Rubber Band Ligation (RBL) is a common treatment for haemorrhoids. It can be used to tackle lower grade haemorrhoids, and can be performed by a doctor using a variety of devices. RBL is one of the most common surgical options for haemorrhoids treatment as the risk of pain is significantly lower than with more invasive forms of treatment; it also boasts a much shorter recovery time. It does have its limitations however in that it generally has a high recurrence rate of between 30%-50% meaning that the patient is likely to see their symptoms come back and necessitate repeated treatments.
The process for the Rubber Band Ligation procedure is straightforward. Once a medical professional has diagnosed a patient with haemorrhoids (usually via a colonoscopy or anoscopy/proctoscopy), he or she may recommend an RBL treatment, though other options are available.
An RBL procedure doesn’t require the patient to undergo any prior preparation. During the treatment, the patient will be positioned on proctology table (kneeling or in the fetal position on the left side of the table). A proctoscope is then inserted into the anus, and the haemorrhoids gripped using forceps (though a suction device can also be used). The medical professional then moves or draws the haemorrhoids into the cylindrical opening of the ligator device, which is then pressed against the haemorrhoid base. At this point, the rubber band is attached.
If forceps are not used, medical professionals carrying out the RBL may employ the CRH O’Regan ligation system, which is more expensive than the suction ligator, which is reusable. This approach is much less common, however, and is rarely used by most colon and rectal surgeons. The CRH O’Regan system uses gentle suction to help the doctor place a small rubber-band around the bottom end of the haemorrhoid. These banding sessions must be carried out three times at regular two-week intervals in order for the treatment to be effective. If the patient is under general anaesthetic, more bands can be applied.
As with all surgical procedures, a small number of complications may arise. These include pain, infection, bleeding, thrombosed haemorrhoids occurring, pelvic sepsis, and the appearance of non-healing ulcers.
In a small number of cases, patients who have undergone Rubber Band Ligation treatment may experience bleeding from the anus for 7-10 days as the haemorrhoids drop off – this is normal, and is especially common after bowel movements for up to a fortnight after the procedure (though untreated haemorrhoids can also bleed). Any patients concerned about the amount or frequency of bleeding should speak to their doctor as soon as possible.
Painkillers can be taken to help reduce the level of discomfort felt by patients after the treatment has been completed. Patients may experience pain and have a feeling of fullness in the lower belly after the procedure – they may also feel as if they need to have a bowel movement. These feelings normally dissipate after a few days.
Patients are also advised not to partake in any strenuous activity (such as heavy lifting) for up to four days after the banding has taken place). Difficult bowel movements should also be avoided as these can cause irritation in the region where the haemorrhoids had been.
While some patients may be able to start going about their daily routines again straight away, others may require a few days of bed rest to recover fully.
To aid in recovery, patients should do the following:
- Rest when feeling tired, and get enough sleep at night.
- Try to go for a walk every day. Increase the length of each walk a little every day. Walking helps increase blood flow and can help prevent pneumonia and constipation.
- Avoid strenuous activities, including jogging, bicycle-riding, aerobic exercises, and weight-lifting until your doctor gives you the all-clear. Also make every effort to avoid lifting anything heavy for up to three weeks after treatment – this can include shopping bags, backpacks, briefcases, vacuum cleaners, pets and children. Your doctor will also be able to tell you when you can drive again as normal.
- Most patients can take baths and showers as normal, but you should pat rather than rub your anal area dry afterwards.
Some patients may need to take some time off work after treatment. This of course depends on the nature of your job and the severity of your surgery. Most patients can carry on eating normal foods, but should make dietary adjustments if they experience stomach or bowel problems. Bland foods such as rice, toast and yogurt can help ease discomfort at these times. It’s also vital that patients drink plenty of fluids and stay hydrated unless advised not to do so by their doctor.
Some patients may find that their bowel movements are less regular than they were before surgery. This is a fairly common side-effect of the treatment and is nothing to be concerned about. It is, however, important that patients consume a good quantity of high-fibre food after the treatment in order to make bowel movements easier and reduce the likelihood of haemorrhoids reoccurring. It’s vital that patients avoid becoming constipated or strain too much during bowel movements as this can cause the condition to flare up again straight away. If you notice your bowel movements have become very infrequent or painful, speak to your doctor, who may be able to prescribe you something to help you pass your stool more easily.
In order to ease post-treatment discomfort, patients can also try using a Sitz bath, a cold or warm compress, or elevating their feet when using the toilet to make bowel movements easier.
NCBI state that: “Rubber band ligatures are safe and effective therapy for symptomatic internal haemorrhoids. It can be used to treat all degrees of haemorrhoids with similar effectiveness. The likelihood of success is lower if more than four bands are needed to eliminate symptoms. The use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin is associated with higher bleeding rates. Rubber band ligatures for recurrence of symptoms is effective; however, time to recurrence is less with subsequent treatments.”