Piles Treatment: Rubber Band Ligation

rubber band ligationThere are a number of treatments available for piles with the different options now being offered to patients depending on how severe their symptoms are and how bad the piles look on examination.

Of these many methods, rubber band ligation is a fairly commonly used technique.

In this article, we shall take a closer look at this procedure, concentrating particularly on how it is performed and what to expect as a patient.

What Is Rubber Band Ligation For Piles Treatment?

Rubber band ligation literally means cutting off the piles using a rubber band. While this can sound very simple and also rather odd, it is in fact a very simple and effective method of treatment of piles.

How Is a Procedure Performed?

Prior to performing the procedure, patients may be offered laxatives or enemas to clear out the bowels and allow the treating surgeon to get a clear view of the piles.

The procedure is usually performed as an outpatient but can also be performed after admitting the patient to hospital. Consent of the patient is obtained having explained the benefits and the risks.

Once the bowels have been cleared out, the patient is placed in an ideal position (usually lying on the left side) so that the doctor can get a clear view of the piles.

Local anaesthetic gel is applied around the anus. A small instrument called an anoscope (or proctoscope) is inserted into the rectal cavity through the anus.

This can be a bit uncomfortable initially but the procedure is performed very slowly and carefully so as to minimise any discomfort.

Once the hemorrhoids are visualized, they are grasped using a pair of forceps and a rubber band applied around the piles at the point where it arises from the lining of the rectum or anus.

Usually, no more than two piles are ligated in one sitting if the procedure is performed as an outpatient. However, if performed under general anaesthetic, all the piles can be ligated in one sitting.

What Happens After The Procedure?

Following rubber band ligation, the patient is observed for a short period of time and then discharged home. Advice will be provided as to how to look after the site of ligation, and patients will be advised to avoid straining when opening their bowels.

Laxatives may be prescribed to help facilitate bowel motions.

Patients will also be informed that bleeding may occur following the procedure and sometimes may also be seen up to 2 weeks after the procedure.

This bleeding that occurs later on happens because the dried out piles are falling off and there may be slight injury when this happens to the surrounding mucous layer or skin.

Patients should also avoid activities that increase pressure within the abdomen such as heavy lifting.

However, this should only be observed for a few days and patients can resume their normal activities after 4 to 5 days following the procedure. 

How Does a Rubber Band Ligation Work?

Since the rubber band is applied to the base of the pile, it cuts the blood supply to the pile. As a result, the blood that is already within the pile clots, eventually drying it out.

As a consequence of this drying out, the piles shrivels up and fall off along with the rubber band.

Is It Effective?

Rubber band ligation is a fairly effective procedure. It bears the advantage that it can be performed in an outpatient setting and very quickly.

However, it is important to be aware that piles can recur, and following a rubber band ligation around one in five patients can have a recurrence of the piles in around five years.

Are There Any Complications?

Complications are part of any procedure and rubber band ligation is unfortunately no exception. The commonest complication that can occur is a bit of pain at the site of ligation. Patients may experience mild dizziness and bleeding as well immediately after the procedure.

The pain that does occur around the anal area can be relieved by painkillers and warm baths. But if the pain is severe and is affecting the patient’s quality of life significantly, then the rubber bands will need to be removed by the doctor.

As has been previously mentioned, bleeding can occur later on as well following rubber band ligation. This occurs due to the shedding of the dried piles along with a rubber band.

In most cases, this bleeding stops by itself. However if the bleeding persists, the doctor may want to perform another examination to find the bleeding points and to stop the bleeding.

In rare cases, patients may develop an infection at the site of rubber band ligation. Patients usually have a fever along with pain at the site of the procedure.

In such cases, the doctor will perform another examination along with procedures to get rid of infection (such as a bowel wash out). Patients may be commenced on antibiotics to help tackle the infection.


Rubber band ligation is an effective way to manage piles. Treatment is safe and can be easily performed quickly in the outpatient department. 


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