Recently our group for haemorrhoid banding has developed a new device. An anoscope equipped with a Doppler identifies specifically the haemorrhoidal artery feeding the pile and with a side-view suction ligator is proven alternative to traditional banding methods. The anoscope is inserted and directed at the appropriate haemorrhoid and suction applied.

Complications of haemorrhoid banding are very seldom and include bleeding, pain, thrombosis and in very rare cases life threatening perineal sepsis. Bleeding generally occurs immediately after banding or 7-10 days later when the band falls off. This is a rare occurrence but occasionally operative intervention is required to control persistent haemorrhage. A dull persistent ache is common for the first one to two days following banding. Significant anal pain is rare but is often secondary to a rubber band placed too close to the dentate line. If the pain is experienced immediately following the banding, then the rubber band can be removed with a beaver blade, although this is a difficult procedure. If the patient develops pain later on then this is generally treated with sit-baths, analgesics and occasionally antispasmodics. It is important to avoid constipation during this period as well. Rarely, haemorrhoid banding can result in thrombosis of internal and external haemorrhoids resulting in significant pain. There have been several anecdotal cases of life threatening perianal sepsis following haemorrhoid banding.(15) Patients are therefore asked to watch for the cardinal signs of this phenomenon which would be significant pain, fever, and difficulty urinating. Although there is only anecdotal evidence, some authors recommend avoiding haemorrhoidal banding in individuals with immune compromised states because of the potential risk of perianal sepsis.

Prospectively studied complications in 1600 patients undergoing haemorrhoid banding, minor complications developed in 4.6% of patients including pain, band slippage, mucosal ulcer, and anal thrombosis. Hospitalization for major complications was necessary in less than 1.5%, and included  haemorrhage, severe pain and urinary retention.

After Treatment

Symptoms

You may feel mild to moderate pain, a dull ache, or essentially nothing for the first 36 to 48 hours. A sense of urgency to have a bowel movement is normal after these treatments. If discomfort is mild, take over-the-counter medications such as Ibuprofen or Diclofenac. Do not take aspirin or products containing aspirin since  they may promote bleeding. If your pain is more severe, you will be given a prescription for pain medicine. Taking warm baths with Kamillosan for 15 to 20 minutes will help relieve your discomfort.

Generally it takes two to four treatments three to six weeks apart to get rid of all the prolapsing mucous. Usually only one area, or occasionally two, is treated at a time. Remember that bleeding and prolapse will probably persist until all the haemorrhoids and prolapsing tissue have been treated.

Diet

After your treatment, it is important to keep your bowel movements soft and regular. Eat foods high in fibre and drink lots of water (6-8 glasses a day). Continue the fibre supplement recommended by your doctor. Caffeine contributes to constipation so limit your consumption of coffee, tea, colas, and chocolate. Electrolyte substitution like Magnosolv Granulat may help while rending your stool softer

Activity

You may continue your normal physical activities. You will be able to drive your car immediately, walk up stairs, and do normal exercise.

Causes for Concern: Call the doctor if you have any of the following problems:

a)    Pain that does not gradually lessen in three days,

b)    Increasing pain several days after treatment,

c)     Tender swelling in the anal area, fever or chills, difficulty urinating, drainage of pus from the rectum

d)    Increased bleeding (more than one cupful)

e)    Three to four large bloody bowel movements within three hours

f)      Severe constipation (no bowel movement for three days)

g)    Diarrhoea (more than three watery stools within 24 hours)

In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort and expense.