Why Can’t You Band External Hemorrhoids?

Why Can’t You Band External Hemorrhoids?

Why can't you band external hemorrhoids? Rubber band ligation is an effective treatment for internal hemorrhoids, so it’s common for patients to hope it will help with external hemorrhoids too. Unfortunately, that’s not the way it works.

The more you learn about external hemorrhoids and the ways they differ from internal ones, the better you’ll understand this situation.

Internal vs External Hemorrhoids

Both internal and external hemorrhoids are swollen, inflamed veins. That’s pretty much where the similarities end, though.


Internal hemorrhoids begin inside your rectum. They may occasionally stick out of the anal opening, but their primary location is the rectum.

External hemorrhoids are around the anus. You may feel or see them near your anal opening.


Internal hemorrhoids have a layer of mucosa over them. Mucosa is the outer layer of the rectal wall.

External hemorrhoids are located in an area of the body with skin rather than mucosa. The hemorrhoids, then, are covered with a layer of skin.


With internal hemorrhoids, the affected veins elongate. The more advanced they are, the longer and more stretched out they become.

External hemorrhoids are flatter. They are lumps that form under the skin.


Internal hemorrhoids bleed easily. That’s often the primary symptom. They may not hurt or itch.

External hemorrhoids, on the other hand, can be quite uncomfortable. They often cause pain, swelling and itching around the anal area. Plus, like internal hemorrhoids, they may bleed.

In this video, you can learn more about the differences between the two types of hemorrhoids:

Hemorrhoid Banding Process

Hemorrhoid banding is a minimally invasive internal hemorrhoid treatment. It’s performed with an instrument such as the Adler Ligator. This tool is loaded with a small rubber band. The doctor navigates it into place and releases the trigger.

The band slides off of the ligator and onto the internal hemorrhoid. It settles around the base of the hemorrhoid. There, it restricts blood flow to the affected tissue. Within about a week, the hemorrhoidal tissue shrinks, separates from the rectal wall, and passes out of the body.

You can watch an animation of this techinque here:

The process of having hemorrhoids banded takes just minutes and can usually be performed in a doctor’s office. If you have internal hemorrhoids, rubber band ligation can be a quick solution. Banding recovery is generally mild, and the procedure often produces good results.

So why can't you band external hemorrhoids? Think about their shape. Internal hemorrhoids protrude and hang down. Banding them is a bit like tying a balloon. External ones are more like flat lumps. They’re not shaped right for placing a band and getting it to stay.

Treatment Options for External Hemorrhoids

Since you can’t band external hemorrhoids, what can you do? Doctors have several approaches that they recommend for patients with external hemorrhoids.

Home Care

External hemorrhoids often resolve on their own over time. At-home care can help speed the process along and improve your comfort while you wait.

Ice packs can help you feel better and encourage the swelling to go down. Sitting in a warm bath can also provide relief. Over-the-counter pain medication is beneficial as well.

Some doctors recommend topical treatments, such as hemorrhoid ointments from the drugstore. Witch hazel is another topical product that may shrink the hemorrhoid.

During the healing process, it’s important to avoid straining as much as possible. Drinking plenty of water, eating high-fiber foods and taking a stool softener may help with that.


When a blood clot forms inside an external hemorrhoid, it can cause sudden, intense pain. It’s a condition known as a thrombosed hemorrhoid.

Draining the hemorrhoid can provide relief, but it needs to be done right away to be a worthwhile procedure. If this happens to you, contact your doctor as soon as possible to inquire whether you’re a good candidate. Otherwise, the thrombosis will eventually resolve on its own.

Drainage takes care of the clot, but it doesn’t actually eliminate the hemorrhoid itself. That will still be there.


Severe external hemorrhoids or ones that recur again and again may require surgical intervention. Hemorrhoidectomy is a surgical procedure that involves cutting a hemorrhoid from the body.

Having a hemorrhoidectomy is rather painful. Recovery can take a while. However, it often produces good results over the long term. You can discuss with your colorectal surgeon whether your external hemorrhoids warrant surgery.

Internal Hemorrhoid Procedures

Some people have combined hemorrhoids; in other words, they deal with both internal and external hemorrhoids at the same time. In that situation, the hemorrhoids may be connected.

In certain cases, taking care of the internal hemorrhoids may help the external ones resolve as well. Your minimally invasive treatment options could include hemorrhoid banding with the Adler Ligator or laser coagulation with the neoV Laser.

Fixing the internal problem won’t always help with the external one, so it’s important to talk to your colorectal surgeon about whether this is a viable approach for you.

Your Hemorrhoid Situation

Why can't you band external hemorrhoids? You now know that their shape isn’t suitable for band placement. Rather, these hemorrhoids require home care or surgical excision.

Fortunately, hemorrhoid banding with the Adler Ligator is still a great option for internal hemorrhoid treatment. If you have internal or combined hemorrhoids, speak to a colorectal surgeon to learn more about rubber band ligation.

As with all medical issues, your physician is the ultimate source as to what procedure best fits your needs. Discuss all options and get a second opinion if you have any doubts. These articles are intended to be a source of general information only.

Brian Chandler