Rubber Band Ligation for Piles Treatment

Overview

Rubber band ligation, hemorrhoidal artery ligation, or hemorrhoid banding is a treatment for internal piles or hemorrhoids that do not respond to medical treatment and home remedies. Hemorrhoids are swollen and inflamed blood vessels. 

What Are The Types of Hemorrhoids?

They are classified according to their location:

• Internal hemorrhoids: They commonly grow inside the lower part of the rectum (the last part of your large intestine, where the feces are stored temporarily before passing into the anus). Their primary symptom is bleeding which can cause soiling of clothes. Pain, itching, etc., can be present These hemorrhoids, due to the pressure, can prolapse (move down) through the opening of the anus and can be visible outside.
• External hemorrhoids: They are commonly present just under the skin of the anus and can be very uncomfortable. Their primary symptoms are pain, swelling, itching, and bleeding

Both internal and external hemorrhoids can occur in an individual. Small and simple hemorrhoids can be treated at home; however, surgical intervention is required when these conservative methods fail, and hemorrhoid enlarges in size. 
Rubber band ligation is one such surgical treatment that helps to get rid of painful and infected hemorrhoids. Read on to know more about this minimally invasive (does not involve extensive incisions or cuts with minimal bleeding and quick recovery) procedure. 

What Is Meant By Rubber Band Ligation For Hemorrhoids/Piles?

Rubber band ligation, also known as hemorrhoid banding or hemorrhoidal artery ligation, is an outpatient (does not require hospitalization) procedure for internal hemorrhoids (forms on the inner lining of the rectum and anus). Banding is possible for internal hemorrhoids as they are present above the dentate line; banding is not effective for external hemorrhoids as they are present below the dentate line (the area is too sensitive for banding)

During the procedure, the base of the hemorrhoid is tied off with a rubber band, cutting off the blood supply to hemorrhoid, which eventually shrinks, and the band detaches during normal bowel movements. There are several methods of performing this procedure:

• Traditional metal banding 
• Endoscopic banding
• CRH O'Regan System

When Is Rubber Band Ligation Recommended For Hemorrhoids/Piles?

Rubber band ligation is recommended when the hemorrhoids do not respond to home remedies, and there is persistent pain and bleeding. 

• Rubber band ligation is a treatment option for internal hemorrhoids of grades 1, 2, and 3.
  • Grade 1- Hemorrhoids can protrude slightly into the anal canal - do not fall below the dentate line (the line that divides the anal canal into upper 2/3rd and lower 1/3rd.). Pain-sensitive nerves are present below the dentate line.
  • Grade 2- These swell and prolapse out of the anus but can reduce by themselves.
  • Grade 3- These prolapse outside the anal can while defecating- fall below the dentate line, causing pain. They need to be reduced manually.
• Rubber band ligation is not recommended for grade 4 hemorrhoids (they are severe, cannot be reduced, and can strangulate, causing excessive pain)
• Hemorrhoids can be treated at home through various conservative methods that include:
  • Sitz bath (soaking your anus and genital area in plain warm water)
  • Oral painkillers (for relief from pain)
  • Topical creams as advised by your doctor (to help ease pain and itching)
  • A high-fiber diet ( fresh fruits and green leafy vegetables)

How To Prepare For A Rubber Band Ligation For Hemorrhoids/Piles?

Preparation before hemorrhoid surgery is essential, as it will make it easier for you and your doctor to plan. important. 

• Your surgeon will review your medical history and enquire about the symptoms and their duration. Your surgeon will conduct a few tests to determine the location and size of the hemorrhoid. These include:
  • Digital examination by inserting a gloved and lubricated finger inside your rectum.
  • Visual examination of your rectum or lower part of the large intestine through special devices like an anoscope, proctoscope, or sigmoidoscope. These are tube-like instruments with a small light source at the tip.
• It is important to inform your surgeon if you suffer from any medical condition like asthma, diabetes (increased blood sugar levels), hypertension (high blood pressure), or any blood disorder. 
• List out the medications you have been taking, like anti-inflammatory drugs, blood thinners, or other herbal supplements. You may need to discontinue them at least 2 weeks before the procedure to prevent any risk of complications during or after the surgery.
• Generally, hemorrhoid banding can be done under local anesthesia, but if the hemorrhoid is extremely painful, your surgeon may advise general anesthesia.
• You may be advised to fast overnight before the procedure, especially if the banding is done under general anesthesia (GA). This helps to prevent the aspiration of food particles into your lungs. 
• As it is an outpatient procedure, you should arrange for someone to drive you back home after the banding procedure, as you may be drowsy due to the effect of anesthesia.

