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Hemorrhoid Ligation

Advantages of the Procedure
Post Treatment Precautions and Risks
Alternative Treatments


Hemorrhoid Ligation is a procedure during which a latex band is placed around the neck of the hemorrhoid (or pile) and/or gets frozen with a cold probe (cryosurgery) to kill the hemorrhoid. The band may be removed after the freezing. The pile then shrinks away over the next couple of weeks.When the hemorrhoid shrinks, there may be some irritation or burning from the raw surface until it heals. For a few days after the procedure patients must avoid excessive coffee, cola, alcohol, spices, heavy lifting and strenuous exercise.

Two to four visits will be needed to complete the treatment. A sigmoidoscopy and colonoscopy may be required to ensure there is no other problem higher up causing your symptoms. Most patients with hemorrhoids will have success with this treatment.

Advantages of the Procedure

  • No hospitalizations
  • No general anesthesia
  • Less time lost from work – most patients return to work and resume normal activities the same day
  • Fewer serious complications in this procedure (i.e., no narrowing of the anal opening or serious bleeding, and there is rarely an infection)
  • With this method, the early recurrence rate is reduced to about 15% and late recurrences average about 20%. Hemorrhoids may recur if you strain during bowel movements, sit on the toilet and read, etc.

Post Treatment Precautions and Risks

  • Constipation and straining at stool must be avoided; this is extremely important. If you have this tendency, take natural wheat bran or other bulk forming laxative daily.
  • Bleeding: Spotting may occur when the hemorrhoid shrinks, which is usually minor. Occasionally you may have a gush of blood in the toilet during a bowel movement, in which case do the following.
    • Lie face down on the bed with your stomach over the edge and place your head on a pillow on the floor so that your bottom is as high as possible – for 15-20mins to allow the bleeding to stop by gravity.
    • After that, lie face down on your bed with four pillows under your hips to keep your bottom elevated for an hour. If the bleeding returns, do these steps again. It is very rare (approximately 1 in 1000) that this will not stop the bleeding. If possible, apply lubricated gauze directly. If it continues, please call the clinic.
    • If you experience periodic bleeding after the treatment is over, it is from anal irritation. You may buy an Anurex, a cold reusable suppository, and use it to soothe the area by cooling.
  • Burning/raw, irritating sensation: Stop all coffee, alcohol, spices (i.e. onions, pepper and garlic) and use Anurex (no prescription needed; reusable cold stick kept in the freezer) four times a day for a few days.
  • Another hemorrhoid: Another swollen hemorrhoid sometimes acts up after one hemorrhoid has been treated. Try to push any prolapsing hemorrhoids back in and use an Anurex.
  • Painful external swelling: This occurs in less than 3% of cases as a result of a blood clot after the procedure. Use ice packs and Anurex, stay off your feet and do not strain with bowel movements. Ibuprofen (Advil or Motrin) may also help significantly. There should be improvement within several days. In few cases, urgent surgery is required.
  • If you are unable to urinate, please call the clinic or go to the nearest emergency department at a hospital. A urinary catheter may (rarely) need to be inserted at the hospital.
  • Local infection or abscess formation may rarely happen.

Alternative Treatments

1. Standard hemorrhoidectomy performed in hospital. This is quite painful and includes a 2-3 week recovery period.

2. Injection with sclerosing agent which scars the blood vessels. This procedure is complicated in many patients.