Preparing for the visit

It is advisable to take an analgesic (Tylenol or Advil, if there is no contraindication from your family doctor) one hour before your visit, as you will probably be getting rubber band ligation and cryotherapy treatment. Although the treatment itself is generally quite tolerable, there may be some discomfort and sometimes even pain, usually of short duration (15 to 30 minutes).

It is important to stop any blood-thinning medications (that prevent clots from forming) to help ensure that you do not experience significant bleeding following the procedure. These may include anti-platelet drugs (Aspirin, Clopidogrel (Plavix) or others) or blood thinners (Coumadin, Eliquis, Xarelto or others). Most of these medications should be stopped the day of the procedure and for at least 7 days afterwards. It is important to get your doctor’s approval before stopping any of these medications.

What to expect during the procedure

Although likely to cause a great deal of apprehension, this examination and the ensuing treatment procedures usually go very smoothly. Your doctor will explain each step. After asking a few questions, he or she will begin by inspecting the anal area and then perform a finger examination (digital rectal exam). He will then insert a small scope through the anus to view the internal hemorrhoids. Once he confirms the presence of hemorrhoids, he will proceed with the treatment after obtaining your approval. The treatment will consist of rubber band ligation followed by cryotherapy. The whole procedure lasts only a few minutes and, although uncomfortable, is generally not very painful.

Internal hemorrhoids are usually treated at a rate of one hemorrhoid per visit to ensure proper visualization and to avoid complications.

What to expect after the visit

Immediately following the procedure, you may feel an urge to defecate. This is almost always a false urge that will disappear spontaneously within one (or a few) hours. It is not dangerous to have a bowel movement after the procedure, but if the bowel movement does not come easily, you should avoid any straining and understand that it is probably just a false urge.

On occasion, patients may experience some pain following the procedure. This varies from one time to the next, so patients may likely experience either more or less discomfort than they did during a previous procedure. This pain is usually moderate and relieved by painkillers (Tylenol or Advil) or anti-inflammatory drugs (Aleve or Naproxen). Sitz baths (sitting with your buttocks in warm water) can also help. Finally, make sure you keep your stools soft by getting enough fibre and water or taking laxatives available by prescription or over-the counter on the advice of your pharmacist.

In the days following the ligation, the hemorrhoidal varicose veins becomes necrotic and combines with the stool. The elastics are released (2 to 10 days) and are evacuated. A wound then forms at the ligation site. This wound may bleed slightly, especially if the stool is rough. A little blood may be seen in the stool or even on the toilet paper, and more rarely in the toilet water. The amount of blood is minimal and bleeding usually stops within two or three days.

The wound then heals and, at the subsequent visit, a whitish scar can often be seen at the ligation site.

When should you worry?

If very heavy bleeding (such as hemorrhaging) occurs, then an emergency room visit is required. This is rare and usually associated with the use of anticoagulants.

If the pain is very severe, and not relieved by medication, if it is accompanied by fever or an inability to urinate, it is important to consult a doctor.

In these circumstances, you can call the clinic during business hours (7:00 a.m. to 1:00 p.m.) and leave a message. We will return your call. Outside of business hours or days, you will need to go to the emergency room.