How Is A Rubber Band Ligation Performed For Hemorrhoids/Piles?

Rubber band ligation is a simple outpatient procedure that usually takes 30 to 45 minutes, but the time can vary depending on the number of hemorrhoids being treated. 

On the day of the procedure:

• Once your vitals (blood pressure, pulse, etc.) are checked, you will be wheeled to the operating theatre and placed on the proctology table in a kneeling down position or towards your left side. 
• You will be administered either local or general anesthesia as per your surgeon’s advice. 
• Your surgeon may perform rubber band ligation by two techniques:

Traditional rubber band ligation (RBL)

• Your surgeon will insert an anoscope into the rectum that helps to locate and reach hemorrhoid(s).
• hemorrhoid (s) will be held or grasped with the help of forceps. 
• Once the surgeon has grasped hemorrhoid (s), a small instrument known as a litigator is inserted through the anoscope.
• The litigator helps to tie the rubber band around the base of hemorrhoid (s).

Endoscopic banding

• This technique involves using an endoscope (a tube-like device with a light source and camera at the tip) that will be fitted with a plastic cap containing elastic bands.
• Once the endoscope is inserted, a suction tool or forceps will secure hemorrhoid, and the bands will be placed around its base. 

The CRH O'Regan Ligation System

• This is a more expensive procedure that eliminates the use of forceps.
• Instead, a special device that applies gentle suction will allow the surgeon to place rubber bands around the base of hemorrhoid.
• 2 to 3 banding sessions will be required at a 2 weeks interval for complete treatment.

How is the Recovery After a Rubber Band Ligation For Piles?

Once the procedure is completed, you will be kept in the recovery room until you regain consciousness. 

Immediately after the procedure

It is normal to experience some pain and discomfort and a feeling of heaviness in your lower belly once the effect of anesthesia wears off. This is normal and usually managed through painkillers. 

Few hours after the procedure

Once you are able to walk on your own, your nurse will instruct you about post-op wound care, and you will be allowed to go home. Rest on the day of the surgery to help your body heal for a quick recovery.

1- week post procedure

You may experience mild bleeding from your anus for 7 to 10 days post-procedure when your hemorrhoid falls off, which is normal. 

Avoid lifting heavy objects and strenuous exercises and activities until you heal completely. Be sure to consume a high-fiber diet (that includes fruits, vegetables, beans, and whole grains) to prevent post-op constipation. You may also take laxatives or stool softeners if required. Recovery may take 1 to 2 weeks, depending on the number and size of the hemorrhoids treated.

Complications Associated With Rubber Band Ligation

Minor complications

• Mild bleeding during the banding of hemorrhoids.
• Extreme pain and discomfort (occur while tying hemorrhoid with a rubber band).
• Accidental slipping of the bands (may cause injury to the surrounding area).
• Vasovagal attack(paleness, nausea, excessive sweating, rapid heartbeat, and repeated fainting episodes).
• Difficulty in urination
• Priapism (unwanted and prolonged erection).
• Anal fissures (small tears in the lining of the anus).
• Chronic (long-lasting) rectal ulcers

Major complications

• Massive, uncontrolled bleeding at the banding site.
• Thrombosed hemorrhoids (when a blood clot is formed inside the hemorrhoidal vein, obstructing the blood flow and causing swelling of the anal tissues).
• Severe persistent pain 
• Retention of urine.
• Pelvic sepsis (a life-threatening complication of persistent infection around the pelvic area).
• Fistula formation (an abnormal connection or passage between two organs or tissues).

Benefits And Risks of Rubber Band Ligation For Hemorrhoids/Piles

Rubber band ligation is a popular choice of treatment for internal hemorrhoids, and it comes with its own benefits and risks:

Benefits

• It is a minimally invasive procedure that involves less pain and bleeding during the surgery.
• There are no external incisions (cuts) involved; thus, there are no visible scars. 
• The procedure does not cause any trauma to the surrounding structures.
• Shorter recovery time with quick healing.

Risks

Complications and risks post rubber band ligation is rare, but there could be a few possible complications, which include:

• Infection (which may lead to high-grade fever, body aches, chills, or pus discharge)
• Bleeding at the site of banding
• Recurrence of hemorrhoids
• Persistent swelling and pain
• Adverse reactions to the anesthetic agent (that may cause rash, itching, hives, dizziness, and breathing difficulties)

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