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Urinary retention
Rubber Band Ligation. Persistent bleeding from first, second, and selected
thirddegreehemorrhoidsmaybetreatedbyrubberbandligation.
Mucosalocated1to2cmproximaltothedentatelineisgraspedandpulledintoa
rubberbandapplier.Afterfiringtheligator,therubberbandstrangulatestheunderlying
tissue, causing scarring and preventing further bleeding or prolapse (Fig. 2931). In
general,onlyoneortwoquadrantsarebandedpervisit.Severepainwilloccurifthe
rubberbandisplacedatordistaltothedentatelinewheresensorynervesarelocated.
Other complications of rubber band ligation include urinary retention, infection, and
bleeding.Urinaryretentionoccursinapproximately1%ofpatientsandismorelikelyif
theligationhasinadvertentlyincludedaportionoftheinternalsphincter. Necrotizing
infection is an uncommon, but lifethreatening complication. Severe pain, fever, and
urinaryretentionareearlysignsofinfectionandshouldpromptimmediateevaluationof
thepatientusuallywithanexamunderanesthesia.Treatmentincludesdbridementof
necrotic tissue, drainage of associated abscesses, and broadspectrum antibiotics.
Bleeding mayoccurapproximately7to10daysafterrubberbandligation,atthetime
when the ligated pedicle necroses and sloughs. Bleeding is usually selflimited, but
persistent hemorrhage may require exam under anesthesia and suture ligation of the
pedicle.