Rubber Band Ligation

Overview

Rubber band ligation (RBL) is a straightforward, well-established procedure where a tiny elastic band is placed around the base of an internal haemorrhoid — the swollen tissue that sits just inside the back passage. The band gently cuts off the blood supply to the haemorrhoid, and over the next 7–10 days the tissue quietly shrinks and separates on its own, in a way you will not feel happening.

Mr Nguyen performs the procedure under sedation or a short general anaesthetic, so you are completely comfortable throughout. You will not be aware of anything uncomfortable. If you have more than one haemorrhoid that needs treating, several can often be dealt with in the same sitting. Occasionally, a second procedure is recommended some weeks later to achieve the best result — Mr Nguyen will let you know if this is likely to be the case for you.

Who needs this procedure?

Mr Nguyen may recommend rubber band ligation if you have internal haemorrhoids — the kind that sit inside the back passage rather than on the outside — and any of the following apply to you:

• You are experiencing bleeding (blood on the toilet paper or in the bowl), tissue that pushes out when you go to the toilet (prolapse), or ongoing discomfort or pressure around the back passage
• Dietary changes, creams, and other conservative measures have not made enough of a difference
• You would prefer to avoid more extensive surgery if a simpler treatment can achieve the same result
• Your haemorrhoids have returned after a previous banding procedure — repeat banding is effective and well tolerated
• Ongoing bleeding from haemorrhoids has led to iron deficiency anaemia (low iron in your blood), and the source needs to be properly addressed

Benefits

• Very effective — more than 9 in 10 people with Grade II–III haemorrhoids (internal haemorrhoids that bulge or prolapse but can be pushed back) experience long-term relief after banding
• No cuts, no stitches, no surgical wound — the band is placed entirely inside the back passage, so there is nothing to stitch and nothing to heal externally
• Quick recovery — most people are comfortably back to their normal routine within 1–2 days. The first day can feel a little uncomfortable, but it is usually manageable with regular paracetamol
• Multiple haemorrhoids can be treated in one session — so you only need one anaesthetic and one recovery period, not several separate visits
• More durable than non-procedural treatments — creams and dietary changes help manage symptoms, but banding addresses the underlying haemorrhoid tissue directly and lasts considerably longer
• Day procedure — you sleep in your own bed — you come in, have the procedure, recover briefly, and go home the same day

Risks & considerations

Rubber band ligation is considered a very safe procedure — the complication rate is low and most people sail through without any issues. That said, it is worth knowing what is normal to feel, and what would warrant a call to our rooms.

• Discomfort or a sense of pressure — It is very common to feel a dull ache or heaviness around the back passage for the first day or two. This is the band doing its job. Regular paracetamol is usually all you need. Avoid ibuprofen for the first week if possible, as it can increase the risk of bleeding.
• Some spotting of blood — A small amount of blood is completely normal, and you may notice it particularly around days 7–10 when the haemorrhoid tissue separates and passes away. This is expected. Significant bleeding — where you are soaking through pads or there is heavy fresh blood — happens in fewer than 1 in 100 cases. If this occurs, call us promptly.
• Band coming off early — Occasionally a band dislodges before the haemorrhoid has fully resolved. This is uncommon and is straightforward to treat with a repeat banding at a later date.
• Thrombosis of a nearby external haemorrhoid — In a small number of people (fewer than 1 in 20), a nearby external haemorrhoid (one that sits on the outer edge of the back passage rather than inside it) can become swollen and painful after banding. This is called thrombosis. It is very tender for a few days but almost always settles on its own within 1–2 weeks. Warm sitz baths and regular paracetamol can help.
• Pelvic infection (very rare, but important to know about) — In extremely rare cases, an infection can develop in the pelvis — the region around your back passage and lower abdomen. The warning signs are a combination of severe pain, fever, and difficulty passing urine. If you experience all three of these together, go to the emergency department immediately — do not wait for a call back from our rooms. This complication is rare, but it needs urgent assessment when it does occur.
• Haemorrhoids returning over time — Haemorrhoids can come back, especially if the underlying triggers — things like a low-fibre diet, straining, or chronic constipation — are not addressed. If they do return, repeat banding is effective and very well tolerated.

