Rubber Band Ligation for Internal Hemorrhoids: Effectiveness and Diagnosis

Hemorrhoid ligation surgery

Hello Doctor, since the beginning of this year, I have undergone three rubber band ligation procedures for grade II hemorrhoids.
Today, I still noticed blood streaks when wiping after a bowel movement and returned for a follow-up.
I would like to ask: 1.
I have now had a total of four ligation procedures, all at different locations.
Does this indicate that the rubber band ligation is ineffective? 2.
Recently, after my last ligation, the doctor mentioned that no other hemorrhoids were found.
However, upon a follow-up examination a month later, the doctor diagnosed an internal hemorrhoid located at the 2 o'clock position relative to the dentate line, stating that this location is less common for hemorrhoids, which is why it was not detected during the previous examination.
I would like to know, when using an anoscope for examination, is it not expected to conduct a comprehensive check? Or is it typical to only examine one area, and further exploration for other locations occurs only if no hemorrhoids are found?

Qiaonasun, 20~29 year old female. Ask Date: 2022/11/18

Dr. Ke Fangxu reply Surgery

1.
Rubber band ligation is not a curative procedure; its primary aim is to reduce significant bleeding.
If the bleeding is reduced to a minor oozing, it can be considered an effective treatment.

2.
After hemorrhoid ligation, it is possible for compensatory swelling to occur in other areas due to disrupted blood flow.
It is common for previously inconspicuous internal hemorrhoids to become swollen after ligation.
If the patient seeks complete removal of hemorrhoidal tissue, then a complete excision of both internal and external hemorrhoids would be the recommended treatment option.

Reply Date: 2022/11/18

More Info

Rubber band ligation (RBL) is a common and effective treatment for internal hemorrhoids, particularly those classified as grade II or III. This procedure involves placing a small rubber band around the base of the hemorrhoid, cutting off its blood supply, which eventually leads to the hemorrhoid shrinking and falling off. While RBL is generally successful, it is not uncommon for patients to experience persistent symptoms, such as bleeding, even after multiple treatments.
In your case, having undergone the procedure four times and still noticing blood after bowel movements raises a few important considerations. First, it is essential to understand that while RBL is effective for many patients, it does not guarantee complete resolution of symptoms for everyone. Factors such as the size, location, and number of hemorrhoids can influence the effectiveness of the treatment. Additionally, the presence of other conditions, such as anal fissures or other types of rectal bleeding, could also contribute to ongoing symptoms.

Regarding your second question about the thoroughness of the examination during the anoscopy, it is important to note that while doctors aim to conduct a comprehensive evaluation, the visibility of certain areas can be limited. Anoscopy typically allows for a direct view of the anal canal and lower rectum, but the position of internal hemorrhoids can vary, and sometimes they may not be easily visible during a single examination. If a hemorrhoid is located in a less common area, such as the 2 o'clock position you mentioned, it might be overlooked if the doctor is not specifically looking for it or if the examination is focused on other areas.

In terms of your ongoing symptoms, it is advisable to follow up with your healthcare provider. They may recommend further diagnostic procedures, such as a flexible sigmoidoscopy or colonoscopy, to rule out other potential causes of rectal bleeding. These procedures allow for a more comprehensive examination of the lower gastrointestinal tract and can help identify any other issues that may not be related to hemorrhoids.

In conclusion, while rubber band ligation is a widely used and effective treatment for internal hemorrhoids, it is not infallible. Persistent symptoms warrant further investigation to ensure that no other underlying conditions are contributing to your bleeding. It is crucial to maintain open communication with your healthcare provider and discuss any concerns you have regarding your symptoms and treatment options. They can provide personalized advice and may suggest alternative treatments or additional diagnostic tests to address your ongoing issues.

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