How does rubber band ligation work for hemorrhoid treatment?

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How does rubber band ligation work for hemorrhoid treatment?

Rubber band ligation (RBL) is a minimally invasive procedure used to treat internal hemorrhoids—swollen blood vessels in the rectum that cause discomfort, bleeding, and prolapse. The procedure works by placing a tight rubber band around the base of the hemorrhoid, cutting off its blood supply. Without a blood supply, the hemorrhoid shrinks, dies, and eventually falls off, typically within a week. Here’s how the procedure works in detail:

1. Purpose of Rubber Band Ligation

Treating Internal Hemorrhoids: Rubber band ligation is specifically used for internal hemorrhoids, which are located inside the rectum and do not have pain-sensing nerves like external hemorrhoids. It is most effective for grades 1 to 3 hemorrhoids (those that bleed, prolapse, or protrude during bowel movements but can be pushed back inside).
Minimally Invasive: RBL is considered one of the least invasive treatments for hemorrhoids, offering relief without surgery.

2. The Procedure

Preparation: The procedure is typically done in a doctor’s office and requires no general anesthesia, though a mild sedative may be offered. The patient lies on their side or in a proctologic position (knees to chest).
Anoscopy: The doctor inserts a small device called an anoscope into the rectum to visualize the hemorrhoid. The anoscope allows the physician to access and treat internal hemorrhoids.
Band Placement: Using a specialized tool called a ligator, the doctor places a small, tight rubber band around the base of the hemorrhoid. The band cuts off the blood flow to the hemorrhoid, causing it to shrink and wither.
Number of Bands: Multiple hemorrhoids can be treated in one session, but typically no more than one or two hemorrhoids are banded per visit to reduce the risk of complications. Additional hemorrhoids can be treated in subsequent visits, usually spaced out over several weeks.

3. What Happens After the Procedure?

Hemorrhoid Shrinks and Falls Off: Over the next few days, the hemorrhoid deprived of blood will shrink and die. Within about 5 to 7 days, the hemorrhoid, along with the rubber band, falls off during a bowel movement.
Healing: A small ulcer or wound may form at the site where the hemorrhoid was banded, but it usually heals within 1 to 2 weeks.

4. Post-Procedure Care

Pain Management: Mild discomfort or a feeling of fullness in the rectum may occur after the procedure. Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage this discomfort.
Avoid Straining: Patients are advised to avoid straining during bowel movements to allow the treated area to heal properly. A high-fiber diet and plenty of fluids can help soften stools and prevent constipation, reducing the strain.
Activity Restrictions: Most people can return to normal activities the same day or within a day or two, but it’s advised to avoid heavy lifting or strenuous activity for a few days.

5. Effectiveness

High Success Rate: Rubber band ligation is effective in treating internal hemorrhoids for about 70-80% of patients. It is particularly successful in reducing bleeding and prolapse associated with hemorrhoids.
Multiple Treatments: Some patients may require more than one treatment session if multiple hemorrhoids are present or if symptoms recur.

6. Possible Side Effects and Complications

Although RBL is generally safe, there are potential risks and side effects, including:

Pain or Discomfort: Mild pain or discomfort is common, but severe pain can occur if the band is placed too close to the sensitive areas below the hemorrhoid (closer to the anus).
Bleeding: Some bleeding may occur after the procedure, especially when the hemorrhoid falls off, but significant bleeding is rare. If severe bleeding occurs, medical attention may be necessary.
Infection: In rare cases, infection can develop, causing fever, pain, and swelling. Immediate medical treatment is required if signs of infection occur.
Urinary Retention: Some patients may experience difficulty urinating after the procedure due to swelling or pain.
Recurrence: While RBL is effective for most people, hemorrhoids can recur, and additional treatments may be needed in the future.

7. Advantages of Rubber Band Ligation

Non-Surgical: RBL is a non-surgical, minimally invasive procedure that avoids the need for a hemorrhoidectomy, which is more painful and involves longer recovery time.
Quick and Convenient: The procedure is quick, typically lasting only a few minutes, and can be done in an outpatient setting without the need for hospitalization.
Short Recovery Time: Most patients can return to their daily activities within a day or two after the procedure.

8. Who Is a Good Candidate for RBL?

Internal Hemorrhoids (Grades 1 to 3): RBL is most effective for internal hemorrhoids that cause bleeding, discomfort, or prolapse. It is not suitable for external hemorrhoids or internal hemorrhoids that have prolapsed too far (grade 4).
Non-Surgical Candidates: It is an ideal option for patients who wish to avoid surgery or cannot undergo more invasive procedures due to other health concerns.

Conclusion:

Rubber band ligation (RBL) is an effective, minimally invasive treatment for internal hemorrhoids, especially in cases of mild to moderate symptoms. It works by cutting off the blood supply to the hemorrhoid, causing it to shrink and fall off. The procedure is quick, has a short recovery time, and provides long-lasting relief for many patients. While some mild discomfort and risks are associated with the treatment, RBL is a widely used and highly successful option for managing hemorrhoids without surgery.