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Hemorrhoid Banding

Banding is a non-invasive technique to remove hemorrhoids. It can be performed as a out-patient procedure. It is simple and easy!

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What is Hemorrhoid or Piles?

Hemorrhoid or Piles are tortuous veins which are pushed outward of the mucosal layer of the anus after prolonged straining. There are internal and external hemorrhoids and they are differentiated by their anatomical location.

In the anus, there is a structure called the Dentate line. This line is a border separating internal and external hemorrhoids. Any hemorrhoids above the dentate line will be considered internal hemorrhoids and below the dentate line will be called external hemorrhoids.


How to grade the severity of Hemorrhoid or Piles?

External hemorrhoids do not have a specific way to classify its severity. It is described based on the size, condition, and location of hemorrhoids but not the degree of severity. 

Internal hemorrhoids are graded into 4 stages:



























Other than the grading of hemorrhoids we also talk about the appearance of hemorrhoid like:

  1. Thrombosed or Non-thrombosed

  2. Bleeding or Non-bleeding

  3. Ulcerating and Non-ulcerating

  4. Reducible and Irreducible

  5. Complicated or uncomplicated


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What is other differential diagnoses for Hemorrhoid or Piles?

  1. External piles some times may look like other common diseases:

    • Anal Skin Tact​

    • Condyloma

    • Warts

    • Perianal Abscess

    • Skin cancers (Squamous cell carcinoma)

    • Verrucous carcinoma


  2. Internal piles can be mistaken for other diseases too:

    • Rectal cancer​

    • Rectal Polyps

    • Rectal warts

    • Rectal Adenoma

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What is the treatment for Hemorrhoid or Piles?

Hemorrhoids can be treated in three methods:

  1. Lifestyle changes

    • Diet​

      • A high fiber diet like oats, vegetables, and fruits can help to soften stool ​

      • Take lots of clear fluids

    • Exercise

      • Doing Kegel exercises in both men and women can strengthen the pelvic floor. This method trains the person to suck in the muscles of the anus as opposed to straining (pushing outward) like childbirth or defecation.

    • Squatting when defecation

      • Squatting to pass motion is the optimal way to relax the anal sphincter and muscle, therefore straining will reduce. Studies have shown that people who sit on the toilet bowl may result in more straining  during passing motion,

  2. Medical

    • Stool softener:

      • Lactulose (not suitable for diabetics)​

      • Macrogel

      • Laxatives

    • Topical creams or gels or suppository

      • Zinc oxide​

      • Lignocaine gels (for pain management)

    • Vasoconstriction of blood vessels

      • Phenylephrine​

    • Strengthen blood vessels

      • Diosmin

      • Hesperidin


  3. In-office procedures

    • External hemorrhoid in-office procedures

      • Excision
        It is a method to cut out the hemorrhoid and suturing the open wound. External hemorrhoids can be easily excised as an outpatient procedure and can be done in clinic settings with the appropriate equipment.


      • Laser
        Can be used to burn off the external hemorrhoid with high-powered lasers


    • Internal hemorrhoid in-office procedures:​

      • Sclerotherapy
        Is a drug injected into the internal hemorrhoid and the drug will obstruct the small blood vessels in the hemorrhoid therefore causing it to die-off on its own.


      • Hemorrhoid banding​
        Is an in-office procedure where rubber bands are placed around the base of hemorrhoid. This rubber band will obstruct blood flow to hemorrhoids which will cause hemorrhoids to spontaneously drop out on its own.


  4. Surgical

    • Doppler Guided Hemorrhoidal Artery Ligation (DG-HAL)

    • Recto Anal Repair (Proctoplasty)
    • Stapled hemorrhoidectomy (SH/PPH)
    • Excisional operation of internal hemorrhoid


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