Pain and Complications After Rubber Band Ligation

Q: Pain and Complications After Rubber Band Ligation

Hello： 1. <br>Internal hemorrhoids typically do not cause pain. <br>The purpose of rubber band ligation is to obstruct blood flow to the internal hemorrhoid, leading to thrombosis and subsequent detachment. <br>Common complications after rubber band ligation include： pain (occurr

Why does tying with rubber bands hurt so much?!

Hello, Doctor.
I have some questions I would like to ask:
1.
After undergoing rubber band ligation, I experience significant pain, especially during bowel movements, which feels like a sharp cutting pain.
The pain persists for several minutes after defecation and usually takes about a week to improve.
Isn't it common for patients to experience less pain after rubber band ligation? Is my situation normal?
2.
On the third day after the ligation, I noticed a long, linear wound near the external hemorrhoid at the anal opening.
Is this the ligation site? Shouldn't the wound from internal hemorrhoid ligation only appear after the hemorrhoid falls off? Also, is it normal for the wound to be located so externally? Shouldn't it be a circular wound? Why do I have a linear wound that looks like a tear?
3.
I have undergone ligation three times, and the rubber bands from the last two procedures fell off the next day (I only saw one).
Will this affect the outcome of the ligation? During the third procedure, the doctor asked me to return for a follow-up, stating that there was still one hemorrhoid left, but I am not experiencing any bleeding now.
Do I need to undergo another ligation?
4.
I had the third ligation on August 10, and as of today (August 18), I still experience slight itching after bowel movements.
What could be the reason for this?
Thank you, Doctor, for taking the time to respond.

Zenme wo hui zhemo tong?, 30~39 year old female. Ask Date: 2015/08/18

Dr. Yang Yaokun reply Surgery

Hello: 1.
Internal hemorrhoids typically do not cause pain.
The purpose of rubber band ligation is to obstruct blood flow to the internal hemorrhoid, leading to thrombosis and subsequent detachment.
Common complications after rubber band ligation include: pain (occurring in about 30% of cases), severe pain may occur if the internal hemorrhoid is too close to the anal opening, and this pain usually lasts for several days.
Warm sitz baths combined with analgesics can often alleviate discomfort.
Other rare complications include vasovagal syncope due to bleeding (less than 5%), external hemorrhoid thrombosis (less than 3%), and ulcer sepsis (very rare).
2.
Please return to the original treating physician for evaluation.
3.
Generally, internal hemorrhoids will fall off within 2 to 7 days after rubber band ligation, with a success rate of approximately 60% to 80%.
To determine if the procedure was successful, a follow-up anoscopy should be performed two weeks after the ligation.
Whether all hemorrhoids are ligated depends on their size.
4.
Please lower the water temperature during sitz baths.

Reply Date: 2015/08/18

More Info

After rubber band ligation (RBL) for hemorrhoids, it is common for patients to experience varying degrees of pain and discomfort. Let's address your concerns one by one.

1. Pain After Rubber Band Ligation: It is not unusual to experience significant pain following RBL, especially during bowel movements. The pain can feel sharp or like a cutting sensation, which may last for several minutes after defecation. This discomfort is typically due to the inflammation and irritation caused by the ligation of the hemorrhoidal tissue. While some patients may report minimal pain, others can experience more intense discomfort, particularly if there is a significant amount of tissue involved or if the ligation was performed on larger hemorrhoids. Pain usually improves within a week as the tissue begins to heal and the ligated hemorrhoid shrinks. If your pain persists beyond this period or worsens, it is advisable to consult your physician.

2. Appearance of the Wound: The presence of a long, linear wound near the anal area could be related to the ligation procedure. While the ligation itself typically results in a round or circular area of necrosis where the hemorrhoid tissue is cut off from its blood supply, some patients may develop fissures or other types of wounds due to the trauma of the procedure or from straining during bowel movements. If the wound appears to be more like a tear or fissure, it could be a result of excessive pressure during defecation or a reaction to the ligation. It is essential to keep the area clean and monitor for signs of infection, such as increased redness, swelling, or discharge.

3. Effectiveness of Rubber Band Ligation: If the rubber bands fell off shortly after the procedure, it may affect the outcome of the treatment. The ligation is intended to cut off blood supply to the hemorrhoid, causing it to shrink and eventually fall off. If the band does not stay in place long enough, the hemorrhoid may not be adequately treated. It is crucial to follow up with your doctor to assess the situation and determine if further treatment is necessary. Your doctor may recommend additional ligation or alternative treatments based on your specific case.

4. Post-Procedure Symptoms: Mild itching or discomfort after bowel movements can be common following RBL. This may be due to residual irritation in the area, healing tissue, or even minor fissures that can develop from straining. It is essential to maintain good hygiene, use soothing topical treatments if recommended by your doctor, and avoid straining during bowel movements. If the itching persists or is accompanied by other symptoms, such as bleeding or severe pain, you should reach out to your healthcare provider for further evaluation.

In summary, while some discomfort is expected after rubber band ligation, persistent or severe pain, unusual wound appearances, and ongoing symptoms warrant further medical evaluation. Always communicate openly with your healthcare provider about your symptoms and concerns to ensure appropriate management and recovery.

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