Can Rubber Band Ligation Help Grade 3-4 Hemorrhoids?

Can hemorrhoids between grade three and grade four be treated with ligation therapy?

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 constant sensation of fullness at the anal area, as if there is something lodged there.
It's quite difficult to find time for surgery since I have to work.
I've heard that hemorrhoids can be treated with ligation.
I'm wondering if this method is suitable for my severe hemorrhoids to alleviate the discomfort? Thank you, doctor.

Kevin, 30~39 year old female. Ask Date: 2007/06/01

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 prolapsed external hemorrhoid, the results may be poor, and it could lead to severe pain.
This is because the principle of hemorrhoid ligation relies on the fact that internal hemorrhoids lack nerve supply, thus they do not cause pain.
If external hemorrhoids are present, it can result in excruciating pain, making ligation impossible.

If the hemorrhoids are large enough that they need to be manually pushed back in, traditional surgical treatment is likely to be the most effective option.
Although it may be somewhat inconvenient, surgical intervention typically yields the best results and minimizes the risk of recurrence.
I recommend setting aside a week for the surgical treatment for optimal outcomes.

Reply Date: 2007/06/01

More Info

Rubber band ligation (RBL) is a common and effective treatment for hemorrhoids, particularly for grade 1 and 2 hemorrhoids. However, when it comes to grade 3 and 4 hemorrhoids, the situation becomes more complex. Grade 3 hemorrhoids are characterized by prolapse during bowel movements but can be manually reduced, while grade 4 hemorrhoids are permanently prolapsed and cannot be reduced.
In your case, with symptoms indicating a mix of grade 3 and 4 hemorrhoids, rubber band ligation may not be the most suitable treatment option. While RBL can provide relief for some patients, it is generally more effective for hemorrhoids that can still be reduced and are not permanently prolapsed. The procedure involves placing a rubber band around the base of the hemorrhoid, cutting off its blood supply, which leads to its eventual shrinkage and detachment. However, for grade 4 hemorrhoids, surgical intervention is often recommended because the hemorrhoids are too large and have lost their ability to retract, making RBL less effective.

Moreover, the discomfort and symptoms you describe, such as the feeling of a lump in the anal area and the inability to find time for surgery, suggest that your condition may require a more definitive surgical approach. Surgical options for grade 3 and 4 hemorrhoids include hemorrhoidectomy, which involves the surgical removal of the hemorrhoids, or other procedures like stapled hemorrhoidopexy, which can be less invasive and may allow for quicker recovery.

It’s important to consult with a colorectal surgeon or a gastroenterologist who can evaluate your specific situation and recommend the best course of action. They can provide insight into the severity of your hemorrhoids and discuss the potential benefits and risks of various treatment options, including RBL and surgical procedures.
In addition, lifestyle modifications can also play a significant role in managing hemorrhoid symptoms. Increasing dietary fiber, staying hydrated, and avoiding straining during bowel movements can help alleviate some discomfort. Over-the-counter treatments, such as topical creams or suppositories, may provide temporary relief as well.

In summary, while rubber band ligation can be a useful treatment for certain grades of hemorrhoids, your grade 3-4 condition may necessitate a more comprehensive surgical approach. It’s crucial to have a thorough discussion with your healthcare provider to determine the best treatment plan tailored to your needs.

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