Hemorrhoid banding is a specialized non-surgical therapy for treating internal hemorrhoids, primarily utilizing rubber band ligation techniques to separate hemorrhoidal tissue from surrounding blood vessels. This method is suitable for patients with Grade I to III internal hemorrhoids and effectively alleviates symptoms such as bleeding, swelling, or prolapse, avoiding the invasiveness and recovery period associated with traditional surgery. The procedure is typically performed in an outpatient setting, allowing patients to avoid hospitalization, making it a common choice in modern hemorrhoid treatment.
This therapy is a physical treatment that involves using a specialized ligator to place a rubber band at the base of the hemorrhoid. The rubber band cuts off blood supply to the hemorrhoid, causing ischemic necrosis and eventual detachment of the tissue. The procedure lasts about 10-15 minutes and is usually performed in multiple sessions, targeting different hemorrhoids each time. The rubber band naturally falls off after about 5-7 days, and the necrotic tissue is absorbed by surrounding tissue, reducing the size of the hemorrhoid.
The mechanism combines tissue necrosis and fibrosis, effectively reducing swelling caused by blood stasis. This process induces a local inflammatory response, promoting new connective tissue formation, which stabilizes the hemorrhoid and prevents prolapse.
Primarily suitable for Grade I to III hemorrhoids presenting with intermittent bleeding, swelling of hemorrhoids, or prolapse during defecation. It is the main target group for patients unresponsive to conservative treatments (such as medication or dietary adjustments) or those who refuse surgery. This therapy is not recommended for external hemorrhoids or mixed hemorrhoids.
Indications include:
The treatment is performed in an outpatient setting with the patient in a lateral or knee-chest position. After locating the hemorrhoid with an anoscope, the physician precisely places the rubber band at the base of the hemorrhoid. Each session typically treats 1-3 hemorrhoids, performed once a week, with a total of 2-4 sessions to achieve the desired effect. The rubber band diameter is about 0.5-1 cm, and placement should avoid damage to the anal sphincter.
No anesthesia injection is required; only topical anesthetic gel is applied to reduce discomfort. Patients can resume daily activities immediately after the procedure but should avoid strenuous exercise for 24 hours. The rubber band usually falls off naturally after 3-5 days, and a mild ulceration at the treatment site is normal during healing.
Main advantages include:
Compared to traditional surgery, this approach preserves the normal anatomy of the anus and reduces complications such as anal stenosis. About 60-80% of patients experience significant symptom improvement, with long-term control of bleeding and prolapse.
Common side effects include:
Important Warning: If persistent bleeding, fever over 38.5°C, or severe swelling occurs, immediate medical attention is required. Patients with diabetes or on anticoagulants should adjust their medications accordingly.
Contraindications include:
Post-treatment care instructions include:
This therapy can be combined with oral medications (such as anti-inflammatory drugs), but should avoid concurrent use with local anesthetics to reduce excessive numbness. Patients undergoing radiotherapy or chemotherapy should have their blood counts evaluated beforehand.
It has an additive effect with sclerotherapy, but the two treatments should be spaced at least 2 weeks apart. Compared to traditional surgery, this method does not affect subsequent surgical options and can be considered an upgraded treatment step.
Multicenter studies show that a single treatment has a success rate of about 65-75%, with cumulative multiple sessions achieving over 85% overall efficacy. About 70% of patients experience no recurrence of symptoms within 6 months post-treatment, and long-term follow-up indicates good preservation of anal function over 5 years.
Compared to traditional rubber band ligation, modern improved devices allow precise positioning of the band, reducing the risk of strangulating normal tissue. A 2019 Cochrane review confirmed that this therapy is superior to medication in improving bleeding symptoms.
Other non-surgical options include:
Surgical options include hemorrhoidectomy or stapled hemorrhoidopexy, suitable for severe Grade IV hemorrhoids or cases unresponsive to other treatments. The choice of method depends on hemorrhoid grade, symptom severity, and overall health status.
Pre-treatment bowel cleansing is necessary, usually involving laxatives or enemas to ensure the rectum is empty. The physician will explain the procedure in detail and confirm that the patient has no coagulation abnormalities or is not on anticoagulants. Patients with chronic conditions such as heart disease or diabetes should inform the doctor beforehand for risk assessment.
How long after treatment will discomfort occur? How can it be alleviated?Discomfort or mild bleeding may occur 1-3 days post-treatment, which is normal. Pain relievers or topical anti-inflammatory suppositories can be used as advised. If bleeding is heavy or pain persists beyond 3 days, immediate medical evaluation is recommended for possible complications.
When can daily activities be resumed after treatment?Most patients can resume light activities within 24 hours but should avoid lifting heavy objects or prolonged sitting for at least 1 week. Sitz baths (2-3 times daily, 10-15 minutes each) are recommended during the first week to promote healing, along with wearing loose underwear to reduce friction.
What is the success rate of hemorrhoid banding?Clinical studies show that the immediate hemostasis success rate is about 90%, with approximately 70-80% of patients experiencing long-term symptom relief. However, if hemorrhoids are prolapsed or thrombosed, additional treatments such as surgical excision may be necessary to improve outcomes.
How can diet help prevent recurrence after treatment?Increasing dietary fiber intake (such as whole grains and vegetables), drinking at least 1500cc of water daily to maintain bowel regularity, avoiding spicy foods and alcohol to reduce anal congestion, and engaging in regular exercise can help prevent constipation and reduce the risk of hemorrhoid recurrence.
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