A hemorrhoid is a collection of swollen tissue and blood vessels in the lower rectum or anus. Commonly occurring after age 30, hemorrhoids will affect more than half the population at some point in their lives. Common causes include constipation, diarrhea, pregnancy, childbirth, obesity, heavy lifting, and sitting for long periods..

There are two types of hemorrhoids, which are classified based on location– internal or external. The type of hemorrhoid will determine the options available for treatment and for pain relief. If you are unsure which type of hemorrhoid you have, the best course of action is to consult a physician who is experienced in diagnosing hemorrhoids, such as Dr. Prokupek

Home remedies such as creams, suppositories, and warm baths may offer temporary relief from the symptoms of hemorrhoids. But for many people, hemorrhoids don’t go away. Instead, they can get progressively worse over time, growing in both size and number.

Fortunately, you don’t have to put up with recurring hemorrhoid flare-ups and increasing pain.

Patients Guide To Hemorrhoids Treatment

What to Expect
The first appointment will typically consist of a consultation and physical exam. noscopy and/or proctoscopy may also be performed, which are visual examinations of the anorectal region.  There is no need for anesthesia, fasting, or other preparation for these procedures. If hemorrhoids are diagnosed, you may be prescribed a cream along with lifestyle and dietary recommendations.

If it is determined that the hemorrhoids need to be removed, we may discuss the  CRH O'Regan System to rubber band your hemorrhoids.This system may not be appropriate for all patients. Dr. Prokupek will work with you to determine an appropriate treatment for your hemorrhoids.

In the event of multiple hemorrhoids, often the largest, most symptomatic hemorrhoid is banded first.  Additional appointments are then scheduled to treat the remaining hemorrhoids at two week intervals, with a final check-up 2 or more weeks after the last hemorrhoid is banded.

Sometimes patients have both an anal fissure and hemorrhoids. Our ligation system often allows us to begin concurrent treatment of both conditions, allowing for a quicker recovery.

After Care
Following hemorrhoid banding, we recommend normal activities as tolerated, except for heavy lifting, rigorous exercise, or similar activities. You can resume full activity the next day.  You can have normal bowel movements during this time, but you may want to soak in a sitz bath (a warm tub with a tablespoon of table salt added) or use a bidet for a gentler cleansing of the anal opening.

Soon you’ll be feeling much better, but you’ll need to make some changes to prevent future problems.  Straining due to constipation should be diligently avoided, so be sure to drink seven or eight glasses of water a day and add 15 grams of fiber to your diet (two tablespoons of natural oat or wheat bran).  Metamucil, Benefiber, flax, or other soluble fiber may be helpful as well.

We also recommend that you not sit longer than two minutes on the toilet.  If you can’t have a bowel movement in that time, come back later. This two-minute rule can help keep you from straining during bowel movements without realizing it.  Finally, when traveling by air, stay hydrated, avoid alcohol, eat fiber, and walk around when you can.

Frequently Asked Questions

1. How does banding work?

A tiny rubber band is placed around the tissue above the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to shrink and fall off, typically within one to five days. You probably won’t even notice when this happens, or be able to spot the rubber band in the toilet.

2. Does banding hurt?

No. Thanks to our improved instruments and technique, band placement is painless. You may experience a feeling of fullness or dull ache in the rectum for the first 24 hours, but this can generally be relieved by over-the-counter pain medication. Multiple studies of our banding technique show that 99.1% of patients experience no significant post-procedural pain.

3. How many bands are necessary?

There are three sites where hemorrhoids form frequently, and it is not uncommon for all three sites to require treatment. We generally only band one hemorrhoid site at a time in separate visits, as multiple bandings have been found to increase complications. Also, some extremely large hemorrhoids may require additional banding sessions. Thus, multiple bands may be used in severe cases, but one to three is standard.

4. Can you treat external hemorrhoids?

Yes. Most hemorrhoidal symptoms are from dilated internal hemorrhoids and or anal fissures. The banding of internal hemorrhoids usually shrinks the external hemorrhoids as well and is highly effective in relieving the symptoms of pain and bleeding. After banding is completed there may be an external component or skin tag that persists, but usually they do not cause much in the way of symptoms. An acute thrombosis of an external hemorrhoid can be very painful and may require drainage.

5. Will I have to miss work or other activities?

Your first appointment with our office will probably be the longest, as it involves a consultation, obtaining a medical history, making a diagnosis of your problems, and formulating a treatment plan. We suggest you allot up to an hour. Subsequent treatment sessions will be shorter, around 15-30 minutes total. After a hemorrhoid banding procedure, we recommend that you refrain from vigorous activities the rest of the day and resume full activity the next day. Most patients with office jobs find they can return to work immediately following their appointment.

6. Why aren't creams and home remedies enough?

Hemorrhoid creams and suppositories are designed to provide temporary relief for symptoms such as pain and itching. They cannot shrink the hemorrhoid, stop it from growing larger, or make it go away. Ultimately, the only permanent cure for recurrent symptoms is the destruction or removal of the hemorrhoid itself.

7. How do I know if I have hemorrhoids or an anal fissure?

Good question. Anal pain, itching, and rectal bleeding are symptoms of both hemorrhoids and anal fissures. As a result, it’s possible for people to incorrectly self-diagnose themselves. Always consult a physician for a proper diagnosis. Because bleeding is also a symptom of colorectal cancer, it’s important to rule out other problems as well.

8. How much does banding cost?

Please call our office for the most up-to-date pricing on the services you may require. Medicare and most major insurance plans cover hemorrhoid banding, anal fissure treatment, and colorectal cancer screening.

9. Do hemorrhoids increase the risk of colorectal cancer?

No. Hemorrhoids do not increase your risk of developing colorectal cancer. But since both conditions can cause rectal bleeding, it’s important to determine whether cancer may also be present. Because of this fact, further diagnostic procedures, such as flexible sigmoidoscopy or colonoscopy, may be recommended. Research shows that up to 2.3% of patients with bleeding hemorrhoids may also have colorectal cancer.

10. Will my insurance cover banding?

Medicare and most major insurance plans cover hemorrhoid banding, anal fissure treatment, and colorectal cancer screening. However, as insurance coverage varies, please call our office for assistance with your specific policy.

11. How common is banding?

Rubber band ligation is the most frequently used non-surgical treatment for hemorrhoids in the world. However, not all banding procedures are the same. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding.


Dale Prokupek, MD is an award-winning, board-certified internist and gastroenterologist.  He has over 14 years of experience treating hemorrhoids, including the most complex cases. He understands the need for thorough evaluation, aggressive treatment, and close follow-up. Dr. Prokupek uses the most current, state-of-the-art medical equipment to accurately diagnose and treat hemorrhoids.

 Dale Prokupek, MD receives outstanding reviews from patients, and has been awarded the Patient’s Choice Award. He is also an associate clinical professor of medicine at the Geffen School of Medicine at UCLA. Dr. Prokupek sees patients at his private practice in Beverly Hills, and at Cedars-Sinai Medical Center.