This method involves the placement of small latex rubber bands around the base of grade 2, grade 3 or grade 4 hemorrhoid tissues. Grade one hemorrhoids are not big enough to be grasped by the bands. RBL is done right in the doctor’s office and is quick and effective. Most patients return right back to work after their treatment.
There have been a few methods of rubber band ligation in the past but none better than the vacuum suction ligation technique. This banding technique allows for a very even distribution of the grasping pressures and restricts the “over grab” of tissues by limiting the amount of tissue that can be placed within the banding instrument. With this limitation, the underlying nerve is not disturbed and pain or discomfort is minimal. Most people state this is only a 1-2 on a 1-10 scale. Well over half of the patients do not require even Tylenol after the bands are placed.
Once the RBL is in place, the tissue that was grasp begins a dying process that may take a day or two up to 10 days or more to fall off. This process then forms a scab on the rectal wall that usually sloughs in another week or so. Start to finish healing is anywhere from 2 to 3 weeks so patients are usually scheduled for their return visit after that healing time frame.
Recurrence rates of hemorrhoids seem to be higher with those requiring RBL treatment. Not because this is an ineffective treatment but that a patient in this situation has more stretchy tissues or is at a more advanced disease state and has worn the elasticity of the tissue down considerably over time. This is due to the stretching of the vessel walls after an increase in rectal venous pressure. Much like varicose veins and similar in physiologic nature, the weakening of the hemorrhoid walls cause continued bulge and stretch over time and formation of new bulging hemorrhoids or recurrence of past treatment areas. Rubber Band Ligation is a very effective office treatment and has much less risk than surgery. Often times, this can be combined with IRC to provide maximal improvements with minimal side effects and minimal down time.