Rubber band ligation (RBL) is a commonly used, minimally invasive procedure for treating internal hemorrhoids. For some patients, it can provide symptom relief without surgery. However, like any medical procedure, rubber band ligation has limitations—and understanding its disadvantages is important before deciding if it’s the right treatment option.
If you’re considering rubber band ligation or have already undergone the procedure and are still experiencing symptoms, knowing the potential downsides can help you make a more informed decision about your care.
Rubber Band Ligation Does Not Treat the Root Cause
One of the main disadvantages of rubber band ligation is that it treats the hemorrhoid itself, not the underlying cause.
Hemorrhoids often develop due to increased pressure and abnormal blood flow in the rectal veins. Rubber band ligation cuts off blood supply to a single hemorrhoid, causing it to shrink and fall off—but it does not address the blood vessels that caused the hemorrhoid to form in the first place.
Because of this, new hemorrhoids can develop over time, even after successful banding.
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Hemorrhoid Symptoms Can Return
Another limitation of rubber band ligation is the risk of recurrence.
While some patients experience relief after treatment, others may notice:
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Bleeding returning weeks or months later
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New hemorrhoids forming
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Persistent discomfort despite multiple banding sessions
In many cases, patients require repeat treatments, especially if they have more than one internal hemorrhoid or ongoing risk factors such as chronic constipation or prolonged sitting.
Post-Procedure Discomfort Is Common
Although rubber band ligation is considered minimally invasive, it is not always pain-free.
After the procedure, patients may experience:
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Rectal pressure or fullness
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Pain or cramping
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Bleeding when the banded hemorrhoid falls off
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Difficulty sitting comfortably for several days
Discomfort varies from person to person, but for some patients, recovery can be more uncomfortable than expected.
RBL Is Not Suitable for All Types of Hemorrhoids
Rubber band ligation is only effective for internal hemorrhoids.
It is not recommended for:
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External hemorrhoids
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Mixed internal and external hemorrhoids
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Advanced or prolapsed hemorrhoids that cannot be repositioned
Patients with more complex or severe hemorrhoids may not be good candidates for banding and may require alternative treatment options.
Risk of Complications with RBL
While serious complications are uncommon, rubber band ligation does carry some risks, including:
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Significant pain if the band is placed too low
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Infection
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Excessive bleeding
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Thrombosed hemorrhoids
In rare cases, complications may require additional medical treatment or intervention.
May Require Multiple Office Visits
Rubber band ligation is often performed one hemorrhoid at a time. If multiple hemorrhoids are present, patients may need several appointments spaced weeks apart.
For individuals seeking a single-procedure solution, this can be inconvenient and prolong the overall treatment timeline.
When Rubber Band Ligation May Not Be Enough
If hemorrhoid symptoms are chronic, severe, or continue after banding, rubber band ligation may not provide long-term relief. Patients who experience ongoing bleeding or recurring symptoms may benefit from a treatment that addresses hemorrhoids more comprehensively.
A thorough evaluation by a specialist is essential to determine whether rubber band ligation is appropriate—or if another minimally invasive option may be better suited.
Hemorrhoid Artery Embolization vs. Rubber Band Ligation
For patients who continue to experience hemorrhoid symptoms or want a more comprehensive treatment approach, it’s helpful to understand how hemorrhoid artery embolization (HAE) compares to rubber band ligation (RBL).
While both are minimally invasive and performed without traditional surgery, they treat hemorrhoids in very different ways.
How the Treatments Differ
Rubber band ligation works by placing a small rubber band around an individual internal hemorrhoid. This cuts off its blood supply, causing the hemorrhoid to shrink and fall off. The treatment focuses on addressing one hemorrhoid at a time and does not target the underlying blood vessels that contribute to hemorrhoid formation.
Hemorrhoid artery embolization, on the other hand, treats hemorrhoids by reducing blood flow to the arteries that feed them. Using image guidance, a specialist blocks the abnormal blood vessels responsible for hemorrhoid symptoms. Over time, the hemorrhoids shrink naturally without being cut, removed, or banded.
Key Differences to Consider
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Treatment focus:
Rubber band ligation treats individual hemorrhoids, while hemorrhoid artery embolization addresses the underlying blood supply contributing to hemorrhoid symptoms. -
Pain and recovery:
Rubber band ligation can cause post-procedure discomfort, pressure, or bleeding when the banded tissue falls off. Hemorrhoid artery embolization is often associated with minimal discomfort and a smoother recovery. -
Number of treatments:
Rubber band ligation may require multiple sessions if more than one hemorrhoid is present. Hemorrhoid artery embolization is typically completed in a single procedure. -
Recurrence risk:
Because ligation does not treat the root cause, symptoms may return. By targeting the blood flow, embolization may reduce the likelihood of recurring hemorrhoids for some patients.
Hemorrhoid Artery Embolization Information
Which Option May Be Right for You?
Rubber band ligation may be appropriate for patients with mild to moderate internal hemorrhoids and limited symptoms. Hemorrhoid artery embolization may be a better option for patients with chronic bleeding, recurring hemorrhoids, or those who have not found lasting relief with banding.
A proper evaluation is essential to determine the most appropriate treatment based on symptom severity, hemorrhoid type, and overall health.
Talk to a Hemorrhoid Specialist About Your Options
While rubber band ligation can be effective for some patients, it is not a one-size-fits-all solution. Understanding its disadvantages helps set realistic expectations and ensures you receive the right treatment for your specific condition.
At USA Hemorrhoid Centers, patients receive personalized evaluations to determine the most appropriate approach based on symptoms, hemorrhoid type, and overall health.
Take the Next Step
If hemorrhoids are affecting your quality of life—or if prior treatments haven’t worked—it may be time to explore your options with a specialist. The right treatment plan starts with understanding what works best for you.