What is rubber band ligation?

Rubber band ligation (often simply called “banding”) is the most commonly performed outpatient treatment for internal haemorrhoids. It is a quick procedure that is performed in the clinic without the need for sedation or a general anaesthetic.

Rather than removing the haemorrhoid itself, the aim is to reduce its blood supply. A tiny rubber band is placed around the blood vessel immediately above the haemorrhoid. This interrupts the blood supply, causing the excess haemorrhoidal tissue to shrink. The treated tissue usually separates naturally over the following few days and passes unnoticed during a bowel motion.

Banding works best for Grade II haemorrhoids (those that prolapse during bowel motions but return inside by themselves) and selected Grade III haemorrhoids (those that need to be pushed back inside manually). It is particularly effective when bleeding is the main symptom.

What happens during the procedure?

You will usually lie on your left-hand side while a small plastic instrument (proctoscope) is inserted into the anal canal.

Before the procedure, I usually apply Instillagel® local anaesthetic gel, which helps to reduce discomfort during the examination and treatment.

The haemorrhoid is identified and the rubber band is placed around the blood supply immediately above it, rather than around the haemorrhoid itself.

The procedure normally takes around five minutes.

What should I expect afterwards?

Most patients are able to walk out of the clinic immediately afterwards.

I usually recommend that patients remain in the waiting room for 15–30 minutes after the procedure before leaving. A small number of patients feel light-headed immediately afterwards, and this usually settles quickly with a short period of rest.

Although most patients are physically able to drive afterwards, I recommend arranging for someone to drive you home if possible. If you do drive yourself, please ensure that you feel completely well before setting off.

Most patients return to normal activities later the same day or the following day.

For the first few hours it is common to experience:

• A feeling of pressure or fullness in the back passage.
• The sensation that you need to open your bowels (tenesmus), even when there is nothing to pass.
• Mild aching or discomfort.

The discomfort usually settles over the first few days. The sensation of needing to open your bowels can occasionally persist for up to two weeks. Simple pain relief such as paracetamol or ibuprofen is usually all that is required.

For the first 6–12 hours after the procedure, it is sensible to avoid opening your bowels if comfortably possible. If you do need to open your bowels, try to avoid straining.

Continue to eat normally, drink plenty of fluids and keep your stools soft. Maintaining a high-fibre diet and, where appropriate, taking a fibre supplement or stool softener will help reduce discomfort during recovery.

Bleeding afterwards

A small amount of spotting is common during the first day or two after treatment.

Some patients also notice a small amount of bleeding several days later, when the treated tissue separates. This is usually minor and settles quickly without treatment.

Risks and possible complications

Rubber band ligation is a very safe procedure, but like all medical treatments it carries some risks.

Common side effects include:

• Mild discomfort or aching.
• A feeling of pressure or fullness.
• Temporary tenesmus.
• Minor bleeding.

Less common complications include:

• Significant bleeding, usually between 5 and 10 days after treatment when the treated tissue separates. Approximately 1 in 400 patients require admission to hospital because of bleeding. The risk may be higher in patients taking blood-thinning medication.
• Difficulty passing urine.
• Severe pain if the band slips onto the pain-sensitive lower part of the anal canal.
• Thrombosis (clotting) within an external haemorrhoid.
• Very rarely, a serious pelvic infection can occur. Although exceptionally uncommon, this requires urgent treatment.

How successful is banding?

Rubber band ligation is one of the most effective outpatient treatments for internal haemorrhoids.

Overall, around 70% of patients experience a worthwhile improvement in their symptoms. It is particularly successful for treating bleeding haemorrhoids, while larger prolapsing haemorrhoids are more likely to require further treatment or surgery.

Some patients require more than one treatment session to achieve the best result.

Will the haemorrhoids come back?

Banding treats the haemorrhoids that are present but does not prevent new haemorrhoids developing.

Approximately one in four patients will experience recurrent symptoms over the following few years. Many can be successfully treated with repeat banding, while others may ultimately benefit from surgery.

Maintaining a high-fibre diet, drinking plenty of fluids, avoiding constipation and avoiding prolonged straining on the toilet all help reduce the chance of recurrence.

What are the alternatives?

The most appropriate treatment depends on the size of the haemorrhoids and the symptoms they are causing.

Alternative options include:

• Conservative management with dietary and lifestyle measures.
• Repeat rubber band ligation.
• Surgical haemorrhoidectomy.
• Haemorrhoidal artery ligation (HAL-RAR) in selected patients.

I do not routinely offer injection sclerotherapy. In my experience, rubber band ligation provides better long-term symptom control for most patients, while injection treatment has lower success rates and, although uncommon, can occasionally result in significant complications.

During your consultation, I will discuss the advantages and disadvantages of each option and recommend the treatment most likely to give you the best long-term outcome.

Helpful answers

Frequently Asked Questions

When should I seek urgent medical attention?

You should seek urgent medical advice if you develop:

• Heavy bleeding, particularly if you feel faint or dizzy.
• Severe pain that is not controlled with simple painkillers.
• Difficulty passing urine.
• Fever, increasing swelling around the anus, or feeling generally unwell.

These complications are uncommon but should be assessed promptly.

How can I reduce the chance of my haemorrhoids returning?

The most effective long-term measures are:

• Eating a high-fibre diet.
• Drinking plenty of fluids.
• Avoiding constipation.
• Avoiding prolonged sitting on the toilet.
• Avoiding excessive straining during bowel motions.

These measures reduce the risk of developing further haemorrhoids and improve the long-term success of treatment.