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Hemorrhoid Banding

Hemorrhoid Banding

Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum similar to varicose veins. The two main types of hemorrhoids are internal and external. Internal hemorrhoids develop within the rectum, while external hemorrhoids develop under the skin surrounding the anus.

Hemorrhoids are a common condition affecting many men and women at some point during their life, although they may be more likely with older age. Research has found approximately 50% of people will experience hemorrhoids by the age of 50.

Numerous factors and lifestyle habits may increase a person’s risk of developing hemorrhoids, including constipation, obesity, excess straining and a poor diet. Abnormal or irregular hemorrhoids also tend to be hereditary, meaning you may be more likely to develop them if you have a family history of them.

Uncomfortable or painful hemorrhoids can negatively impact a person’s daily life. Fortunately, treatment options are available.

Hemorrhoid Banding

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What Is Hemorrhoid Banding?


A banding treatment for piles is a nonsurgical, effective treatment for internal hemorrhoids. Hemorrhoid band ligation can safely and effectively cut off the circulation to an internal hemorrhoid, helping it to fall off naturally and painlessly. 

Before considering hemorrhoid banding, it is important to understand the basics of hemorrhoids and how internal hemorrhoids are classified:

  • Grade 1 hemorrhoids: Grade 1 hemorrhoids are internal hemorrhoids that protrude into the anal canal but do not experience prolapse outside of the anus. Grade 1 hemorrhoids are the mildest of hemorrhoids and often respond well to lifestyle changes, including adding healthy fiber to your diet or topical hemorrhoid creams and treatments. Over-the-counter hemorrhoid treatments can reduce swelling, inflammation and itching caused by hemorrhoids.  Grade 1 hemorrhoids also respond very well to hemorrhoid banding.
  • Grade 2 hemorrhoids: Grade 2 hemorrhoids are internal hemorrhoids that prolapse from the anus during a bowel movement but return inward after. While these are slightly more pronounced than Grade 1 hemorrhoids, they often respond well to nonsurgical or conservative hemorrhoid treatment modalities. Rubber band ligation is a popular in-office procedure that can be performed for internal hemorrhoids. The treatment or procedure you may be eligible for varies depending on whether you have internal or external hemorrhoids. Internal hemorrhoid banding requires multiple sessions but can effectively treat hemorrhoids. 
  • Grade 3 hemorrhoids: A Grade 3 hemorrhoid ranges from moderate to severe and is an internal hemorrhoid that prolapses during a bowel movement and needs to be physically reinserted into the anus. Grade 3 hemorrhoids often have more noticeable symptoms. They may cause bleeding, pain, inflammation and itchiness, especially when prolapsed. Grade 3 hemorrhoids also respond to hemorrhoid banding, however, in more severe cases can require more extensive treatment, including hemorrhoid stapling.
  • Grade 4 hemorrhoids: Grade 4 hemorrhoids are internal hemorrhoids that prolapse from the anus but cannot be reinserted, even with physical manipulation. Grade 4 hemorrhoids are the most severe form of hemorrhoids.  Grade 4 hemorrhoids can rarely be treated with hemorrhoid banding and typically require more extensive treatments, including hemorrhoid stapling and hemorrhoid surgery. One of the most common surgeries for Grade 4 hemorrhoids is excisional hemorrhoidectomy.

The Benefits of Hemorrhoid Banding

Hemorrhoid banding is an effective procedure where a band is placed at the base of an internal hemorrhoid to reduce the overall blood flow to the pile. In most cases, a hemorrhoid requires multiple banding sessions to be treated effectively. Within a few days of your final hemorrhoid banding treatment, the pile will naturally and painlessly fall off, typically during a bowel movement. 

Some of the main benefits of hemorrhoid band ligation include:

  • Effectiveness: A hemorrhoid banding procedure is an innovative, effective treatment for internal hemorrhoids. Research has found rubber band ligation to be very effective, with a success rate of 98% of patients after 180 days. Hemorrhoid banding is typically performed on just one hemorrhoidat a time, focusing on improving the symptoms of the most severe hemorrhoids first.
  • Quick procedure times: While the procedure time varies depending on which banding technique is being used and how many hemorrhoids are being addressed, many banding techniques only take five to 15 minutes to perform. Some methods, like the CRH O’Regan System, can even be performed in as little as one minute. 
  • Minimal pain: Rubber band ligation is an innovative treatment that does not require painful incisions or an uncomfortable recovery period. Depending on the type of hemorrhoid banding procedure, you may experience minimal to no pain at all.
  • Speedy recovery: Because hemorrhoid ligation is a nonsurgical treatment, there is little to no downtime needed depending on the type of hemorrhoid banding performed. Many patients can return to their daily activities immediately after treatment. Patients who lift heavy objects or perform strenuous activities for work can typically return to these tasks the following day.
  • The prevention of regrowth: Hemorrhoid banding can remove an internal hemorrhoid, causing a small scar to form in this area. This small, harmless scar tissue helps prevent a hemorrhoid from developing in the same spot again. Hemorrhoid banding can achieve long-lasting results and help patients find permanent relief.

