Hemorrhoid Treatments (IRC and Banding)

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Hospital Affiliations

NYU Langone Hospital – Long Island

Mount Sinai Hospital, New York

Mount Sinai South Nassau

Mercy Medical Center

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What Are Hemorrhoid Treatments?

It’s estimated that three out of four people will experience hemorrhoids at least once in their lifetime. Hemorrhoids can be caused by many different things, from pregnancy to straining during bowel movements. Many times, patients can use over-the-counter medications to treat hemorrhoids, but sometimes they’re not effective, and hemorrhoids may need medical intervention. Two of the most common treatments for hemorrhoid removal are hemorrhoid banding, which cuts off blood flow to the hemorrhoid, or infrared coagulation (IRC) therapy, which uses infrared light to shrink and shrivel hemorrhoids. The treatment method depends highly upon whether the hemorrhoids are external (around the anus) or internal (in the rectum). In rare cases, surgery is needed to remove hemorrhoids. 

What Are the Symptoms of Hemorrhoids?

Hemorrhoid symptoms depend upon whether the hemorrhoid is internal or external. Often, patients don’t have many symptoms with internal hemorrhoids, except when making a bowel movement. Symptoms of external hemorrhoids include:

  • Swelling around the anus
  • Anal bleeding
  • Irritation or itching around the anus
  • Pain

External hemorrhoids can be quite uncomfortable and can affect the quality of life. 

Internal hemorrhoids may not be noticeable, but sometimes patients can experience the following while passing stool:

  • Pain or irritation
  • Painless bleeding 

Anytime there is anal or rectal bleeding (you may notice it on tissue after wiping) or blood in the stool, you should consult your gastroenterologist. Bleeding is a common symptom of hemorrhoids, but it can also be indicative of more serious concerns, such as colorectal cancer. Also, if hemorrhoids don’t improve after a week or so of over-the-counter treatments or home remedies, you should see your physician. 

What Causes Hemorrhoids?

Hemorrhoids have many causes, but they can also appear with no apparent cause. The greatest risk factor for hemorrhoids is age, as your chances of developing hemorrhoids are greater as you become older. Pregnancy is another risk factor for hemorrhoids and is a quite common and minor complication. Causes of hemorrhoids include:

  • A diet low in fiber
  • Heavy lifting
  • Straining during bowel movements
  • Frequently sitting for too long on the toilet
  • Obesity
  • Chronic constipation or diarrhea
  • Anal intercourse

You can help prevent hemorrhoids by being active, drinking plenty of fluids, taking fiber supplements, and eating a fiber-rich diet.

What Is Rubber Band Ligation (Hemorrhoid Banding)?

If either type of hemorrhoids are persistent and don’t respond to home care, your physician may recommend rubber band ligation, more commonly known as hemorrhoid banding. It is a minimally invasive outpatient procedure, and you can resume regular activities the same day (no anesthesia) or the next (with anesthesia).

In hemorrhoid banding, you’ll either be given sedatives or local anesthesia around the anus and rectum. If you have painful hemorrhoids or many that need banding, your gastroenterologist may recommend general anesthesia to ensure you don’t feel pain or discomfort. 

During the procedure, the doctor inserts an anoscope into the rectum until it locates the hemorrhoid. This scope has a small light on the end of it to help the physician with the ligation. Afterward, a ligator is inserted into the anus and rectum, which ties rubber bands around the base of the hemorrhoid. Banding usually only takes a few minutes. 

If your doctor has concerns you may have other gastrointestinal conditions, they may perform a colonoscopy or sigmoidoscopy on the same day. A colonoscopy examines the entire large intestine (colon), while a sigmoidoscopy only examines the lower (sigmoid) region. Both are screening tests for colon cancer and can also diagnose other conditions, such as inflammatory bowel disorder (IBD), like Crohn’s disease and ulcerative colitis (UC).

After the procedure, you’ll need someone to drive you home if you’ve had twilight sedation or a deeper form of anesthesia. You can typically return to normal activities the next day. You may experience pain, bloating, or constipation after the procedure, which is completely normal. You may also see bleeding—if this persists for more than three days, consult your physician. After a few days, the hemorrhoid band will fall off by itself, and you may not even notice.

What Is Infrared Coagulation (IRC)?

If your hemorrhoids are prolapsed (internal hemorrhoids that push out through the anus), or if you have internal hemorrhoids, your doctor may suggest infrared coagulation. This is a procedure where your physician inserts a small probe into your rectum that emits infrared light. This light applies thermal energy to the rectal tissue above the hemorrhoid. This action leads to scarring, which then shrinks the hemorrhoid.

After the procedure, you may feel slight discomfort or pain for a few days, or slight bleeding that will also disappear. If it does not, be sure to consult your physician.IRC therapy is a minimally invasive, safe procedure, but it does carry with it some risks. Urinary problems, infection, and heavy rectal bleeding are very rare but can occur. 

What If Hemorrhoid Banding and IRC Are Unsuccessful?

Both ligation and IRC therapy are successful in most cases. However, some patients have recurrent hemorrhoids or the treatment was successful. In these cases, your gastroenterologist may suggest hemorrhoidectomy, a surgical removal of the hemorrhoid, or hemorrhoid stapling, which is a surgical procedure to block blood flow to the hemorrhoid.