Rubber Band Ligation is one of several treatments known as Fixative procedures. The treatment itself dates back to ancient Greece, and was first attributed to Hippocrates, who in 460 B.C. referred to a practice that consisted of tying off the hemorrhoid using a piece of thread. In the 19th century a primitive form of the modern procedure was practiced in Europe and America, but was abandoned because of the severity of the pain it generated. A more refined method was reintroduced in the late 1950’s, which by 1963 was streamlined and perfected.

Rubber Band Ligation is a non-surgical procedure that targets second-degree internal hemorrhoids, a condition in which the inflammation remains within the anal canal. The primary objective of a Fixative procedure is to reduce the flow of blood to the inflamed site. The intervention consists of tying off the hemorrhoids with rubber bands, which in turn aborts the blood supply necessary for the hemorrhoid to remain inflamed.

Prior to the procedure it is not uncommon for the patient to undergo an enema, which may be necessary to clear the anal canal of stool. The actual procedure requires the patient to lay on their left side, in a lateral, or fetal position, allowing the buttocks to protrude over the edge of the operating table, thereby giving the doctor direct access to the inflamed site.

Using forceps to manipulate the hemorrhoid, the doctor then pulls it into the ligator, a cylindrical tool that isolates the region of the hemorrhoid, known as the base, from the anal canal, where the rubber band is then applied. It is not uncommon for two rubber bands to be secured in place to ensure that the blood supply to the hemorrhoid has indeed been sufficiently reduced to alleviate the condition. Typically, following the procedure, the hemorrhoid shrinks and falls off from within seven to ten days.

Following the procedure it is common to experience some bleeding, especially after the first several bowel movements, in addition to experiencing mild pain or discomfort, and the sensation of pressure. Heavy post-operative bleeding is highly rare and requires hospitalization. Severe pain is usually the result of misapplication of the rubber band, and requires removal and reapplication of the band. Several other post-operative complications that require hospitalization are a) Blood Clotting, b) development of an Anal Fissure, and c) Sepsis, which is an infection of the pelvic area and is distinguished by pain, fever, and difficulty urinating.

According to studies, Rubber Band Ligation has a 60% to 80% success rate, and its efficacy is comparable to other Fixative treatments such as Coagulation Therapy. It tends to be a less risky and less painful procedure than surgery, with a far shorter healing time than surgical procedures require. Because of these factors, doctors will undoubtedly continue to favor treating hemorrhoids of this nature with Fixative procedures such as Scarring, or with Rubber Banding Ligation.

*David Gilbert received his BA from U.C.L.A. He is currently doing graduate work in psychology at California Graduate Institute, in Los Angeles, CA. Throughout his career in the mental health field he has worked clinically with several populations, and also contributed to academic works whose topics address both health and mental health issues.