Rubber Band Ligation: What It Is and How It Works

Rubber band ligation has been used for decades and remains one of the most effective, least invasive ways to treat Grade I through Grade III internal hemorrhoids. It's done in the office, takes about 10 minutes, requires no anesthesia, and most patients are back to normal activities the same day.

The concept is simple: a tiny elastic band is placed around the base of the hemorrhoid, cutting off its blood supply. Without blood flow, the hemorrhoidal tissue dies and falls off within a few days — usually unnoticed during a bowel movement.

Where the tissue was, a small scar forms. That scar actually does something useful: it anchors the surrounding tissue in place, reducing the likelihood of future prolapse at that location.

You'll be positioned comfortably on the exam table. Dr. Chung uses an anoscope to visualize the hemorrhoid, then passes a small ligating instrument through the scope to place the band. The whole thing takes less than 10 minutes.

Because internal hemorrhoids are located above the dentate line — where pain-sensing nerves are sparse — most patients feel only pressure or fullness during the procedure, not pain. Some feel a brief pinch when the band is placed.

Typically one to three hemorrhoids can be treated per session. If you have more, additional sessions are scheduled 2 to 4 weeks apart.

A dull ache or sense of fullness in the rectal area for 24 to 72 hours is normal and expected. Over-the-counter pain relievers and warm sitz baths handle this well. Avoid heavy lifting and prolonged sitting on the toilet in the days following the procedure.

Light spotting of blood around days 7 to 10 (when the banded tissue falls off) is normal. Heavy or sustained bleeding is uncommon but should prompt a call to the office.

Rubber band ligation works for Grade I, II, and III internal hemorrhoids. It is not used for external hemorrhoids — those are covered by pain-sensitive skin, and placing a band there would be extremely uncomfortable and is not indicated.

Patients on blood thinners should discuss this with Dr. Chung in advance, as the medication may need to be paused. Most patients are good candidates without any special modifications.

Rubber band ligation successfully treats the targeted hemorrhoid in roughly 70 to 80 percent of cases. Multiple sessions may be needed for multiple hemorrhoids, and some patients require a second round of treatment months or years later if new hemorrhoids develop.

Compared to surgery, ligation is significantly less invasive with minimal recovery time. For most people with moderate internal hemorrhoids, it's the right balance of effectiveness and convenience.