What is Rubber Band Ligation (RBL)?
Rubber band ligation (RBL) is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. Rubber band ligation works well for prolapsed internal hemorrhoids, such as the advanced grade 2 and grade 3 hemorrhoids.
How is Rubber Band Ligation Performed?
Your doctor will insert an anoscope into your anus and grasp the prolapsed hemorrhoid with a separate instrument to place a rubber band around its base. The procedure is done in a doctor’s office and only takes a couple of minutes. Treatment is usually limited to one hemorrhoid per office visit; additional areas may be treated in two-week intervals.
Is Rubber Band Ligation Performed Under Local Anesthesia?
No. The nerves that are located higher up the anal canal (above the dentate line) do not sense pain, though they do feel pressure. Internal hemorrhoids, located above the dentate line, are associated with these visceral nerves, so rubber band ligation is usually a painless procedure.
Why is RBL Performed?
Rubber band ligation is one of the most popular treatments for internal hemorrhoids. If symptoms continue after three or four treatments, surgery may be the next option.
What Should I Expect After Treatment?
Some patients may feel tightness and mild pain or feel as if they need to have a bowel movement. Everyone responds a little differently to this procedure.
Most patients are able to return to regular activities (avoiding heavy lifting) almost immediately. A few patients may need a few hours or a day of rest. Tylenol or Ibuprofen can be taken as needed, and daily sitz baths for 15-30 minutes per session are helpful in reducing discomfort. Some patients may experience slight rectal bleeding in a week when the hemorrhoid dies off. However, if you notice significant rectal bleeding, call your doctor’s office.
How Effective is RBL?
Up to 80 percent of patients who have gone through this procedure reported that their symptoms improved.
Side effects are rare, but may include severe pain that won’t go away even after various methods of pain relief are used. The bands may have been placed too close to the area of the anal canal that contains pain sensors.