Complications After Rubber Band Ligation for Hemorrhoids

Are there any complications associated with hemorrhoid ligation surgery?

Hello Dr.
Ke: I have five internal hemorrhoids.
A doctor in Taipei said that three of them are more severe, and one even shows signs of prolapse.
I originally scheduled surgery for the end of October.
However, after a relative recommended a doctor in Taoyuan who only uses rubber band ligation, I canceled the surgery.
After seeing the doctor in Taoyuan, he said the same as the doctor in Taipei but only performed the rubber band ligation.
During a recent follow-up, the doctor mentioned that the previous wound had not healed, and the remaining two hemorrhoids have not improved, so treatment is not necessary for now.
He advised that if there is any bleeding during bowel movements, I should return for a check-up.
Currently, I am experiencing intermittent pain on the left side of my anal area (similar to the pain of a bruise being pressed).
Is this normal? Additionally, there is a small flesh lump around my anus that was present before the rubber band ligation.
The doctor in Taoyuan said that it is not a concern.
Should I ignore this lump? Do the remaining two internal hemorrhoids really need to heal before treatment, as the doctor in Taoyuan suggested? Also, once the hemorrhoids are treated, how long should I wait before getting checked for recurrence? Thank you for your help, Dr.
Ke.

ann, 30~39 year old female. Ask Date: 2013/11/01

Dr. Ke Fangxu reply Surgery

The purpose of rubber band ligation for hemorrhoids is to stop bleeding, and it can also be used to treat mild prolapse.
Whether to continue treatment depends on the presence of these symptoms.
If the symptoms are mild, there is indeed no need for further ligation.
It is also normal to experience slight pain and a feeling of fullness after the procedure.
Frequent ligation is not recommended, as it can affect the healing of the ligation sites, and the National Health Insurance Administration mandates that there must be an interval of at least two weeks between procedures.
Regarding the issue of recurrence, I always inform patients that if they do not maintain good lifestyle and bowel habits, recurrence is inevitable.
This is a key difference between ligation and surgical intervention.

Reply Date: 2013/11/01

More Info

Rubber band ligation (RBL) is a common and effective procedure for treating hemorrhoids, particularly internal hemorrhoids. While it is generally safe, there are potential complications and side effects that patients should be aware of following the procedure.
Firstly, it is important to understand that after RBL, some discomfort is expected. The pain you are experiencing on the left side of your anus, described as a bruised feeling, can be a normal response to the procedure. This discomfort typically arises from the ligation of the hemorrhoids, which can cause inflammation and irritation in the surrounding tissues. The pain should gradually decrease over time as the area heals. However, if the pain becomes severe or is accompanied by other symptoms such as significant bleeding, fever, or signs of infection, it is crucial to seek medical attention.

Regarding the small "meatball" or tag you mentioned, it is not uncommon for patients to have skin tags or residual tissue after hemorrhoid treatment. These tags can be benign and may not require treatment unless they become symptomatic or bothersome. Your doctor’s reassurance that it is not a concern is likely based on its appearance and lack of associated symptoms. However, if you notice changes in size, color, or if it becomes painful, it would be wise to have it evaluated again.

As for the remaining internal hemorrhoids, it is generally advisable to allow the area to heal before considering further treatment. Healing time can vary, but it is typically recommended to wait several weeks to a few months after RBL before reassessing the need for additional procedures. This waiting period allows the tissues to recover and can help in determining the effectiveness of the initial treatment.

In terms of follow-up care, once your hemorrhoids are treated, it is important to monitor for any signs of recurrence. Many patients may not experience a recurrence for years, but it is advisable to have a follow-up examination within 6 to 12 months after treatment to ensure that everything is healing properly and to check for any new developments. Regular check-ups can help catch any potential issues early.

Additionally, lifestyle modifications can play a significant role in preventing the recurrence of hemorrhoids. Maintaining a high-fiber diet, staying hydrated, and avoiding straining during bowel movements can help reduce the risk of developing hemorrhoids again. Regular exercise and avoiding prolonged sitting can also be beneficial.

In summary, while some discomfort and minor complications can occur after rubber band ligation for hemorrhoids, these are often manageable and resolve with time. It is essential to follow your doctor's advice regarding healing and to keep an eye on any changes in your symptoms. Regular follow-ups and lifestyle adjustments can significantly contribute to your overall recovery and help prevent future issues. If you have any concerns or if your symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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