Hemorrhoids come back after banding because the procedure removes the swollen tissue you can feel, but not the blood supply that fed it. A rubber band cuts circulation to the cushion, the tissue sloughs off in about 7 to 10 days, and the artery above keeps doing what it was doing before. New tissue can engorge along the same path. The StatPearls review of hemorrhoid banding reports recurrence rates well above zero across patient series, and the HubBLe multicenter trial published in The Lancet found a 49% recurrence rate one year after a single banding session. If your bands are not holding, the mechanism is the reason. Not you.
01 · The ProcedureHow banding actually works
Banding, known clinically as rubber band ligation, places a tight rubber band around the base of an internal hemorrhoid. The band cuts off blood flow to that cushion. Over the next 7 to 10 days, the tissue dies, dries, and passes during a bowel movement. The session takes a few minutes in the office and requires no anesthesia.
It is the most common in-office treatment for symptomatic hemorrhoids in the United States. The StatPearls review of hemorrhoid banding describes the technique as having been used in roughly its current form since the 1960s, and the American Society of Colon and Rectal Surgeons (ASCRS) hemorrhoid practice guidelines identify rubber band ligation as the first-line office-based procedure for grade I to III internal hemorrhoids.
02 · The AnatomyWhy banding leaves the underlying problem in place
Banding treats the cushion. It does not treat what feeds the cushion. Hemorrhoidal cushions are vascular pads supplied by branches of the superior rectal artery. The anatomic study by Aigner and colleagues in the American Journal of Surgery traced these branches in detail, documenting how the superior rectal artery divides into multiple branches that feed the anal cushions from above the anorectal junction. A rubber band removes the swollen cushion above the anal canal, but leaves that arterial supply unchanged. The upstream pressure that produced the cushion is still there.
The Sias and Milone five-year cohort study published in Journal of Surgery describes the underlying mechanism in detail: rubber band ligation removes the cushion but does not address the artery supplying it, and the upstream vessel is several centimeters above where the band sits.
This is the most important thing to understand if your bands are not holding. The blood vessel above the hemorrhoid is still doing its job. If the conditions that engorged the original cushion have not changed, the tissue at that site, or right next to it, can swell again. Patients sometimes describe this as "a new one in the same spot." Often it is exactly that.
This is also why banding is rarely a one-session procedure. The standard playbook, per the ASCRS hemorrhoid practice guidelines, is two to four sessions, several weeks apart, addressing one or two cushions at a time. Even with the full series, the underlying anatomy is unchanged at the end of treatment.
03 · The NumbersWhat the numbers say about banding recurrence
The published banding recurrence numbers are not a secret in the colorectal literature — they simply rarely come up in the office. The HubBLe multicenter trial followed patients for one year after a single banding session and found a 49% recurrence rate. A long-term follow-up by Savioz and colleagues in the International Journal of Colorectal Disease reported a 68% probability of remaining symptom-free at 10.6 years — meaning roughly one in three patients eventually relapses over the long run. The HollAND multicenter randomized trial in Diseases of the Colon and Rectum widens the durability gap further when banding is compared head-to-head with hemorrhoidectomy.
- 49% one-year recurrence after a single banding session in the HubBLe trial.
- 47.5% one-year recurrence with banding versus 6.1% with hemorrhoidectomy in the HollAND multicenter trial for patients with recurring hemorrhoids.
- Roughly 32% of patients relapse over a decade of follow-up after rubber band ligation, per Savioz and colleagues.
Banding vs. hemorrhoidectomy at a glance
| Factor | Rubber band ligation | Hemorrhoidectomy |
|---|---|---|
| Setting | In office, no anesthesia | Hospital or surgery center, under anesthesia |
| Session length | A few minutes | Typically 30–60 minutes |
| Recovery | Pressure or dull ache, a few days | 3 to 6 weeks, significant pain weeks 1–2 |
| 1-year recurrence (HollAND trial) | 47.5% | 6.1% |
| Typical use | First-line, repeated as needed | After repeat banding stops holding |
Recurrence is not the exception with banding. It is closer to a coin flip in the first year and a majority over the longer run. The gap on durability is the trade most patients are making, whether they realize it or not. Neither answer is automatically the right one. But the numbers should be on the table.
04 · Not Your FaultWhy your banding "not working" isn't your fault
If you are reading this after your second or third banding session, there is a quiet thought worth saying out loud: this is not because you did something wrong. You followed the directions. You ate the fiber. You took the stool softener. You did the sitz baths. You came back for the second appointment.
Recurrence after banding is a feature of the procedure's mechanism, not a verdict on the patient. The procedure removes the part you can see. The biology that produced that part is still there. The StatPearls hemorrhoid banding review places typical first-year recurrence in the 40 to 60 percent range across the published literature — including patients who did everything right.
It is reasonable to be frustrated. It is reasonable to feel like you have been in a loop. Patients sometimes describe banding as "managing the problem on a subscription," and the description is not unfair. What it is not is a sign that you, specifically, are doing something wrong.
05 · The OptionsWhat people consider when banding isn't holding
When patients have had banding more than once and the symptoms keep returning, the in-office conversation usually narrows to three options: another round of banding, surgical removal of the tissue, or one of the newer artery-directed techniques. None of them is right for everyone, and most colorectal surgeons will walk through all three before making a recommendation.
