Hemorrhoid Banding: When Symptoms Persist After Surgery

Sterilization Issues

Hello Dr.
Ke, I have been experiencing a feeling of incomplete bowel movements, and I notice that the hemorrhoids protrude but retract on their own, without any bleeding.
After a clinic evaluation, I was diagnosed with grade II hemorrhoids and scheduled for rubber band ligation surgery.
Since early November, I have undergone this procedure three times, but I am still facing issues with the protrusion during bowel movements.
I would like to know if the symptoms can persist even after completing the ligation surgeries.
Would I need to undergo further surgery, or are there other treatment options available? Thank you.

binghuan, 30~39 year old female. Ask Date: 2022/12/27

Dr. Ke Fangxu reply Surgery

If hemorrhoids are not accompanied by persistent bleeding or severe pain, surgical treatment is not necessary.
If there is prolapse, surgery is generally more effective.
If it does not affect daily life, surgical removal is also not required.
Rubber band ligation can temporarily alleviate symptoms but is not a definitive cure.
It is advisable to discuss with your physician in detail before deciding on further treatment options.

Reply Date: 2022/12/27

More Info

Hemorrhoid banding, also known as rubber band ligation, is a common procedure used to treat hemorrhoids, particularly internal hemorrhoids. This minimally invasive technique involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and eventually fall off. While many patients experience relief from symptoms after this procedure, it is not uncommon for some to continue experiencing issues even after multiple banding sessions, as you have described.

In your case, the persistent sensation of incomplete evacuation and the protrusion of hemorrhoids after three banding procedures could be attributed to several factors. First, it is important to understand that hemorrhoids can be classified into different grades, and while banding is effective for grade I and II hemorrhoids, more severe cases (grade III and IV) may require more invasive surgical interventions. If your hemorrhoids are still protruding after banding, it may indicate that the hemorrhoids are more advanced than initially assessed, or that there are additional hemorrhoids that have not been treated.

Another possibility is that the symptoms you are experiencing may not solely be due to hemorrhoids. Conditions such as anal fissures, rectal prolapse, or even pelvic floor dysfunction can mimic hemorrhoid symptoms. Therefore, it is crucial to have a thorough evaluation by a healthcare professional, preferably a gastroenterologist or a colorectal surgeon, to rule out other potential causes of your symptoms.

If the banding procedure has not resolved your symptoms, there are several options to consider. First, lifestyle modifications can play a significant role in managing hemorrhoid symptoms. Increasing dietary fiber intake, staying well-hydrated, and avoiding straining during bowel movements can help alleviate symptoms. Over-the-counter treatments, such as topical creams or suppositories, may also provide temporary relief.

If conservative measures fail and your symptoms persist, surgical options may be necessary. These can include procedures such as hemorrhoidectomy, which involves the surgical removal of hemorrhoids, or other techniques like stapled hemorrhoidopexy, which can be effective for more advanced cases. Your healthcare provider can discuss the risks and benefits of these procedures based on your specific situation.

In summary, while hemorrhoid banding is an effective treatment for many, it is not a one-size-fits-all solution. Persistent symptoms after multiple banding sessions warrant further evaluation to determine the underlying cause and appropriate treatment options. It is essential to communicate openly with your healthcare provider about your symptoms and concerns to ensure you receive the best possible care.

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