Hemorrhoidal Artery Embolization

A non-surgical treatment for chronic hemorrhoids

Traditional surgery to treat chronic hemorrhoids—called hemorrhoidectomy—is unfortunately known for its long and often painful recovery. Today, there is a new and minimally invasive option to permanently treat hemorrhoids and alleviate symptoms: Hemorrhoidal artery embolization (HAE).

Who suffers from hemorrhoids?

About half of all Americans will experience hemorrhoids in their lifetimes. In most cases, hemorrhoids will go away on their own or with diet changes, topical treatments, medications or supplements. But they can also persist and cause bleeding, itching and painful bowel movements.

If conservative treatments have failed and symptoms persist, the potential complications of hemorrhoids and resulting painful conditions can include:

Perianal thrombosis
Incarcerated prolapsed hemorrhoids
Anemia
Blood clots
Blood loss (due to a burst hemorrhoid)
Infection
Skin tags

HAE Brochure

Hemorrhoid Treatment Comparison Guide

What causes hemorrhoids?

Most people have the wrong idea about hemorrhoids. Hemorrhoids are actually swollen veins inside the lower rectum or under the skin around the anus, similar in nature to varicose veins. They most commonly occur in those between 45 and 65 years of age. They may be caused by an increase in pressure in the lower rectum through one or more of the following factors:

Sitting for long periods
Straining or excessive exercise
Spinal cord injury
Constipation or diarrhea
Being overweight
Pregnancy or childbirth
Family history

A diet high in fiber, as well as drinking plenty of fluids and getting regular exercise can help prevent hemorrhoids.

What are my hemorrhoid treatment options?

Conservative treatment for hemorrhoids may include diet changes, topic treatments (such as an over-the-counter hemorrhoid cream), sitz baths and oral pain relievers (such as Tylenol). If the symptoms do not disappear, and if you are experiencing severe pain, bleeding, changes in bowel habits or changes to the color or consistency of your stools, you will want to talk with your doctor about other treatment options.

When conservative treatment has failed, hemorrhoidectomy is a surgical procedure to remove them. However, surgery comes with risks and complications that can include infection, bleeding, difficulty emptying the bladder, rectal prolapse and more.^1,2 Recovery takes at least 2 weeks, and it can be as long as 3-6 weeks before you feel normal again.

Another procedure, called rubber band ligation, is a less invasive technique that has been used more commonly in the last few years. However, this approach is also associated with pain and complications, especially for those taking anti-platelet or anti-coagulant medication and who have a higher risk of hemorrhage and infectious complications.³

A new and minimally invasive option to treat hemorrhoids is called hemorrhoidal artery embolization (HAE). This is typically recommended for patients with grade 1 to 3 internal hemorrhoids who have not responded to conservative treatment.

The hemorrhoidal artery embolization (HAE) procedure

HAE is performed by an interventional radiologist who inserts a tiny catheter into an artery in your upper thigh and then uses x-ray imaging to guide it through the body’s blood vessels to the rectal artery. Special coils are inserted into the artery to cut off the blood supply to the hemorrhoid, causing it to shrink. The success rate of this procedure is greater than 90%.⁴

Unlike surgery, there is no general anesthesia required for the procedure, no incisions and no scarring. You are able to return home the same day and resume your normal activities.

Hemorrhoidal Artery Embolization Frequently Asked Questions

About half of all Americans will experience internal hemorrhoids in their lifetimes. They are swollen veins inside the lower rectum, similar to varicose veins. They are most common in people between 45 and 65 years of age.

If conservative therapy has failed, hemorrhoidectomy surgery is sometimes recommended. Unfortunately, this surgery is known for its long and painful recovery, made more difficult because you will continue to have bowel movements during the recovery period. Rubber band ligation is a less invasive option, but just like with surgery, recovery from this procedure can also be painful. A new and minimally invasive procedure called hemorrhoidal artery embolization is an excellent option for those who do not wish to have surgery or be inconvenienced by a painful recovery.

HAE is a minimally invasive, outpatient procedure that treats internal hemorrhoids from inside the bloodstream, using catheters guided by imaging. There is no hospital stay required, and therefore a low risk of hospital-acquired infections. The procedure does not require incisions or stitching, only a small nick in the skin in the wrist or upper thigh (similar to a blood draw). No general anesthesia is required.

A specially trained doctor called an interventional radiologist uses imaging to guide a special catheter into the body and advances it through the bloodstream and into the rectal artery. Special coils are then inserted into the part of the artery causing the hemorrhoid, which causes it to shrink and symptoms to disappear.

The success rate of this procedure is greater than 90%. Most people experience significant symptom improvement in 2-4 weeks.

Approximately 75% of patients experience no bleeding for at least a year after the HAE procedure. Up to 10% of patients may require another HAE procedure in the future.

HAE is covered by most insurance plans and Medicare. We are happy to contact your insurance provider to find out if the procedure is covered by your plan.

Complications are very rare, and may include bleeding, discomfort and/or infection at the catheter site. There is also a risk of hemorrhoids returning in the future. Up to 10% of patients may experience this. If this occurs, the procedure may be repeated.

HAE is recommended for those with grade 1 to 3 internal hemorrhoids who have not responded to conservative treatment. It is also ideal for those who do not wish to have surgery.

Those with grade 4 prolapsed internal/external hemorrhoids, or those with a history of colorectal surgery, severe inflammatory bowel disease, significant vascular anomalies in the pelvic area, allergies to contrast dye or a pelvic radiation therapy may not be eligible for HAE.

Talk to your doctor about HAE

This procedure is performed on an outpatient basis by the experienced doctors at Memphis Vascular Center. If your doctor is not familiar with hemorrhoidal artery embolization, we are happy to help provide them with the information they need to make an informed recommendation.

Our doctors are fellowship trained in vascular and interventional radiology. With more than 13 years of education and training, they are among the most highly trained doctors practicing medicine today and are uniquely qualified to provide both diagnostic evaluations as well as the required treatment.

If you believe you are a candidate for HAE, we invite you to schedule a consultation with us. We are happy to work with your doctor(s) and other members of your care team to find the right treatment for your specific condition.

To schedule your consultation please fill out the form below. For faster results, please call 901-683-1890.

Hiroko Kunitake, MD, MPH and Vitaliy Poylin, MD, FACS, FASCRS2 Complications Following Anorectal Surgery Clin Colon Rectal Surg. 2016, Mar; 29(1): 14-21.
Christos Simoglou et al. Milligan-Morgan Haemorrhoidectomy Complications. Hellenic Journal of Surgery 86, 68-71
Andreia Albuquerque Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg. 2016 Sep 27; 8(9): 614-620
Sandeep Bagla, MD et al. Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center. Journal of Vascular and Interventional Radiology.