Before the procedure

• Most people do not need any special bowel preparation before this procedure — there is no large cleansing drink or day-before fasting beyond what is listed above. That is one of the advantages of rubber band ligation over a full bowel procedure
• On some occasions, Mr Nguyen may recommend a small phosphate enema (a short preparation given at the hospital on the day of the procedure) — his team will let you know in advance if this applies to you
• Because you will be having sedation or a general anaesthetic, you will need a responsible adult to drive you home and stay with you for the rest of the day. You cannot drive yourself, even if you feel fine when you wake up

On the day

Here is what you can expect from start to finish:

• You will be admitted to the day-stay unit at Warringal Private Hospital or Epworth Eastern. The nursing team will welcome you, check through your details, and answer any last questions. It is a calm, unhurried environment — you will not be rushed.
• The anaesthetist will give you sedation or a light general anaesthetic through a small drip in your hand, so you are completely relaxed and unaware throughout. This is not a procedure where you are expected to just "put up with it" — your comfort is a priority.
• Mr Nguyen uses a small, smooth instrument called a proctoscope — a short tube gently placed into the back passage — to see inside and identify the haemorrhoid tissue that needs to be treated.
• A tiny rubber band is placed around the base of each haemorrhoid. You will not feel this happening — the sedation ensures that completely.
• If you have more than one haemorrhoid to treat, several can be banded in the same session. No need for separate appointments.
• Once the procedure is finished, you will rest comfortably in the recovery area for 1–2 hours while the sedation wears off. The nursing team will give you written aftercare instructions before you leave, and they will answer any questions you have before you go home.

Recovery & aftercare

• Day of the procedure — rest at home: Go home and take it easy. A dull ache or sensation of pressure around the back passage is very common for the first few hours and into the evening — this is normal, and it is the band doing its work. Regular paracetamol is usually all you need. Avoid alcohol and strenuous activity. Sleep in your own bed.
• Days 1–2 — gentle return to normal: Most people feel well enough to return to desk work and light daily activities. The discomfort is usually much better by day 2. Avoid heavy lifting, vigorous exercise, or anything that puts strain through the pelvic floor for at least a few days.
• Days 7–10 — the haemorrhoid separates: Around this time, the haemorrhoid tissue falls away and passes out of the body. You may notice a small amount of blood in the toilet — this is entirely expected and is not cause for alarm. It usually lasts just a day or two. If it is heavy or is not settling, give us a call.
• Looking after your bowels — the most important long-term step: Keeping your stools soft and your bowels regular is the single most important thing you can do to support healing and prevent haemorrhoids from returning. Aim for a high-fibre diet (plenty of vegetables, fruit, whole grains), drink at least 8 glasses of water a day, and do not ignore the urge to go. Sitting on the toilet for long periods — especially while scrolling your phone — adds unnecessary straining pressure.
• Avoid straining: If you feel constipated in the weeks after your procedure, please let us know. There are safe, gentle options we can recommend — do not strain through it.
• If a staged approach is needed: Sometimes haemorrhoids on different sides of the back passage are better treated in two separate sessions, rather than all at once, to reduce the risk of post-procedure pain. If this applies to you, Mr Nguyen will discuss the plan with you before the first procedure — nothing happens without you knowing why.
• Your follow-up: Mr Nguyen routinely schedules a follow-up 2–6 weeks after your procedure. This is included at no additional charge and gives you the opportunity to ask questions, discuss your recovery, and confirm whether any further treatment is needed.

Related patient guides

These guides are written in plain language for patients and their families. Haemorrhoids are one of the most common things people quietly worry about — these articles answer the questions most people are hesitant to ask.