This is a simple procedure that can be done in the rooms without any sedation or anaesthetic or in the operating theatre if combined with another procedure such as a colonoscopy. A proctoscope is placed in the anus and the internal haemorrhoids are viewed. A very small elastic band is placed at the base of the haemorrhoid in effect decreasing the blood supply to the haemorrhoid making it much less likely to bleed. The band is put on above the level where there are pain receptors and so in most cases there should not be much discomfort afterwards. Up to three haemorhoids can be banded at one occasion (but not always). Banding is a very successful treatment for bleeding internal haemorrhoids. Occasionally, banding is repeated for ongoing bleeding. It is less successful for symptoms of prolapse (ie protruding haemorrhoids) but is usually offered as it is much less invasive than other treatments. The long-term results are excellent and a recurrence of problems is infrequent, as long as you maintain a normal bowel habit and avoid straining.
You may feel some pressure discomfort due to the application of the rubber bands. The pressure feeling usually lasts a few hours but may remain until the haemorrhoids have dropped away, giving the sensation that the last bit of bowel motion has not been completely passed after you open your bowels. The urge to strain should be resisted, as it is the treated haemorrhoids which cause this sensation rather than any retained bowel motion.
After banding, haemorrhoids may take several days to drop into the toilet bowl. The rubber bands will fall away with them. You may or may not notice this happen. As the haemorrhoids separate after banding there will be several tiny wounds left within the lower anal canal, which will need to heal; this may take a little over two weeks. It is natural therefore to see a little blood either on the paper or in the toilet during that time as the motions pass through.
Bowels and diet
You should try to ignore the natural urge to open your bowels for approximately six hours following the treatment. You may do so if you need to, but try to avoid straining.
You may eat normally but it is important to maintain a high fibre diet (cereals, bran, fruit and vegetables). If you are constipated, it may be necessary for you to take a bulking agent such as psyllium husks, Agiofibe granules with water or Metamucil. Take plenty of fluids, especially water. For more significant constipation take movicol 1-2 sachets daily.
Do not insert suppositories during the two weeks after banding. You may use ointments around (but not inserted into) the anal canal. Local itch and irritation may not disappear immediately, particularly if the problem has been longstanding. Avoid exceptionally strenuous activity such as running, lifting heavy weights or bicycle riding for 1 week.
Pain – sometimes it is necessary to place the rubber band rather close to the skin of the anal canal at the lower edge of the bowel lining. Some discomfort, or even pain, may occur, although this is rare. A warm bath with a handful of household salt is most comforting. You may take simple pain tablets such as Panadol (two tablets every four hours as required) and nurofen (400mg every 4 – 6 hours).
Significant bleeding after the procedure occurs in about 1%. It is most likely to occur between 1 and 2 weeks following the treatment. You will recognise it by the presence of a significant volume of blood (more than a cupful)in the toilet, which may be repeated in several bowel actions. If this occurs you should seek immediate medical advice. During office hours, please telephone the rooms. Out of office hours, you should attend the nearest emergency department. Should you need to seek urgent medical help away from your surgeon, please show your doctor this sheet and bring the following paragraph to his /her attention.
To the Hospital Medical Officer:
Secondary haemorrhage between 7 and 14 days post-banding is best treated by insertion of a Foley’s catheter with a large balloon (60mls if possible) placed well into the rectum. The balloon is then inflated and traction applied so that the balloon maintains pressure on the pelvic floor. Strap the catheter to the thigh to ensure traction for at least 12, and preferably 24, hours. There is usually little to be gained by proctoscopy or digital rectal examination. If colonoscopy and polypectomy were performed as well, then the differential diagnosis will rest between post-banding (most likely) and post-polypectomy secondary haemorrhage.
Very rarely the banded haemorrhoid prolapses out of the anus leading to a significantly painful external lump. This will usually settle without further treatment but it is important to get in touch with your surgeon if this occurs.