Rubber Band Ligation for Hemorrhoids: Common Concerns and FAQs

Rubber band ligation

Hello Doctor: In May of this year, I experienced pain around the anus and saw a doctor who diagnosed me with external and internal hemorrhoids.
I have undergone rubber band ligation twice, but the second procedure was very painful, and the next day during a bowel movement, I noticed one of the rubber bands had fallen off.
When I called the nurse for clarification, she mentioned that there should still be another band inside.
On the second and third days, I noticed a small amount of blood oozing when I wasn't having a bowel movement, and the area on the right side of the anus was particularly swollen and painful.
I examined the anal area and saw that there was originally a dark purple hemorrhoid on the right side, which seemed to have shrunk, and the source of the bleeding and pain appeared to be from there.
It has now been four days since the rubber band ligation.
Doctor, may I ask:
1.
Is the hemorrhoid wound I see on the right side inside the anus an internal hemorrhoid? It is more swollen and painful and is bleeding a bit; could this be related to the rubber band ligation? However, I don't see the rubber band, so is it possible that both have fallen off? Would this be considered a failure?
2.
After the third day, I have been applying medication, and the pain has somewhat eased, but after bowel movements in the following hours, I still experience slight pain at the anal opening.
I am unsure if this pain is from the hemorrhoids or the wound; is this normal?
3.
After the first ligation, I noticed that the inside of the anus on the right side repeatedly developed skin tears, sometimes in two places.
The doctor said that this was due to the hemorrhoids tearing.
This time, the swollen and painful area on the right side has not healed, but my bowel movements are not very hard.
What should I do? Is it because I have both internal and external hemorrhoids that it leads to skin tears? Is there a difference between skin tears around the anus and those caused by hemorrhoids? What is the best way to treat these skin tears?
4.
Since my consultation, the doctor has only used an anoscope and has not performed a visual or digital examination; is this acceptable? I apologize for asking so many questions, and I appreciate your time in answering them.
Wishing you all the best.

Xiao Xiao, 30~39 year old female. Ask Date: 2013/11/05

Dr. Ke Fangxu reply Surgery

1.
The target of rubber band ligation therapy is the internal hemorrhoids, with the aim of stopping bleeding or improving prolapse.
Therefore, the wound you see should be at the original location of the internal hemorrhoids.
The rubber bands are typically ligated in pairs and usually fall off about a week after the procedure, although they may also fall off two days earlier or later, so this is not considered a failure.
2.
It is common to experience pain if the ligation site is closer to the anal opening.
As long as the pain is not severe, taking oral pain relievers along with warm sitz baths is generally sufficient.
3.
The so-called "skin breakdown" is difficult to assess without a direct examination.
However, it is not advisable to constantly "check" the condition of the anus to avoid causing infection or additional wounds.
As long as there is no severe pain, fever, or bleeding, it should be fine.
Regular warm sitz baths and applying hemorrhoid ointment externally should promote gradual healing.
4.
An anoscope is an appropriate tool for examining the internal anal area and checking the ligation site.
While a digital rectal exam can also be helpful, its effectiveness depends on the individual physician's preferences, and there is no definitive right or wrong regarding its use.

Reply Date: 2013/11/05

More Info

Rubber band ligation is a common procedure used to treat hemorrhoids, particularly internal hemorrhoids. It involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and eventually fall off. While this procedure is generally safe and effective, patients often have concerns and questions regarding the process and recovery.
1. Understanding the Pain and Bleeding: It’s not uncommon to experience some pain and bleeding after the procedure. The pain you felt during the second ligation could be attributed to the sensitivity of the area, especially if the hemorrhoids are inflamed or if there are multiple hemorrhoids present. The bleeding you noticed after bowel movements could be due to the ligation itself or irritation from the procedure. If the rubber band has fallen off, it’s possible that the ligation was not fully successful, but this does not necessarily mean the procedure was a failure. It’s important to monitor the situation and communicate with your healthcare provider about any ongoing symptoms.

2. Identifying the Source of Pain: The pain you feel after bowel movements could be due to several factors: the healing process of the ligation site, irritation from the stool, or ongoing issues with the hemorrhoids themselves. It’s essential to keep the area clean and avoid straining during bowel movements, as this can exacerbate pain and lead to further irritation. If the pain persists or worsens, it would be advisable to consult your doctor for further evaluation.

3. Skin Breakdown and Healing: The repeated skin breakdown you mentioned could be related to the presence of both internal and external hemorrhoids. Hemorrhoids can cause friction and irritation, leading to skin breakdown, which may appear as fissures or tears. The distinction between anal fissures and hemorrhoids is important; fissures are typically painful and can bleed, while hemorrhoids may cause discomfort but are usually less painful unless thrombosed. Treatment for skin breakdown often includes maintaining good hygiene, using topical treatments to promote healing, and avoiding irritants. Your doctor may recommend specific ointments or creams to help with healing.

4. Diagnostic Procedures: The use of an anoscope for examination is standard practice for assessing hemorrhoids. While a visual inspection and digital examination can provide additional information, the anoscope allows for a more thorough evaluation of the rectal and anal canal. If you feel that your concerns have not been fully addressed, or if your symptoms persist, it may be worthwhile to discuss further diagnostic options with your healthcare provider.

In summary, while rubber band ligation is a common and generally effective treatment for hemorrhoids, it can come with discomfort and complications. It’s crucial to maintain open communication with your healthcare provider regarding your symptoms and any concerns you may have. They can provide guidance tailored to your specific situation, including pain management strategies and recommendations for further treatment if necessary. Remember that recovery can take time, and it’s essential to be patient with the healing process while also taking proactive steps to manage your symptoms.

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