Ligation of Piles

Piles ligation, also known as rubber band ligation, is a non-surgical procedure used to treat internal haemorrhoids that protrude during bowel movements. It involves placing a small rubber band around the base of the haemorrhoid, cutting off its blood supply. Within a few days, the haemorrhoid shrinks and falls off, with the wound healing in one to two weeks.

When Do I need to do the procedure

• Recommended for second-degree haemorrhoids that cause bleeding, or discomfort.
• Suitable for cases where medications and dietary changes have not improved the condition.
• 8 out of 10 people recover fully after the procedure.

What do I Expect

You will be positioned on your left side, and sedation will be administered. Once you are asleep, the doctor will start the procedure.

1. A doctor inserts an anoscope into the anus to locate the haemorrhoid.
2. A special instrument grasps the haemorrhoid, and a rubber band is placed around its base.
3. The haemorrhoid loses blood supply, dries up, and eventually falls off.
4. A scar forms, preventing future bulging of veins into the anal canal.

Rubber band ligation for piles can often be performed alongside a colonoscopy. This approach is practical because both procedures involve the anal and rectal regions, and the preparation for colonoscopy (bowel cleansing) ensures a clear view for both evaluations. Combining the procedures can save time and reduce the need for separate appointments.

However, the decision to perform both together depends on factors like the severity of haemorrhoids, the patient’s overall health, and the doctor’s assessment.

After the Procedure

After rubber band ligation for haemorrhoids, proper aftercare is essential for a smooth recovery. Here are some general guidelines:

1. Rest: Take it easy for the first 24–48 hours. Avoid strenuous activities like heavy lifting or intense exercise.
2. Pain Management: Mild discomfort is common. Over-the-counter pain relievers or sitz baths (sitting in warm water for 10–15 minutes) can help alleviate discomfort.
3. Diet: Stick to a high-fiber diet and drink plenty of fluids to prevent constipation. Consider using a stool softener if needed to avoid straining during bowel movements.
4. Hygiene: Keep the anal area clean and dry. Use warm water to gently clean the area after bowel movements and pat dry.
5. Monitor Symptoms: Minor bleeding is normal, especially when the haemorrhoid falls off (usually within 7–10 days). However, contact your doctor if you experience heavy bleeding, fever, or severe pain.
6. Activity: Gradually resume normal activities as you feel comfortable, but avoid anything that causes strain.

Safety of the Procedure

Rubber band ligation is generally considered a safe and effective procedure for treating internal haemorrhoids. It is minimally invasive, does not require surgery, and has a high success rate. However, like any medical procedure, it carries some risks.

Potential Risks

• Pain or Discomfort: Some patients experience mild pain or a feeling of fullness in the lower abdomen, which usually subsides in a few days.
• Bleeding: A small amount of bleeding may occur 7 to 10 days after the procedure when the haemorrhoid falls off.
• Infection: Rare, but possible. Signs include fever, chills, or worsening pain.
• Straining Issues: Heavy lifting or straining during bowel movements should be avoided to prevent complications.

Effectiveness

• Most patients recover without complications and return to normal activities quickly.
• The procedure is highly effective for second-degree haemorrhoids, with a low recurrence rate.
• It’s common for patients to require multiple sessions of rubber band ligation to achieve optimal results, especially for larger or multiple haemorrhoids. The procedure is effective, but sometimes not all haemorrhoids can be treated in a single session. Typically, 2–3 treatments spaced a few weeks apart may be needed.
• This approach ensures that each haemorrhoid is properly addressed while minimizing discomfort and complications.

Cost for The Procedure

• As ligation of piles is a hospital procedure, the cost is covered by most hospitalization plans.
• The procedure is also Medisave deductible. Most of the companies’ health benefits and private health insurances cover the cost of the procedure, which may extend to the private hospitals.
• The fee benchmarks on the procedure done in different hospitals can be found in the website of Ministry of Health Singapore.
• Before the endoscopic procedure, a detailed financial counselling will be done to help the patients understand the cost breakdown in the preferred hospital.
• Patients should also check with their insurance provider on the updated policy regulations before the procedure.