Post-Banding Pain and Discomfort After Hemorrhoid Treatment

It has been a week since the rubber band ligation for internal hemorrhoids, and there is still soreness and pain?

Hello Dr.
Ke,
I have been experiencing bleeding from internal hemorrhoids.
I underwent ligation twice at a large hospital over ten years ago.
In the past three to four years, I have had episodes of "painless" bleeding approximately every 2 to 3 months, sometimes with splattered blood in the toilet.
This time, the bleeding seems to be closer to the anal area.
I find that rinsing with warm water while having a bowel movement helps alleviate the pain, although there is still slight bleeding.
The next day, I experienced a strong acidic bloating sensation and a persistent urge to urinate.
It has been a week since then; while the bleeding is not as intense as immediately after the procedure, I visited a nearby rectal clinic on October 14, where the doctor performed a ligation.
In the past, I only experienced mild discomfort on the first day, but this time, the bloating, pain, and acidity are much more intense.
The first night was very uncomfortable, and the doctor prescribed pain relief, anti-inflammatory medication, and the hemostatic agent tranexamic acid for three days, advising me not to have a bowel movement within 24 hours and to soak in warm water to relieve discomfort.
The day after the ligation, using the restroom was very painful, and I used a handheld showerhead to soothe the soreness and bloating around the anus.
However, for the past few days, having bowel movements, passing gas, or even anal contractions have been painful.
I still need to use the handheld showerhead to rinse the area with warm water while having a bowel movement to avoid pain, and this has happened several times.
There have been moments when I felt a persistent acidic sensation and an urge to urinate.
Over the last two days, I purchased a topical treatment for hemorrhoids and applied it with gloved fingers, reaching the ligation site, but I found that the painful area is not at the ligation site itself.
Instead, it seems to be slightly raised blood vessels near the anal opening that are very painful.

I wonder if this is due to increased pressure in the surrounding blood vessels because of the ligation, as the blood has nowhere to flow.
Will this condition naturally heal and improve over time? Will the currently painful blood vessels eventually recover and stop hurting? If the pain persists, what would you recommend? I somewhat regret having the ligation done this time, as it has been quite painful.

WEN, 50~59 year old female. Ask Date: 2023/10/20

Dr. Ke Fangxu reply Surgery

If the ligation of hemorrhoids is done at a shallower depth, it may lead to discomfort.
Generally, the symptoms will subside as the wound heals.
During this period, taking warm sitz baths and applying ointment can help.
If the pain is severe, oral medications can also be used to alleviate symptoms.
It is important to avoid constipation and spicy or irritating foods during this time.
Recovery typically takes about two weeks.

Reply Date: 2023/10/20

More Info

Post-banding pain and discomfort following hemorrhoid treatment, particularly after procedures like rubber band ligation, can be a common experience for many patients. The symptoms you are describing, including significant pain, a feeling of pressure, and a burning sensation, are not unusual after such a procedure. Here’s a comprehensive understanding of your situation and some recommendations based on medical knowledge.

Understanding Your Symptoms
1. Pain and Discomfort: After a rubber band ligation, it is typical for patients to experience varying degrees of pain and discomfort. This is due to the body's response to the procedure, which involves cutting off blood supply to the hemorrhoid, leading to its eventual necrosis and shedding. The pain can be exacerbated by bowel movements, as straining can put additional pressure on the area.

2. Pressure and Urgency: The sensation of needing to urinate frequently, along with the feeling of pressure, can be attributed to irritation of the surrounding tissues or nerves in the anal region. This can occur after any surgical intervention in the area, as swelling and inflammation can affect nearby structures.

3. Swelling and Bruising: The presence of swelling and a feeling of fullness or pressure around the anal area may indicate localized inflammation or even a hematoma (a collection of blood outside of blood vessels). While some swelling is expected, significant or worsening swelling should be monitored.

Recommendations for Management
1. Pain Management: Continue to use the prescribed pain medications as directed. If the pain is not adequately controlled, it is essential to communicate this with your healthcare provider, as they may need to adjust your medication or explore other pain management strategies.

2. Sitz Baths: Regular sitz baths can help alleviate discomfort. Soaking in warm water for 15-20 minutes several times a day can promote blood flow to the area, reduce swelling, and provide symptomatic relief.

3. Avoid Straining: It is crucial to avoid straining during bowel movements. Consider using a stool softener or increasing your dietary fiber intake to ensure softer stools, which can help minimize pain during bowel movements.

4. Topical Treatments: While you mentioned using a topical hemorrhoid cream, it is advisable to consult your physician before applying any new treatments. Some creams may provide temporary relief, but they should not interfere with the healing process.

5. Monitoring Symptoms: Keep an eye on your symptoms. If you notice increased pain, fever, or any signs of infection (such as pus or increased redness), it is essential to seek medical attention promptly.

6. Follow-Up Care: Since you are experiencing significant discomfort, it may be beneficial to schedule a follow-up appointment with your healthcare provider. They can assess the area for any complications, such as a hematoma or infection, and provide additional treatment options if necessary.

Conclusion
While the discomfort you are experiencing is concerning, it is often a part of the healing process following hemorrhoid treatment. Most patients find that their symptoms gradually improve over time. However, if your pain persists or worsens, or if you have any other concerns, do not hesitate to reach out to your healthcare provider for further evaluation and management. Remember, your comfort and recovery are paramount, and there are various strategies available to help you through this healing phase.

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