Rubber Band Ligation
Internal hemorrhoids are one of the most common causes of rectal complaints and bleeding in the country. In spite of conservative management and topical creams often patients tend to have ongoing symptoms. We are currently using the OCRH O’Regan System for definitive treatment of internal hemorrhoids. This highly effective, minimally invasive procedure is performed in our offices in just a few minutes, and most patients return to work that same day. We make recommendations to reduce the chance of recurrence later (currently 5% in two years). Typically, we treat one hemorrhoid at a time in separate visits.
During the brief and painless procedure, we use a small rubber band to ligate the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding. The banding procedure works by causing focal sclerosis of the rectal mucosa and thus interrupting the blood supply to the hemorrhoid. This causes the obliteration of the hemorrhoid. Patients won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the internal wound usually heals over several weeks.
Soon after the procedure some patients may experience a feeling of fullness or a dull ache in the rectum. This can typically be relieved with Tylenol. However, over 99% of patients treated with our method have no significant pain or complication. In fact, thanks to design improvements, this procedure has a ten-fold reduction in complications compared to traditional banding. The new instrument is smaller, affording greater comfort for patients and better visualization for the physician. Unlike other devices, this is a single use instrument that is disposable.
Infrared coagulation (IRC)
As an alternative to the rubber band ligation, we also offer treatment using infrared coagulation. IRC does not require any special preperation or anesthesia. This is an office based procedure that uses a probe to deliver a two second pulse of light energy to the base of a hemorrhoid. This results in cutting off the blood supply to the hemorrhoid causing it to shrink and recede. The procedure is very quick and essentially painless. It is considered one of the safest treatment modalities for treatment of internal hemorrhoids.
Treatment of hemorrhoids at the time of colonoscopy
Aside from colorectal cancer (CRC) screening, rectal bleeding is one of the most common indications for referral of patients for colonoscopy. In the vast majority of these cases the source of bleeding is typically internal hemorrhoids. However once a diagnosis is rendered the management of internal hemorrhoids is not always effective with topical creams. The most beneficial, simple and widely implemented in-office treatment of internal hemorrhoids is rubber band ligation (RBL). This procedure has typically required multiple visits and anoscopy in order to band each of the three major columns of internal hemorrhoids. With advent of endoscopic band ligation it is possible to consolidate this treatment to a single procedure.
Since most of the diagnostic colonoscopies are performed to evaluate rectal bleeding and internal hemorrhoids are the most common cause of such bleeding (especially in younger patients), it makes sense to treat the source of the bleeding at the time of the colonoscopy. Given the fact that the patient is already prepped, sedated and monitored during the colonoscopy, ligation of internal hemorrhoids only adds another 5-10 minutes to the endoscopic procedure. Hence this one-step combined procedure provides both diagnostic and therapeutic benefit to the patient with hemorrhoidal bleeding.