Rubber Band Ligation for Hemorrhoids: Post-Procedure Concerns

Rubber band ligation for hemorrhoids?

Hello, Dr.
Ke.
I underwent rubber band ligation for hemorrhoids around 6:30 PM on April 20.
I have a few questions:
1.
I did not have a bowel movement on April 21, but on April 22 around 12:30 PM, I had a bowel movement.
There was no bright red blood, but the stool had a stronger odor, which I am unsure if it was bloody or just a more intense version of the odor I experienced before the procedure.
Is this normal?
2.
After the rubber band ligation, I experienced pain for the first few hours, but it subsided the next day.
I only felt discomfort as if there was something inside the anal area.
After the bowel movement on April 22, I felt a sharp pain, but the discomfort was gone.
Is it normal to experience this sharp pain? Does this mean the hemorrhoid has already fallen off? Is it possible for it to fall off so quickly, within two days?
3.
On the night of the procedure, the doctor advised me not to worry and to use a suppository before bed.
However, due to the pain, I was concerned about dislodging the rubber band and worsening the injury, so I paused the hemorrhoid suppository for two days (April 20 and 21).
I would like to use the suppository again tonight, April 22, since there is still one internal hemorrhoid that hasn’t been ligated.
Is it okay to do so, or should I wait until the ligated hemorrhoid has fully healed before continuing with the suppository?
4.
The doctor mentioned that we would decide on the other hemorrhoid ligation in two weeks based on the situation.
In fact, I had already been using the suppository for a week before the follow-up on April 20, and the bleeding had stopped.
There was only one instance of a few drops of blood with a larger stool.
I am a bit anxious about the rubber band ligation.
If I see improvement, should I continue using the suppository, or is the rubber band ligation a more effective method for treatment? Thank you.

Mr. Feng, 40~49 year old female. Ask Date: 2021/04/22

Dr. Ke Fangxu reply Surgery

1.
It should be normal.

2.
Whether it falls off normally is not important; as long as there is no bleeding, it should be fine.

3.
Yes.

4.
You can continue using the suppository.
Rubber band ligation, like suppositories, is not a curative method; as long as there is no ongoing bleeding, ligation may not need to be repeated.

Reply Date: 2021/04/22

More Info

After undergoing rubber band ligation for hemorrhoids, it's common to have various concerns regarding post-procedure symptoms and recovery. Let's address your questions one by one.

1. Bowel Movements and Odor: It's not unusual for your bowel movements to have a different odor after the procedure. The presence of a stronger or unusual smell can be attributed to several factors, including dietary changes, the healing process, or even the presence of any residual tissue. As long as you did not notice any fresh blood, this is likely a normal part of your recovery. However, if you experience significant changes in your bowel habits or if the odor is accompanied by other symptoms like fever or severe pain, it would be wise to consult your physician.

2. Pain and Discomfort: Experiencing discomfort or a sensation of pressure in the anal area after rubber band ligation is typical. The procedure can cause some irritation and inflammation, which may lead to a feeling of having something in the rectum. The sharp pain you felt after your bowel movement could be due to the ligation site being irritated or the hemorrhoid itself being in the process of falling off. It is indeed possible for the hemorrhoid to detach within a few days post-procedure, but this varies from person to person. If the pain persists or worsens, or if you notice any unusual bleeding, it’s advisable to reach out to your healthcare provider.

3. Use of Suppositories: It's understandable to be cautious about using suppositories after your procedure. If your doctor advised you to use them, it’s generally safe to resume their use unless you are experiencing significant pain or discomfort. However, since you have already paused for a couple of days, it may be best to consult your physician before reintroducing the suppository, especially since you have a hemorrhoid that has not been treated yet. They can provide personalized advice based on your current condition.

4. Follow-Up and Treatment Options: Your doctor’s recommendation to reassess the need for further ligation after two weeks is standard practice. If you notice improvement in your symptoms and minimal bleeding, continuing with the suppositories may be sufficient for managing your condition. Rubber band ligation is often considered a more definitive treatment for hemorrhoids compared to topical treatments like suppositories, as it directly addresses the hemorrhoid by cutting off its blood supply. However, the best course of action depends on your specific situation and how well you respond to the current treatment.

In summary, while some discomfort and changes in bowel habits are expected after rubber band ligation, it's essential to monitor your symptoms closely. If you have any concerns, especially regarding pain, bleeding, or changes in bowel movements, do not hesitate to contact your healthcare provider for further evaluation and guidance. They can help ensure that your recovery is on track and that any necessary adjustments to your treatment plan are made.

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