Hemorrhoid Artery Embolization: Nonsurgical Treatment for Bleeding Hemorrhoids
What are hemorrhoids?
Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They're extremely common, with roughly 1 in 5 adults experiencing them at some point in their life.
Internal hemorrhoids are graded I through IV based on severity. Grade I bleeds but doesn't prolapse, Grades II and III prolapse to varying degrees, and Grade IV is permanently prolapsed. Bleeding, itching, and discomfort are the most common symptoms, and most cases start with conservative measures like increased fiber intake, stool softeners, and topical treatments. When those aren't enough, several procedural options exist, including rubber band ligation, surgical hemorrhoidectomy, and hemorrhoid artery embolization (HAE),
What is hemorrhoid artery embolization?
Hemorrhoid artery embolization (HAE), also known as the emborrhoid technique, is a minimally-invasive, image-guided procedure that treats hemorrhoids by reducing the blood flow feeding them rather than removing or banding tissue. An interventional radiologist accesses the artery through a small puncture in the groin or wrist, navigates a catheter into the superior rectal arteries supplying the hemorrhoidal tissue, and places tiny coils or particles to reduce blood flow. With less blood flow, the hemorrhoids shrink and bleeding improves. Patients go home two hours after the procedure and many patients return to work within one to two days.
Who is a candidate?
You may be a candidate for HAE if you:
• Have grade I–III internal hemorrhoids where bleeding is the primary symptom and conservative treatment hasn't worked.
• Want to avoid surgery or an anal procedure, or who are at higher surgical risk.
Who is not a candidate?
You may not be a candidate for HAE if you:
• Have acute hemorrhoidal complications, such as a clotted or strangulated hemorrhoid.
• Have a history of colorectal surgery that alters the relevant anatomy.
• Have a chronic anal fissure.
• Have grade IV hemorrhoids with significant permanent prolapse.
Rectal bleeding can have causes other than hemorrhoids. Any new or unevaluated bleeding needs a colonoscopy or exam to rule out other conditions first. We strongly recommend consultation with your gastroenterologist or colorectal surgeon to confirm your diagnosis before pursuing treatment with us.
What to Expect
Your visit starts with a consultation to review your symptoms and prior workup. If you haven't had a colonoscopy or anoscopy to confirm the diagnosis, we'll coordinate that first. Once you are confirmed to be a suitable candidate, you can schedule your procedure with us.
During the procedure, you will first be given moderate (conscious) sedation to ensure your comfort. Following local anesthesia, your interventional radiologist will thread a small catheter through either your groin or wrist and use live X-ray guidance to navigate into the hemorrhoidal arteries. Once there, the clinician will use either endovascular coils or particles to slow blood flow into the corpus cavernosa recti, the vascular bed which supplies the hemorrhoids. After the procedure, patients typically go home within two hours and can return to normal activity in two to three days. Symptom improvement, particularly reduced bleeding, is typically noticeable within two to four weeks.
Q: How is HAE different from rubber band ligation or hemorrhoidectomy?
A: Banding and hemorrhoidectomy work directly on the hemorrhoidal tissue itself by either tying it off or removing it. HAE instead reduces the blood supply feeding the hemorrhoids from the inside, without touching the anal canal. It typically means less pain than hemorrhoidectomy, though the trade-off is a higher chance of needing retreatment than with surgery.
Q: Will this fix prolapse, or just bleeding?
A: HAE is most effective for bleeding. Grade I–II hemorrhoids often improve broadly, but if significant prolapse is your main symptom (especially Grade IV), a procedure that directly addresses the prolapsed tissue is usually more effective.
Q: Is it painful?
A: The procedure itself is done under sedation and you’ll only have a small incision in your groin, no larger than width of a dime, so you should not experience any significant discomfort.
Q: What if my hemorrhoids come back?
A: Recurrence occurs in roughly one in five patients. Repeat embolization is usually possible and is performed the same way as the original procedure. This procedure also does not impact future surgery.
Q: Does insurance cover this?
A: Most private insurers and Medicare cover HAE, though coverage and documentation requirements vary by plan. Our team verifies your specific benefits before scheduling.
Q: How is this different from what my colorectal surgeon offers?
A: Your colorectal surgeon can evaluate hemorrhoids and other causes of bleeding and can perform banding or surgical removal when needed. HAE is a nonsurgical, image-guided alternative performed by an interventional radiologist. We work directly with your colorectal surgeon or gastroenterologist to confirm the diagnosis and determine whether HAE, a surgical option, or a combination is right for you.
Q: Do I need a referral?
A: No, you can schedule a consultation directly with one of our interventional radiologists. If you haven't already had a colonoscopy or exam to confirm the source of bleeding, we'll help coordinate that first.