Banding/Ligation of Hemorrhoids: CRH O’Regan System Make an Appointment Ask a Question Refer Patient Hemorrhoids are swollen, inflamed blood vessels in the lower rectum or anus caused by increased pressure or straining during bowel movements, or from increased pressure on these veins during pregnancy, amongst other causes. They can cause pain, itching, bleeding and swelling, and when more severe, they can extend through the anus and even clot off or become gangrenous. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids). Hemorrhoids are common ailments. By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. Hemorrhoids Treatment Alternatives to hemorrhoid banding/ligation consists of conservative treatment that may include adherence to a high fiber diet and use of fiber supplements, laxatives, warm sitz baths and topical treatments such as creams and ointments. Cautery such as infrared coagulation may be useful in some cases though is less effective than band ligation. Surgery may also be utilized in severe cases or in hemorrhoids that have clotted. Unfortunately, hemorrhoids often don’t go away without treatment, and tend to worsen over time. Hemorrhoid Banding/Ligation Hemorrhoid banding/ligation is a simple, painless and highly effective procedure (99.1%) that can be performed in less than a minute. Your doctor will place a tiny rubber band around the internal hemorrhoid to cut off its blood supply. The hemorrhoid then shrinks and falls off within 3-5 days, usually without you noticing. Once the hemorrhoid is gone, your symptoms should resolve. You may require up to three sessions at two week intervals as all people have 3 hemorrhoidal veins. Only one hemorrhoid is ligated during each session to minimize complications and discomfort. Who should not have hemorrhoid banding? Please inform your health care provider if you: Are pregnant Have portal hypertension Have concurrent proctitis (Crohn’s, ulcerative, ischemic, radiation) Are on anticoagulation medicine - Discontinue Coumadin, Aggrenox, or Pradaxa 4-5 days and Plavix 7 days prior to your procedure if approved by the prescribing doctor. Low dose aspirin is not an issue and does not need to be stopped before the procedure. Have a latex allergy. Preparing for the Procedure There are no special preparations for hemorrhoid banding/ligation. There is no fasting, cleansing or enemas. If you take blood thinners such as Coumadin, Aggrenox, or Pradaxa, stop taking them 4-5 days before the procedure if approved by the prescribing doctor. If you are taking Plavix, you must stop taking it 7 days prior to your procedure if approved by the prescribing doctor. Please let your health care provider know if you are on any medications that thin your blood to prevent clots. Arrive for your appointment at the scheduled time. During the Procedure The doctor uses a special technology that resembles a modified syringe without the needle. It is plastic and a single-use device. It uses gentle suction to draw the hemorrhoid tissue into the barrel of the ligator. What prevents discomfort during the procedure is that the band is placed in an area where there are no nerve endings and gentle suction is used instead of any metal toothed instruments. The procedure has amongst the highest success rates with the lowest complication rates compared to any non-surgical approaches to hemorrhoids. Length of the Procedure The procedure takes about a minute to complete. You will stay in MIDC (Minimally Invasive Diagnostic Center) and be monitored for 10 minutes following the procedure. After the Procedure Please tell your health care provider if you feel a “pinching” sensation, sharp pain, or rectal cramping any time during the 10 minutes after the procedure. The band can be adjusted, relieving the discomfort prior to leaving MIDC. Day of the Procedure Please check in at the Front Desk in the Adult Clinic and tell them you need to go MIDC (Minimally Invasive Diagnostic Center) West. If you have questions, need to change or cancel the appointment, please call 303.398.1355. This information has been approved by Miranda Y. Ku, MD, MPH (May 2013).