Hemorrhoid Banding

The History of Hemorrhoid Banding

Hemorrhoid treatments have been used for thousands of years. Before highly effective treatments like modern rubber band ligation were introduced, physicians used many treatment modalities to improve hemorrhoidal symptoms. Various iterations of rubber band ligation have even existed throughout history, including tying a woolen thread around a hemorrhoid to remove the growth.

Modern rubber band ligation was developed in the 1950s when Paul C. Blaisdell proposed the idea that internal hemorrhoids have few pain-sensing nerve endings and were relatively easy to access. Because rubber band ligation was such a simple, effective procedure, physicians could offer this treatment from their offices instead of a hospital.

In 1963, J. Barron popularized this procedure further when he modified the treatment to use rubber bands and a device known as the Barron band ligator, a metal device using forceps to gently grab the hemorrhoid and place the rubber band at its base. Following Barron’s technique, many variations of forceps and devices have been utilized for rubber band ligation.

While Barron’s ligation technique is widely considered safe and effective, small improvements have since improved the procedure. One of the most notable changes has been the device used for rubber band ligation. Traditional forceps are difficult for some physicians to use, and they have the potential to cause post-procedure discomfort and pain.

In 1997, Dr. Patrick J. O’Regan, a renowned laparoscopic surgeon, created a painless suction device known as the CRH O’Regan ligator. Today, physicians can use the CRH O’Regan ligator to band hemorrhoids quickly, safely and effectively in just a few seconds without patients experiencing post-procedure pain.

Hemorrhoid Banding FAQs

Is Hemorrhoid Banding Considered Surgery?

No, hemorrhoid banding is not considered surgery because it does not involve sedation or incisions. Hemorrhoid banding is a nonsurgical internal hemorrhoid treatment.

While hemorrhoid banding is incredibly effective, traditional surgery may be necessary for some patients if symptoms do not improve after three or four treatments.

Can You Band External Hemorrhoids?

Unfortunately, rubber band ligation is not an ideal treatment for external hemorrhoids. External hemorrhoids are situated under the dentate line, where many pain-sensing nerves are located. As a result, external hemorrhoids are too sensitive for treatment.

That said, the CRH O’Regan System can help alleviate various symptoms and inflammation attributed to external hemorrhoids. Also, some patients may confuse prolapsed or protruding internal hemorrhoids for external hemorrhoids. Be sure to ask your doctor whether hemorrhoid banding is right for your situation.

Are You Awake During Hemorrhoid Banding?

Yes — the CRH O’Regan System is a fast, painless procedure that doesn’t require sedation. Patients remain awake during hemorrhoid banding and typically feel little to no pain or discomfort during and after the procedure.

Types of Hemorrhoid Banding

There are many forms of hemorrhoid banding, each using different techniques and approaches. Some of the main types of hemorrhoid banding include endoscopic banding, traditionally rubber band ligation and the latest in hemorrhoid banding, The CRH O’Regan System.

The CRH O’Regan System

The CRH O’Regan System is the premier banding technique. The procedure is similar to traditional banding, but it is designed to be painless and reduces discomfort because it does not involve the use of metal clamps. Instead, this nonsurgical hemorrhoid banding treatment uses a disposable ligator, a small plunger-like device that creates suction to gently secure the pile.

Once this hemorrhoid banding device secures the tissue, the physician can quickly place a rubber band around the base of the hemorrhoid. The nerves in this area do not sense pain, so this treatment causes little to no discomfort and can be performed in as little as one minute. Another benefit of the CRH O’Regan System is it does not require any preparation.

Because hemorrhoid banding with the CRH O’Regan System is painless, the majority of patients can return to work or their daily activities immediately after treatment. Your physician will likely only place one band per session, as treating multiple hemorrhoids simultaneously may increase the risk of pain, discomfort or various complications.


