For people who’ve heard there’s a hemorrhoid treatment with no cutting — and want to know exactly what it is
Hemorrhoid artery embolization — HAE for short — is a same-day, non-surgical procedure for internal hemorrhoids, and especially for the bleeding they cause. Through a pinhole in the upper thigh, an interventional radiologist reduces the blood flow feeding the hemorrhoids from inside the arteries. Nothing is cut, nothing is removed, and nothing enters the anal canal. IV sedation, about an hour on the table, home the same day.
A covered benefit under most insurance plans No referral needed for your initial consultation No cutting, no banding, no wound
Maybe you came here from our hemorrhoids page, where HAE is the treatment nobody had told you about — and you want the full picture before you take it seriously.
Maybe banding didn’t hold, or you couldn’t face a second round. Maybe a doctor said the word “surgery,” you went looking for what that recovery is really like, and decided you could live with the bleeding a while longer.
Or maybe you just typed “hemorrhoid treatment without surgery” into a search bar and landed on a word you’d never seen — embolization.
Whatever brought you here: this page shows you what HAE does — including before-and-after angiograms from procedures done at ARVC. Judge it with your own eyes.
The procedure
Internal hemorrhoids are cushions of blood vessels inside the lower rectum — everyone has them. They become a problem when the blood flowing into them outruns the blood flowing out: the cushions swell, slide downward, and bleed. The arteries feeding them are branches of one vessel, the superior rectal artery, and in people with symptomatic hemorrhoids those branches carry more flow than they should. That extra inflow is the supply line that keeps the swelling and the bleeding alive.
HAE goes at that supply line directly. Through a pinhole in your upper thigh, a catheter thinner than a phone-charger cord travels to the small branches feeding the hemorrhoids. There, an interventional radiologist places tiny coils and microscopic particles, and turns the excess inflow down. The hemorrhoidal tissue stays exactly where it is — nothing is cut or removed — but with its supply reduced, it shrinks over the following weeks and the bleeding eases. Because the rectum has more than one blood supply, the healthy tissue around the hemorrhoids keeps the flow it needs.¹
Notice what HAE is not: it’s not a procedure done at the anus at all. Banding, sclerotherapy, and surgery all work from inside the anal canal — on the tissue itself. HAE works on the arteries upstream, from the inside. That’s why the muscle that gives you control is never touched, why there’s no wound to heal where you sit, and why it can help people whose banding didn’t hold.¹
Hemorrhoids · HAE
How hemorrhoid artery embolization works — explained by the ARVC team Watch on YouTube →
What HAE is not
External hemorrhoids have a different blood supply, and HAE wasn’t designed for them. Many people have both kinds; a brief exam at the consultation tells us which ones are actually causing your symptoms — and whether this is the right tool.
HAE treats internal hemorrhoids graded 1 through 3. A hemorrhoid that stays prolapsed and won’t go back in — grade 4 — still needs surgery, and we’ll refer you for exactly that rather than sell you the wrong procedure.
In the published studies, roughly 2 in 3 to 9 in 10 patients got lasting relief, and about 1 in 7 needed a second session for bleeding that came back.¹ The full numbers are below, uncropped.
Limits first, results second — that’s the order you deserve. Now the results.
See it for yourself
These are angiograms — X-ray pictures taken while dye flows through the arteries — from a hemorrhoid artery embolization performed here at ARVC. In the “before” images, the dark tangle at the top of each picture (arrow) is the cluster of vessels feeding the hemorrhoids, flooding in with the dye. In the “after” images, minutes later: the tangle no longer fills, the tiny coils are visible where they were placed, and the main artery is still flowing. Nothing in these pictures went anywhere near the anal canal.
Before
After
Before
After
The treatment itself, step by step
The pairs above are before and after. These four runs show the treatment itself — one branch, at ARVC, in the order it was done. Nothing here goes anywhere near the anal canal.
Angiograms from a hemorrhoid artery embolization performed at ARV Centers, San Antonio. Patient identifying information removed. Individual results vary — the study data below is the fairer way to set expectations.
Procedure day
You get comfortable. A nurse starts an IV, and it delivers sedation — an anti-anxiety medicine plus pain medicine. You’re relaxed and drowsy, breathing on your own. Not general anesthesia. Nothing about your position is undignified: you lie on your back, covered, the whole time.
The pinhole. The doctor numbs a spot on your upper thigh and makes a pinhole opening in the artery. No incision, no stitches — and nothing anywhere else.
The map. A catheter travels up to the artery that supplies the rectum, dye flows, and the X-ray reveals the branches feeding your hemorrhoids — the same pictures you saw above. Everyone’s branches are a little different; this is where the doctor finds yours.