More banding
Another session, or another series, is sometimes the right move — particularly when symptoms are mild, the cushions are smaller, and the patient has not completed a full course. The honest caveat is that the recurrence numbers in the HubBLe trial and the StatPearls hemorrhoid banding review are baseline averages, not first-timer averages.
If you have already had two or three sessions and the same cushion keeps returning, more banding can produce diminishing returns. Worth asking your doctor directly: at what point do they recommend stopping bands and considering something more durable?
Hemorrhoidectomy
Hemorrhoidectomy is surgical removal of the hemorrhoidal tissue. It is the most durable answer the field has had for decades. The HollAND multicenter trial in Diseases of the Colon and Rectum found a 6.1% recurrence rate at 1 year for hemorrhoidectomy, compared with 47.5% for banding in the same study.
The trade is recovery. Hemorrhoidectomy is performed under anesthesia, in a hospital or surgery center, and the post-operative period is widely described by patients and surgeons as the hardest part. Recovery typically runs 3 to 6 weeks, with significant pain for the first 1 to 2 weeks, limits on sitting, and time away from work. For some patients, that is the trade they accept in exchange for being done. For others, the recovery is the reason they have not scheduled it. Both reactions are common. Both are reasonable.
Newer artery-directed approaches
A third category has been developing in the colorectal literature. Rather than removing the visible cushion, these techniques target the blood supply above the hemorrhoid — the upstream driver of engorgement. One published example is described in the thermal submucosal hemorrhoidopexy paper by Sias and Milone in the Journal of Surgery, which delivers thermal energy to the submucosal artery above the hemorrhoid.
This category is newer than banding and hemorrhoidectomy, and the published evidence base for any specific technique is still smaller. Patients should ask their doctor what is available in their area and what the published evidence looks like for the specific approach being discussed. This is a category note, not a recommendation.
06 · The ConversationThe question to bring to your next doctor's visit
Patients often leave a banding follow-up with the same vague summary: "they said to come back if it gets worse." That is a holding pattern, not a plan. Walking in with one direct question changes the conversation. The randomized trial by Kravitz and colleagues in JAMA showed that patient requests for a specifically-named treatment roughly double prescribing rates.
If your bands are not holding, the question that opens the right conversation is some version of this:
That is the sentence. It names the problem. It names the two options you already know about. And it asks your doctor to put the rest of the map on the table. You are not being a difficult patient by asking it. You are being a prepared one.
07 · FAQFrequently asked questions
How long does banding usually last before hemorrhoids come back?
The HubBLe multicenter trial reported a 49% recurrence rate one year after a single banding session. The long-term cohort study by Savioz and colleagues found roughly 32% of patients eventually relapse over a decade. Some patients see symptoms return within months. Others stay symptom-free for several years. The average is closer to a coin flip in the first year than to permanent resolution.
Does it mean banding failed if my hemorrhoids came back?
No. Banding removes the swollen cushion but leaves the arterial blood supply that fed it in place. Recurrence is a known feature of the procedure's mechanism, not a sign the procedure was done wrong or that you did anything wrong. The StatPearls hemorrhoid banding review places typical first-year recurrence in the 40 to 60 percent range across the published literature.
Can I just keep getting bands forever?
Some patients do, and for milder symptoms it can be reasonable. The ASCRS hemorrhoid practice guidelines describe banding as the first-line office-based procedure and acknowledge it is often repeated. The honest caveat is that repeat banding tends to produce diminishing returns when the same cushion keeps recurring, and the underlying anatomy does not change with each session. If two or three rounds have not held, ask your doctor when they would recommend considering a more durable option.
Is hemorrhoidectomy really the only durable option?
Hemorrhoidectomy is the most established durable option, with a published 1-year recurrence rate of about 6.1% in the HollAND multicenter trial in Diseases of the Colon and Rectum, compared with 47.5% for banding. Newer artery-directed techniques have been developing in the colorectal literature. Your doctor is the right person to walk you through what is published and locally available.
Why do hemorrhoids form in the same spot again?
Because the artery feeding that area is still there. Hemorrhoidal cushions are supplied by branches of the superior rectal artery, mapped in detail by Aigner and colleagues in the American Journal of Surgery. Banding removes the swollen cushion but does not change the blood supply. If the conditions that engorged the original cushion have not changed, new tissue at the same site can swell — "a new one in the same spot."
Is banding safe to do multiple times?
Banding is generally considered safe to repeat, which is part of why the ASCRS hemorrhoid practice guidelines name it the first-line office procedure. Most patients tolerate it well. Complications are uncommon but not zero — they include bleeding, pain, and rare infection. Your doctor will weigh the safety of another session against the likelihood of durable benefit, given how previous sessions went.
What should I ask my doctor if banding isn't working?
Ask directly: "I've had banding more than once and the hemorrhoids keep coming back. What are my options between more banding and a hemorrhoidectomy?" That sentence names the problem and the two options you already know about, and asks your doctor for the rest of the map. A colorectal surgeon is the right person to walk you through what fits.