Hemorrhoids typically form in three sites, meaning most patients need three treatments for maximum effectiveness. Each session is usually scheduled about two weeks apart. After the final session, patients experience relief from various hemorrhoidal symptoms and can expect a low recurrence rate. Some of the main benefits of the CRH O’Regan System include:


  • Safety and effectiveness: The CRH O’Regan System is a safe procedure that is tolerated well by most patients. Hemorrhoid banding can effectively target the cause of piles at their source, providing long-term relief from uncomfortable symptoms.
  • Covered by insurance: Treatment with the CRH O’Regan System is covered by Medicare. Most insurance plans also cover part or the full cost of treatment.
  • Quick procedure time: The procedure takes approximately 60 seconds to complete. 
  • A painless approach: Because the CRH O’Regan System does not use forceps or invasive treatment modalities, the procedure is pain-free. The CRH O’Regan System can gently suction a hemorrhoid to avoid creating pain or discomfort during or after the procedure.
  • The use of disposable devices: Hemorrhoid banding with the CRH O’Regan System can be performed using just gloves, lubrication and a disposable ligator, minimizing the risk of health care-associated infections (HAI). HAI can develop when reusable instruments, such as forceps, are used and may not be fully sterile. Because the CRH O’Regan System uses disposable suction devices, this risk greatly decreases, promoting a safer procedure for patients.
  • The ability to return to work immediately: While health is of the utmost importance, some people may not be able to take off work for an extensive recovery period for traditional hemorrhoid surgery. Fortunately, the CRH O’Regan System does not require extensive downtime, allowing patients to return to work or their daily life immediately after treatment.

If you are considering hemorrhoid banding as a treatment option, visit CRH O’Regan’s clinic finder to locate a hemorrhoid specialist in your area. 

 Endoscopic Banding

Endoscopic rubber band ligation involves the use of an endoscope. Physicians often use these flexible tubes to insert tools, including forceps. Endoscopes for this procedure are specifically designed and fitted with a plastic cap, which houses the rubber bands. A physician can insert the endoscope into the anus and use forceps or a suction device to gently hold the hemorrhoid and place the rubber band at its base. 

Before endoscopic banding, most patients will need to fast and undergo bowel preparation. This treatment also typically requires sedation, making it more complex and costly. Endoscopic banding may result in some post-procedure pain or discomfort.

Traditional Rubber Band Ligation

Traditional rubber band ligation involves using a clamp to secure the hemorrhoid with metal forceps to remove it from the anal lining. Once the hemorrhoid is securely held, the physician can place the elastic band around its base to cut off the blood flow and circulation. While procedure times vary from patient to patient, traditional rubber band ligation often takes approximately five to 10 minutes to perform.

Traditional ligation requires approximately three days of downtime for a full recovery. Patients may experience post-procedure pain, discomfort and even bleeding. Physicians often prescribe medication to minimize pain during the recovery process. While pain is the most common postoperative symptom, each patient is unique and may experience different side effects and symptoms.


When Is Hemorrhoid Banding Used as a Treatment Option?

Hemorrhoids can negatively impact your quality of life each day. While over-the-counter and at-home hemorrhoid remedies may be helpful in some cases, other patients may need hemorrhoid banding to experience relief. During a consultation with your doctor, be sure to discuss your symptoms and explain anything you feel.

In most cases, physicians will generally recommend trying noninvasive treatments, such as creams or ointments, to see if your hemorrhoids improve. If you have used over-the-counter products and have not experienced relief, your physician will be much more likely to consider you as a candidate for hemorrhoid banding or even hemorrhoid surgery.

Before recommending hemorrhoid banding or another treatment, your doctor should determine the grade of your hemorrhoids and how much and often they may prolapse or protrude from the anus. Hemorrhoid banding is an effective treatment typically recommended for Grade 1,2 or 3 hemorrhoids.

More severe hemorrhoids, including Grades 3 and 4, can hemorrhoid stapling or surgery. In some cases, Grade 3 hemorrhoids may be effectively treated using the CRH O’Regan System, but it depends on the patient’s symptoms. While the CRH O’Regan System may be customized to treat Grade 3 hemorrhoids, it often needs more than three treatments to be effective.

