Rubber Band Ligation for Hemorrhoids: Pain and Complications

The rubber band ligation method for hemorrhoids?

Hello Dr.
Ke,
I would like to ask about the rubber band ligation method for hemorrhoids.
During my consultation, the doctor mentioned that I have three internal hemorrhoids.
After the first ligation, I felt no pain but experienced some soreness and pressure for a few hours.
However, after the second ligation, I experienced pain for over 20 hours (I had to lie down to feel somewhat better).
I took several painkillers and had a sitz bath, but the painkillers only alleviated the pain slightly; it was still very painful.
The entire anal area felt hard and painful, with one specific spot being particularly painful (which also affected the area around my thigh).
The pain felt similar to having a severe inflammation of a boil at the anal opening.
My heart would race, and the pain at the ligation site would intensify.
Additionally, less than 24 hours after the first ligation, the rubber band fell out during a bowel movement.
I went back for a re-ligation that same day.
The second ligation also fell out after only 52 hours, despite my careful avoidance of squatting.
After the second ligation, urination became slow; it took one to two minutes to urinate, and I had to take deep breaths while slowly urinating, but I couldn't empty my bladder completely (I had to exert some force).
Now, I find myself needing to go to the bathroom two to three times an hour.
So, I would like to ask if it is common for the rubber band ligation to fall out easily (as articles mention it should fall out in 7-10 days).
My second ligation fell out in less than three days, and the first ligation fell out the next day.
Online articles state that the rubber band ligation method should not be painful, but my second experience was quite painful.
I am unsure if there is an issue.
Thank you for your guidance.

Xiao Xuan, 40~49 year old female. Ask Date: 2012/05/09

Dr. Ke Fangxu reply Surgery

Rubber band ligation will typically fall off about a week after the procedure, but this can vary depending on the depth and size of the ligation.
If the ligation is shallower and the hemorrhoidal tissue is smaller, it may fall off in just a day or two.
Theoretically, rubber band ligation should not be painful because the internal hemorrhoidal tissue does not have a distribution of surface nerves.
However, if the ligation is shallower and affects the dentate line (approximately one centimeter inward from the anal opening), it can lead to the symptoms you described.
Regular warm sitz baths along with oral anti-inflammatory and analgesic medications can help, and recovery typically occurs within about a week.

Reply Date: 2012/05/09

More Info

Rubber band ligation (RBL) is a common and effective procedure for treating hemorrhoids, particularly internal hemorrhoids. It involves placing a small rubber band around the base of the hemorrhoid, cutting off its blood supply, which eventually leads to the hemorrhoid falling off after a few days. While this procedure is generally safe and effective, it can be accompanied by pain and complications, which are important to understand.

Pain After Rubber Band Ligation
Pain is a common experience following RBL, and its intensity can vary from person to person. After the procedure, some patients report mild discomfort, while others may experience significant pain. The pain typically arises from the inflammation and irritation of the surrounding tissues as the body reacts to the ligation. In your case, experiencing severe pain after the second ligation could be attributed to several factors:
1. Individual Pain Threshold: Each person's pain tolerance is different. Some may find the procedure more painful than others.

2. Technique and Placement: The skill of the practitioner and the exact placement of the rubber band can influence the level of discomfort. If the band is placed too tightly or incorrectly, it may cause more pain.

3. Infection or Complications: If the pain is severe and persistent, it could indicate a complication such as an infection or thrombosis (formation of a blood clot) in the hemorrhoid. This could explain the localized pain and discomfort you are experiencing.

Complications of Rubber Band Ligation
While RBL is generally safe, complications can occur. Some of the potential complications include:
1. Severe Pain: As mentioned, some patients may experience significant pain, particularly if there is an underlying issue such as infection or improper ligation.

2. Bleeding: Minor bleeding can occur after the procedure, but if you notice significant bleeding or if the rubber band falls off prematurely, it may warrant further evaluation.

3. Urinary Retention: Difficulty urinating, as you described, can occur due to pain or anxiety related to the procedure. It is essential to monitor this symptom, as prolonged urinary retention can lead to further complications.

4. Infection: If the area becomes infected, it can lead to increased pain, swelling, and discharge. Signs of infection include fever, increased redness, and pus.

What to Do Next
Given your symptoms, it is crucial to follow up with your healthcare provider. Here are some steps you can take:
1. Contact Your Doctor: Inform your doctor about the severe pain, urinary difficulties, and the premature loss of the rubber bands. They may want to examine you to rule out any complications.

2. Pain Management: Continue to manage your pain with over-the-counter pain relievers as recommended by your doctor. Warm sitz baths can also help alleviate discomfort.

3. Monitor Symptoms: Keep track of any changes in your symptoms, including the severity of pain, any signs of infection, or changes in bowel or urinary habits.

4. Follow-Up Care: Ensure you have a follow-up appointment scheduled to monitor your recovery and address any ongoing issues.

Conclusion
Rubber band ligation is a widely used procedure for treating hemorrhoids, but it is not without its challenges. Pain and complications can occur, and it is essential to communicate openly with your healthcare provider about your experiences. By doing so, you can ensure that any potential issues are addressed promptly, leading to a smoother recovery process. Always prioritize your health and seek medical advice when in doubt.

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