Rubber Band Ligation
Many people with grade 1 or grade 2 hemorrhoids can be treated successfully in the office setting with rubber band ligation. Using local anesthesia only, the hemorrhoid is "tied off" with a rubber band applied with a special instrument. The procedure takes only a few minutes and is nearly painless. The hemorrhoid then falls off 7 - 10 days later. Some discomfort may be experienced the first few days after the procedure but this is far less than surgical hemorrhoidectomy and is easily controlled with local pain medication applied topically. I usually do not recommend strong narcotic pain medications as this may lead to constipation and worse pain when straining for a bowel movement. In addition, I place patients on a regimen of sitz baths and stool softeners. Patients are also advised to drink 6 to 8 large glasses of water per day. This is all to create soft bulky easy bowel movements which are not painful.
This procedure is not for more severe hemorrhoids or those that are thrombosed. In addition, complete treatment of a patient may involve multiple sessions as attempts to ligate multiple hemorrhoids during a single session increases the likelihood of complications. If multiple sessions are necessary they are scheduled at least two and usually three weeks apart.