It is important to seek proper treatment for a hemorrhoid as soon as possible. While hemorrhoids, especially Grades 1 and 2, are not immediately dangerous, they can worsen over time. If left untreated, these hemorrhoids can progress to Grade 3 or 4. Hemorrhoids can also become thrombosed, causing severe pain and swelling. A thrombosed vein occurs when blood collects within a hemorrhoid, forming a clot. 

Another complication of untreated hemorrhoids is prolapse, meaning protrusion from the anus. Hemorrhoids often prolapse during or after a bowel movement. Prolapsed hemorrhoids can harbor stool and mucus particles, increasing the likelihood of pain, discomfort and itching.

Other Procedures Used to Treat Hemorrhoids

While hemorrhoid banding is an extremely effective treatment, many other options are available as well. If a patient does not experience relief from hemorrhoid banding, a physician may recommend one of the following procedures.

Traditional Hemorrhoid Surgery

Hemorrhoid surgery, also known as hemorrhoidectomy, involves a surgeon making incisions into the tissue surrounding the hemorrhoid. The surgeon then ties off the swollen vein within the hemorrhoid, helping to prevent bleeding. The surgeon may or may not suture the area closed depending on the size of the pile removed.

Unlike hemorrhoid banding, hemorrhoid surgery requires general anesthesia, leading to a longer recovery period. Hemorrhoidectomy is often performed in a hospital or surgical center and can take 40 to 90 minutes.

Coagulation Therapy

Coagulation therapy, commonly referred to as infrared photocoagulation, uses heat to stop the blood supply to the hemorrhoid. During coagulation therapy, a physician uses a device that produces a concentrated beam of infrared light to heat the hemorrhoid. A physician can perform coagulation therapy in approximately 30 seconds to three minutes.

Coagulation therapy is often recommended for smaller hemorrhoids that may not respond to other treatments. Coagulation therapy can be performed in-office, but only one hemorrhoid can be treated per session.


Sclerotherapy is another possible hemorrhoid treatment that is typically recommended for smaller piles that may not be eligible for rubber band ligation. Sclerotherapy involves a physician injecting the hemorrhoid with a special solution that will cause it to fall off in time.


Cryosurgery is an effective treatment that involves a physician freezing the hemorrhoid using nitrous oxide or liquid nitrogen and a cryoprobe. Approximately three weeks after cryosurgery, the hemorrhoid will fall off. While cryosurgery may be effective for some patients, it does have the potential for more complications and risks.

Hemorrhoid Stapling

Hemorrhoid stapling is another surgical technique that can treat larger prolapsed piles. In this procedure, a doctor uses instruments to maneuver hemorrhoidal tissue back to its original location and staple it in place. A typical hemorrhoid stapling procedure may take 15 to 90 minutes depending on the grade of prolapse.

When to Talk to a Doctor About Hemorrhoids

In general, it is always a good idea to talk to your physician about hemorrhoidal symptoms, even if they are not severe.  If you are looking for a hemorrhoid doctor in your area, you can use CRH O’Regan’s clinic locator to find a specialized physician, trained in hemorrhoid banding. Early treatment can help minimize the risk of hemorrhoids worsening or advancing grades. 

If you notice intense pain or severe symptoms, like excessive bleeding or intense itchiness that disrupts daily life,  you should contact your doctor as soon as possible. Your physician can address these symptoms and ensure there are no other diseases or complications that may be causing them. Talking with your physician can also help you create an effective treatment plan customized for your unique needs.

Hemorrhoid banding is often recommended for patients who experience prolapsed hemorrhoids that cause itching, soiling, bleeding or swelling. The banding procedure is an effective treatment that can alleviate symptoms for most patients. Still, it is important to note not all techniques are the same or provide the same results.

Talking with your physician can help you learn more about hemorrhoid banding and the various techniques and procedures available. It can be helpful to ask your doctor if they offer hemorrhoid banding using the CRH O’Regan System, which is generally viewed as the most effective treatment currently available.


After selecting a treatment option right for your needs, your physician can also help educate you on preventing future hemorrhoids from developing.

Hemorrhoid Banding

Heal Your Hemorrhoids

If you live with persistent, painful or uncomfortable hemorrhoids, you deserve to find relief. The CRH O’Regan System is designed to be safe, effective and pain-free. This banding system uses innovative technology and gentle suction to ensure patient comfort and effectively treat hemorrhoids. The CRH O’Regan System can provide long-lasting results without the need for extensive surgery. To get started with a hemorrhoid banding treatment, or to talk to a trained doctor about the treatment, visit their website to find a physician near you.