At a glance
Banding (rubber band ligation) is a treatment option for certain types of rectal prolapse — specifically mucosal prolapse, where the inner lining of the rectum protrudes. It is the same technique used to treat internal hemorrhoids: small rubber bands are placed at the base of the prolapsing tissue to cut off its blood supply, causing it to shrink and fall off.
This guide covers who banding is suitable for, what the procedure involves, and what to expect afterwards.
Who banding is suitable for
Banding is typically considered for:
- Mucosal prolapse — where only the inner lining (mucosa) of the rectum protrudes, not the full wall
- Internal rectal prolapse — in some cases where the prolapse is internal and mucosal
- Mild prolapse that has not responded to conservative measures
Banding is not typically suitable for:
- Full-thickness rectal prolapse — where the entire wall of the rectum protrudes
- Large or established external prolapse — these usually need surgical repair
- Prolapse with significant incontinence — which suggests sphincter weakness that banding will not address
The distinction between mucosal and full-thickness prolapse is made during clinical examination and is crucial for treatment planning.
The procedure
Banding for rectal prolapse is typically done as an outpatient procedure:
- No general anaesthesia is usually required — the procedure is done through a proctoscope
- The clinician visualises the prolapsing tissue and places rubber bands at its base
- The bands constrict the tissue, reducing blood supply
- The banded tissue shrinks and eventually falls off (usually within a few days to two weeks)
- Multiple bands may be placed in a single session or across several sessions
The procedure itself takes only a few minutes.
What to expect afterwards
Immediately after
- A sensation of pressure or fullness in the rectum — commonly described as feeling like you need to have a bowel movement
- Mild discomfort or a dull ache — this typically settles within hours to a day or two
- Some people describe feeling lightheaded briefly — this is a vagal response and passes
The first few days
- Mild discomfort that is manageable with standard pain relief
- Some people describe a small amount of bleeding when the banded tissue separates
- Avoiding heavy lifting and straining for a few days
- Continuing normal diet and stool management
- Sitz baths for comfort
What to watch for
- Significant pain — some discomfort is normal, but severe pain is not and should be reported
- Heavy bleeding — a small amount is expected when the band and tissue separate, but heavy bleeding needs attention
- Fever or feeling unwell — rare but important to report
- Difficulty urinating — uncommon but can occur
Effectiveness and limitations
Banding can be effective for its specific indication — mucosal prolapse:
- Reduces the prolapsing tissue
- May need to be repeated for complete treatment
- Less invasive than surgical options
- Allows assessment of response before considering more involved procedures
Limitations:
- Not effective for full-thickness prolapse
- Recurrence is possible, particularly if the underlying contributing factors (straining, constipation) are not addressed
- Multiple sessions may be needed
- Does not address sphincter weakness or incontinence
After banding: ongoing management
Whether banding fully resolves the prolapse or not, ongoing management matters:
- Stool management to prevent straining — the key modifiable factor
- Pelvic floor exercises to support the pelvic structures
- Regular review to monitor for recurrence
- Discussion of further options if the prolapse recurs or progresses