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 morning 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.

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.

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.

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.

First off, it is important to ensure that the symptoms are not caused by another condition. For example, the presence of blood can be the result of an anal fissure, proctitis or a tumor. This is why it is so important to perform a differential diagnosis.

If hemorrhoids are identified as being the cause of the symptoms, the most appropriate treatment is then chosen. Very often, the creams and ointments offered on the market only provide temporary and partial relief. If this is the case, it is time to consult a doctor.

For over 25 years, other treatments have been preferred over surgical treatment in the vast majority of cases. Hemorrhoid surgery has a reputation for being very painful: indeed, patients often have to endure severe pain for anywhere from two to four weeks. Furthermore, surgery does not in any way prevent hemorrhoids from recurring.

Several other techniques have been attempted with a view to replacing surgery and only one has proven to be superior to all other methods: hemorrhoidal ligation.

The procedure consists of sucking the hemorrhoidal vein into a small cylinder, then ejecting two elastic bands at the base of the hemorrhoidal varicose veins. This results in strangulation of the vein.

When the technique is performed well, ligation is not painful. The patient experiences discomfort that usually lasts about twelve hours. He will also feel a false urge—in other words, the need to defecate—(even if the rectal ampulla is empty).

The exception is when patients have a concomitant anal fissure. In this case, the pain can be more severe, sometimes lasting up to a week. Patients are generally given analgesic medication or ointments in this particular situation.

After two to three days, the necrotic hemorrhoid and the rubber bands combine with feces.

A little blood can often be seen in the week following the ligation. This occurs when the hemorrhoid falls off.

After one or two weeks, a whitish scar will often appear at the ligation site.

In addition to eliminating the hemorrhoid, the ligation technique creates a small scar that keeps the mucous membrane in place and helps prevent new hemorrhoids from forming.

As most patients generally have two or three hemorrhoidal bundles, the treatment is done over two or three sessions.

In certain cases, more than one ligation can be done during the same visit. This does, however, result in greater discomfort.

When the decision is made to treat more than one, such as when two hemorrhoidal bundles are bleeding, you can expect more pain in the days that follow, but the pain remains moderate in most cases.

Exceptionally, up to six ligations or more can be done in one session, but this is quite rare.

External hemorrhoids should not be confused with other lesions that can be found at the anal margin: skin tags, condylomas, tumour lesions or others. It is the physician’s role to determine the nature of the lesions observed.

External hemorrhoids are the result of hemorrhoidal swelling (internal and external) that has occurred in the past, for example during pregnancy. They are strips of skin that usually cause few symptoms.

Their main disadvantage is that they interfere with local hygiene when they are bulky. Their appearance can also be a cause of concern for certain people.

When treatment is prescribed, the lesions can be surgically removed under local anesthesia, although cryotherapy is sometimes sufficient for smaller lesions.

In most cases, it is best to leave them where they are, while ensuring good local hygiene.