Procedure Preparations

Rubber Band Ligation

What is rubber band ligation?

Rubber band ligation is a minimally invasive office-based procedure to treat internal hemorrhoids. A rubber band is placed around/above the area of the hemorrhoid in order to shrink its blood supply. Typically within 7 to 14 days, the treated area sloughs leading to eventual scarring and fixation of the tissue with improvement of the symptoms. While some patients can find relief after 1 session of rubber band ligation, often multiple sessions are needed. At the 1st session, Dr. Maher Abbas will treat 1 hemorrhoid but at subsequent sessions 2 hemorrhoids can be treated at a time. This painless procedure takes less than 10 minutes and is done with you awake. If there is a particular hemorrhoid that is bothering you, it will be targeted first. If you cannot tell which side is most bothersome, Dr. Maher Abbas will rubber band the largest or most inflamed hemorrhoid seen on the day of the procedure.

How do I prepare for the procedure?

On the day of the procedure you can eat and take your usual medications unless instructed otherwise. If you are on blood thinners, aspirin, or non-steroidal anti-inflammatory medications (medications used for pain, arthritis, or headaches, such ibuprofen, naproxen, diclofenac, etoricoxib), or have a heart condition, let Dr. Maher Abbas and his nurse know. Prior to coming for your visit, perform 2 Fleet enemas at home [see section on How To Do An Enema]. You can drive yourself to the appointment. Ideally you should have the procedure and have the remainder of the day off to rest. Kindly arrive 15 minutes prior to your procedure time.

Post rubber band ligation care


It is best to rest the day of the procedure. Ideally try to schedule your procedure the last day of the working week before the weekend. You can resume your usual activity in 24 to 48 hours but no strenuous activity or vigorous exercise such as bicycle riding, jogging, weight lifting, or aerobic exercise for 1 week. Avoid heavy lifting or straining during your recovery. Get enough sleep and rest when tired. Take a sitz bath twice a day or more frequently if needed the first 3 days [see section on Sitz Bath]. You can shower and bathe.


You can have regular diet with high fiber content and drink plenty of liquids. Avoid constipation and straining.


You can resume your home medications. If you are on any blood thinner, ask Dr. Maher Abbas for specific instructions. Remain on a high fiber diet and if a laxative is prescribed then take it in order to avoid constipation or straining. If you have discomfort you can take 1 to 2 acetaminophen 500 mg pill every 8 hours [panadol, paracetamol, tylenol]. Drink plenty of water.

Signs to watch for

Expect minor bleeding with defecation, some fullness or ache/pressure inside the anus for approximately 48-72 hours. Some minor bleeding can occur up to 3 weeks after rubber band ligation. Significant bleeding or infection rarely occur after rubber band ligation. If any of the following symptoms occurs, contact Dr. Maher Abbas immediately:

  • Bleeding that does not stop or blood clots
  • Severe anal pain with swelling
  • Fever with temperature > 38 degrees Celsius
  • Severe pelvic or abdominal pain
  • Shortness of breath or racing heart beats
  • Painful or difficult urination

Follow-up appointment

The rubber band can fall off any time following the procedure [from 1 day up to 3 weeks]. Often you will not notice it when it happens. A follow-up appointment will be scheduled in 2 weeks to assess your progress and check the area for healing. If there is a need to perform additional rubber band ligation then it will be scheduled at a later date after obtaining insurance authorization if needed.

Any questions? Contact Dr. Maher A. Abbas’ office nurse here.