crucial to attend these visits, especially since your doctor mentioned that there are two additional hemorrhoids that require ligation. Follow-up appointments allow your doctor to assess your healing progress and determine the best course of action for any remaining hemorrhoids. Skipping these appointments could lead to complications or inadequate treatment of the remaining hemorrhoids. It’s understandable to want to take a break, but delaying treatment could result in further discomfort or complications down the line.

Regarding your question about the severity of pain associated with the ligation of a prolapsed hemorrhoid, it is common for more severe cases to be more painful. Prolapsed hemorrhoids are those that have protruded outside the anal canal, which can lead to increased discomfort during the ligation process. In contrast, hemorrhoids that are not prolapsed may not cause as much pain during the procedure, as they are still within the anal canal. However, individual pain tolerance varies, and some patients may experience discomfort regardless of the hemorrhoid's position.

In terms of managing pain post-procedure, it’s essential to follow your doctor’s recommendations. Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate discomfort. Additionally, maintaining a high-fiber diet, staying hydrated, and using stool softeners can prevent constipation and straining during bowel movements, which can exacerbate pain and discomfort.

Lastly, if you have concerns about your recovery or the need for additional treatments, don’t hesitate to communicate with your healthcare provider. They can provide reassurance, address your worries, and offer guidance tailored to your specific situation. Remember, your health and comfort are paramount, and seeking clarification from your doctor is always a wise choice.

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