Recovery After Rubber Band Ligation for Hemorrhoids

Recovery issues after hemorrhoid banding?

Hello Doctor: I have already undergone the second rubber band ligation procedure.
The doctor assessed that I have grade 2.3 hemorrhoids, and a total of three ligations are required.
I had the second procedure about 18 days after the first, and my recovery has been quite good, with only some discomfort on the first day.
However, I have a question: even after the second ligation, why do I still see the same amount of protruding tissue during bowel movements as I did before the surgery? Generally, after the assessment, the doctor indicated that three procedures are necessary.
Does this mean that I will only see a reduction in the protruding tissue after the final ligation and its recovery? It is quite bothersome to have to push the tissue back in after each bowel movement, which is why I sought treatment.
If, after the treatment, I still have to push it back in, wouldn't that render the procedures ineffective? Since my follow-up appointment is not yet due, I hope to get some answers here.
Thank you for your assistance!

pony, 40~49 year old female. Ask Date: 2023/02/21

Dr. Zhang Shuhao reply Surgery

The protrusion of a hemorrhoid after a bowel movement indicates a prolapsed internal hemorrhoid.
If prolapse persists after ligation of the internal hemorrhoid, it is often due to the ligation being positioned too far from the base of the hemorrhoid or the size of the hemorrhoid being too large, which can lead to continued prolapse even after ligation.
These two scenarios suggest that surgical intervention may be more appropriate than ligation for your type of internal hemorrhoids.
However, even if the ligation is not complete, there may still be partial symptom improvement after the ligation site heals and forms scar tissue, typically within two to four weeks.
You can discuss your most bothersome symptoms with your doctor at your next appointment to adjust the treatment strategy as needed.

Reply Date: 2023/02/21

More Info

After undergoing rubber band ligation for hemorrhoids, it's understandable to have concerns about the recovery process and the effectiveness of the treatment. Rubber band ligation is a common procedure used to treat hemorrhoids, particularly those that are classified as grade II or III. The procedure involves placing a rubber band around the base of the hemorrhoid, which cuts off its blood supply, causing it to shrink and eventually fall off.

In your case, having undergone the procedure twice with a third planned, it is not uncommon to still experience some protrusion of tissue during bowel movements. This can be attributed to several factors:
1. Healing Process: After each ligation, the tissue needs time to heal. The body may still be adjusting, and the full effects of the procedure may not be immediately apparent. It is important to allow adequate time for healing between procedures.

2. Inflammation and Swelling: Post-procedure inflammation can cause the tissue to remain swollen, which might make it appear as if the hemorrhoids have not improved. This is a normal part of the healing process.

3. Multiple Treatments: As your doctor mentioned, it often takes multiple sessions to achieve the desired outcome, especially for more severe cases. Each session builds on the previous one, and it is not unusual for symptoms to persist until the final treatment is completed.

4. Bowel Habits: Straining during bowel movements can exacerbate the condition. It's crucial to maintain soft stools and avoid straining, as this can lead to further protrusion of hemorrhoidal tissue. A high-fiber diet, adequate hydration, and possibly stool softeners can help manage this.

5. Post-Operative Care: Following the procedure, it is essential to follow your doctor's post-operative care instructions. This may include recommendations for pain management, hygiene, and dietary adjustments to facilitate recovery.

Regarding your concern about needing to "push back" the tissue after bowel movements, this can be frustrating. However, it is important to remember that the goal of the rubber band ligation is to reduce the size of the hemorrhoids over time. If you continue to experience significant discomfort or if the tissue does not seem to improve after your final ligation, it would be advisable to discuss this with your doctor during your follow-up appointment.

In summary, while it may seem that the treatment has not yet yielded the desired results, it is essential to give your body time to heal and to follow through with the planned treatment schedule. If you have any concerns or if symptoms persist, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. Your comfort and recovery are paramount, and your doctor can provide the best advice tailored to your specific situation.

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