**6.7 Rubber band ligation (RBL)**

Binding of hemorrhoids with rubber rings (**Figure 6c**) will result in ischemia, necrosis, and healing by the formation of scar tissue that will fix the remaining connective tissue to the rectal wall. RBL is indicated for grade I, II, or small grade III hemorrhoids that do not improve with non-interventional treatment. It is important to keep in mind not to do the ligation too close to the dentate line because it will cause severe pain. Research shows ligation at 2 or 3 places at once or sequentially gives the same results, but post-procedural pain is higher in multiple banding [3]. Discomfort or pain in the rectum can be reduced by taking warm baths and avoiding hard stools by consuming high-fiber foods and drinking enough water, or, if necessary, laxatives. Other than pain, complications after RBL include the possibility of bleeding, mucosal ulceration, thrombosis of external hemorrhoids, and, very rarely, pelvic abscess [1, 2].
