Rubber Band Ligation for Hemorrhoids: Patient FAQs

Rubber band ligation for hemorrhoids?

Hello Dr.
Ke.
I am following up on question #167564.
I underwent rubber band ligation for hemorrhoids on April 20, and during my follow-up on April 27, the doctor confirmed that the ligated hemorrhoid had fallen off and the wound was healing normally.
Since the doctor mentioned that there was still one hemorrhoid left, I returned for another follow-up on May 4.
After examination, the doctor diagnosed that the remaining hemorrhoid was slowly shrinking, but a new small one had developed in another location.
The doctor initially suggested another ligation, but I requested to try medication first, so no ligation was performed that day, and I will return for a follow-up on May 11.

I have the following questions for you, Dr.
Ke:
1.
Based on the answer to question #167564, I have not experienced any bleeding during bowel movements, and I informed the doctor of this on May 4.
The doctor continues to recommend ligation, noting that both suppositories and ligation are not curative methods.
If I do not experience any bleeding before my follow-up on May 11, should I continue to refuse the doctor's recommendation for ligation? I have read that rubber band ligation carries some risk of complications.
2.
Since the day I was diagnosed with hemorrhoids, I have changed my lifestyle habits, including avoiding alcohol, spicy foods, and coffee, only having bowel movements when I feel the urge, not straining, limiting each session to no more than 10 minutes, washing with warm water after bowel movements, and taking warm sitz baths twice a day, as well as increasing my fiber intake.
However, the day before my May 4 follow-up, I had to drink alcohol at a social event (about one bottle of red wine per person).
Could this be a reason for the new hemorrhoid? What other methods can I use for prevention?
3.
If I do not experience any bleeding before May 11 and my bowel movements are normal, can I choose not to return for a follow-up, cancel my appointment, and buy the suppositories from a pharmacy to use for another two weeks? I have found a pharmacy that sells the same suppositories prescribed by the doctor.
I have read that if hemorrhoids are not bleeding, continuing to use the suppositories for two more weeks may yield better results.
Is this correct?
Thank you, Dr.
Ke, for addressing my questions.

Feng Xiansheng, 40~49 year old female. Ask Date: 2021/05/06

Dr. Ke Fangxu reply Surgery

1.
The indication for rubber band ligation is bleeding that cannot be controlled by medication.
If there is no bleeding, what is the purpose of the ligation? Personally, I would not recommend performing the ligation again.

2.
It is normal for there to be multiple hemorrhoidal tissues, especially after ligation, as the rerouting of blood flow can cause other hemorrhoids to become more swollen.
3.
Follow-up visits may not be necessary if there is no ongoing bleeding.
The use of anticoagulants is not mandatory; after all, simply adding a couple of weeks won't necessarily prevent further bleeding.
It is more practical to pay attention to diet, lifestyle, and bowel habits.

Reply Date: 2021/05/06

More Info

Rubber band ligation is a common and effective treatment for hemorrhoids, particularly for those that are symptomatic. It involves placing a small rubber band around the base of the hemorrhoid, cutting off its blood supply, which eventually causes the hemorrhoid to shrink and fall off. While this procedure is generally safe, it does come with potential risks and complications, which is important to consider when making decisions about further treatment.

1. Regarding the Decision to Refuse Further Rubber Band Ligation: If you have not experienced any bleeding since your last treatment and your doctor has confirmed that the previous hemorrhoid has fallen off and is healing well, it may be reasonable to consider postponing further ligation. However, it is crucial to weigh the benefits against the risks. While rubber band ligation is effective, it is not a guaranteed cure, and new hemorrhoids can develop, especially if lifestyle factors that contribute to their formation are not addressed. If your doctor recommends ligation for the new hemorrhoid, it is likely because they believe it could prevent future complications. If you feel comfortable with your current symptom management and lifestyle changes, you might choose to monitor the situation closely before proceeding with additional treatment.

2. Lifestyle Changes and Their Impact: The changes you have made to your lifestyle—such as avoiding alcohol, spicy foods, and coffee, as well as ensuring you only go to the bathroom when you have the urge and not straining—are all positive steps in managing hemorrhoids. However, it is possible that consuming alcohol, even occasionally, could contribute to the development of new hemorrhoids, as it can lead to dehydration and constipation in some individuals. To further prevent the formation of new hemorrhoids, consider increasing your fiber intake, staying well-hydrated, and maintaining a regular exercise routine. These measures can help ensure softer stools and reduce the strain during bowel movements, which is crucial in preventing hemorrhoids.

3. Self-Medication and Follow-Up: If you continue to have normal bowel movements without bleeding leading up to your next appointment, it may be tempting to skip the follow-up and self-medicate with over-the-counter suppositories. While this can be a reasonable approach for managing mild symptoms, it is essential to consult with your healthcare provider before making such decisions. They can provide guidance on the appropriate use of medications and ensure that you are not overlooking any underlying issues. Additionally, self-medicating without professional oversight can sometimes mask symptoms that may require further evaluation.

In summary, while rubber band ligation is a common treatment for hemorrhoids, the decision to undergo further procedures should be made based on your current symptoms, lifestyle changes, and professional medical advice. Maintaining open communication with your healthcare provider is crucial for managing your condition effectively. If you have concerns about the development of new hemorrhoids or the effectiveness of your current treatment plan, do not hesitate to discuss these with your doctor during your next visit. They can provide tailored recommendations based on your specific situation and health history.

Similar Q&A

Understanding Rubber Band Ligation for Hemorrhoids: Common Concerns

Hello Dr. Ke, I underwent rubber band ligation for hemorrhoids (stage II hemorrhoids) on March 15. On March 19, I noticed that the rubber band had fallen off while using the restroom. Q1: Will this render the procedure ineffective? Q2: After the rubber band ligation, I experi...

Dr. Ke Fangxu reply Surgery
1. The detachment of the rubber band is inevitable and does not require excessive concern. 2. If the ligation of hemorrhoids is too superficial, it may cause pain; however, if oral pain relievers can alleviate it, then it is not a problem. It is recommended to take warm sitz bath...

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.

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...

Can Rubber Band Ligation Help Grade 3-4 Hemorrhoids?

Hello doctor, I have had hemorrhoids for several years, and they seem to be between grade three and four. I usually don't experience bleeding when using the restroom, but I do feel a lot of swelling. After each bowel movement, I can push the hemorrhoids back in, but I feel a...

Dr. Ke Fangxu reply Surgery
Hello, In response to your question regarding the treatment of hemorrhoids, there is indeed a ligation method available; however, it may not be suitable for your situation. Hemorrhoid ligation is only appropriate for patients with bleeding internal hemorrhoids. If there is a pr...