Treating Hemorrhoids: Rubber Band Ligation

February 26th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

For most minor to moderate hemorrhoid symptoms, the initial treatment is diet and lifestyle modification. There are also many useful topical medications that can help bring relief to your symptoms. However, in some circumstances these conservative measures just aren’t enough. In these cases, simple in-office procedures are used for treatment.

Internal hemorrhoids are supplied by visceral nerves, that is, the same kind of nerves that supply your intestines. Therefore, internal hemorrhoids are relatively insensitive to pain. This makes in-office procedures relatively painless, and the need for anesthesia is minimal to none.


Rubber band ligation is the most common in-office procedure available today. It is generally indicated when you have hemorrhoids that bleed and/or bulge out of the anus. You might also have symptoms such as burning, itching, pain or soiling of your undergarments.

How Rubber Band Ligation Works

First of all, you might receive an enema to clean the area to be treated. Then your surgeon uses a device, called an anoscope, to visualize the hemorrhoids. The symptomatic hemorrhoid is then grabbed with a clamp and stretched. Finally, a special elastic band is placed tightly around the hemorrhoid.

The banding causes the blood supply to the hemorrhoid to be cut off. In about 7 to 10 days the problematic tissue dies and falls off on its own. Sometimes a small amount of blood is seen when the hemorrhoid falls off.

Typically, 1 to 3 hemorrhoids can be banded at a time, and a 4 to 6 week interval is necessary between treatment sessions.

Precautions and Potential Complications

Because of the risk of bleeding, you should avoid taking aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for at least a week after the procedure. Ibuprofen and naproxen are commonly used NSAIDs that should be avoided.  Also, if you take anticoagulant or antiplatelet medications, make sure your surgeon knows this. You might be asked to stop your medication ahead of time in order to minimalize the bleeding risk. Lastly, if you have a true latex hypersensitivity your doctor will probably recommend another treatment since the rubber bands are made of latex.

Complications to rubber band ligation are extremely rare. Some potential complications, however, are:

  • Pain
  • Bleeding
  • Thrombosis (blood clotting)
  • Difficulty urinating
  • Infection

Taking sitz baths after the procedure can help minimize the occurrence or severity of side effects. You just soak your bottom in a few inches of warm water for about 10 to 15 minutes. Do not scrub and do not add soap to the water. Gently pat yourself dry.


Rubber band ligation is the most common in-office procedure for the treatment of symptomatic hemorrhoids that have failed to respond to more conservative treatment. The success rate of the procedure is up to 85%, and it is relatively painless. It is an excellent choice for the treatment of mild to moderate hemorrhoid symptoms.

Check out The H Doctor website. You will find many useful articles and videos that contain more information about hemorrhoid treatment and other digestive health topics.

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