Hemorrhoid Banding or rubber band ligation is a fast and nonsurgical approach to hemorrhoid treatment. Your GI practitioner will use a disposable device to create a soft, gentle suction that pulls the appropriate tissue into it. Then, the rubber band can easily and painlessly be placed around the base of the hemorrhoid, where no pain-causing nerve endings are present. Hemorrhoid Banding does not require sedation or prep and takes about 5 minutes but expect to be here for 15 minutes. Hemorrhoid Banding will usually be done in the clinic.
Hemorrhoidal banding has provided tremendous relief for many of our patients who have internal hemorrhoids. The first banding is usually completed during a colonoscopy procedure or a scope of the lower colon/rectum. Following this, our patients usually receive 2 additional Hemorrhoid bandings in our office using topical anesthesia to avoid discomfort. As discussed in the following case study, significant pain after the procedure can occur. However, this is rare and easily remedied by a return visit to our clinic for band adjustment. Symptoms such as rectal bleeding, rectal itching and rectal pain related to internal hemorrhoids are usually eliminated for our patients with use of the CHR O’Regan System.
Mr. X Is a 57 year old male with a long history of hemorrhoidal symptoms (itching, bleeding, mild prolapse) presenting for treatment. He has had an otherwise unremarkable colonoscopy within the past couple of months, and has no other GI symptoms nor any significant past medical or surgical history. Anoscopy revealed large, grade II hemorrhoids, the largest being in the left lateral position, and this was banded at his first session without incident. Presenting 2 weeks later for his next treatment, the right anterior hemorrhoid was banded without issue, and the patient went home.
The next morning, the patient called the office complaining of perianal pain. He did not have any fever, chills or urinary symptoms. He was asked to come back to the office, and a digital examination was repeated, demonstrating only what was felt to be a fairly typical “polyp” of banded tissue, along with some sphincteric “tightness”. A small amount of dilute topical nitroglycerin ointment was inserted, and the band was manipulated to free up a bit of the distal-most banded tissue, after which the patient almost immediately noted symptomatic improvement. The patient was prescribed NTG moving forward, and advised to purchase an OTC 5% lidocaine cream if there was any residual discomfort. The patient later completed his course of treatment with excellent results and no further issues.
Significant pain after banding Is one of the few potential complications of RBL. Fortunately, using the CRH O’Regan System, this happens less than 1% of the time. Causes of pain may include having too much tissue in the band, tissue which is too close to the dentate line, a coexistent fissure, or spasm secondary to the banding. I treat spasm with the “off-label” use of a dilute topical nitroglycerin ointment, applied into the anal canal 3 times daily, along with sitz baths as needed.
The key to avoiding these problems Is to make certain that the patient understands that they should experience NO pain and NO “pinching” after the band has been placed, and to give them a few minutes after banding to make certain that they only feel a bit of pressure, fullness or mild tenesmus.
We tell our patients that even a “little pain” or a “little pinch” will get worse without adjusting the band. If the patient does leave your office too soon, and finds later on that they are uncomfortable we’ve found that manipulation of the band the next day can still be helpful. However, when you get much further out than 36-48 hours, this maneuver is not helpful, and giving them the topical NTG +/- topical lidocaine is the best approach.
We also avoid banding patients that have significant pain on initial digital exam (typically due to a fissure), “cooling off” the fissure for a couple of weeks with appropriate treatment before beginning to band the patient.