The treatment. Tiny coils and microscopic particles go into each feeding branch until the tangle no longer fills. Some patients feel a sense of pressure right then — expected, and it passes. You’re usually on the table about an hour.
Sealed and resting. The catheter comes out and the pinhole is sealed. Most of the time you rest with us for about an hour under observation — we watch you and give you fluids — and then you go home. Occasionally it’s a bit longer.
Home. Your driver takes you — no driving for the rest of the day. Expect a feeling of pressure or cramping for the first day or so, most noticeable in the first several hours; a heating pad and ordinary Tylenol and ibuprofen, alternated, handle it. Light activity for 48 hours, then your normal routine. We call you the next day to check in.
Plan on three to four hours with us all told — prep, procedure, and recovery. You’ll fast for the eight hours before (clear liquids and black coffee are fine up to two hours ahead), and you’ll bring a driver. No exceptions — it’s the sedation, not the procedure.
If you take a blood thinner, we’ll coordinate a short pause with your prescribing doctor beforehand — being on one doesn’t rule you out. You’ll get the exact pre- and post-procedure instruction sheets at your consultation, so nothing on the day is a surprise.
What goes in — and what it does
HAE turns the supply down with tiny metal coils and microscopic particles — we typically use both, placed where the branches on your angiogram call for them. The coils are a few millimeters long and made of the same stainless steel that has been placed inside blood vessels for decades. They stay in the small artery branches feeding the hemorrhoids, which is the point: a lasting turn-down of the excess inflow, not a temporary one. In the published series, coils with particles and coils alone both worked; using both lets the particles reach the smaller, deeper branches the coils can’t.¹
If you’re wondering whether cutting off blood flow can hurt the tissue: the rectum is fed by more than one artery, and the branches HAE treats are only the ones carrying the excess. The healthy tissue keeps its supply from the others — which is why the published reviews report no significant ischemia and describe the hemorrhoidal tissue as staying in place, shrinking rather than dying.¹ And unlike surgery, nothing is removed, nothing is stitched, and there is no wound where you sit.
The published evidence
93–100%
of published procedures were technically successful — the doctors reached and treated the branches feeding the hemorrhoids.¹
63–94%
clinical success across the published studies — roughly 2 in 3 to 9 in 10 patients got lasting relief of their symptoms.¹
Zero
serious complications reported across every published study reviewed — roughly 250 patients. Minor, temporary side effects do happen; they’re listed below.¹
1 in 7
patients — 34 of about 250 — had bleeding return and were treated with a second embolization session.¹
Start with what the evidence is: a dozen published series from France, Italy, China, Russia, Turkey, and Hungary, reviewed together in the radiology literature in 2022, covering roughly 250 patients with grade 1–3 internal hemorrhoids who had already failed creams, fiber, or banding.¹ Every one reported that the procedure was safe. None reported a serious complication.
The transparent half: these are small studies with short follow-up, and there is no randomized trial yet comparing HAE head-to-head against banding or surgery — the review authors say so plainly, and so do we. Re-bleeding is the main way HAE falls short: about 1 patient in 7 needed a second session, often to treat a small feeding branch that wasn’t reached the first time.¹ Grade matters, too. In one series, 94% of grade 1–2 patients were satisfied with their improvement against 84% of grade 3 patients — both good, but not the same.¹ We’ll tell you which group your hemorrhoids are in.
The side effects, all of them: a pressure sensation like needing the restroom (tenesmus), reported in roughly a third to most patients depending on the study, lasting up to a few days and managed with ibuprofen and Tylenol; temporary abdominal or rectal discomfort; and, in one study of particle sizes, small sores at the anorectal junction with the smallest particles — graded minor, needing no more than routine care.¹ That is the list from the published series, and nothing on it involves the sphincter or bowel control.
What we won’t claim: a cure, permanence, or a number for your hemorrhoids. What we will say: for internal hemorrhoids that bleed, HAE addresses the source with no cutting and no wound, the published safety record is clean, and if it ever isn’t enough, it takes nothing off the table — a repeat, banding, and surgery all remain available afterward.
Source: 1. Talaie R, Torkian P, Dooghaie Moghadam A, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: a review of current evidences. Diagn Interv Imaging 2022;103(1):3–11 — systematic review of 12 published studies (2008–2021), ~250 patients, coils and/or particles in the superior rectal artery branches: technical success 93–100%; clinical success 63–94%; no serious complications reported; 34 of ~250 patients re-bled and were re-embolized; coils vs coils + particles 63% vs 68% (Moussa 2020, no significant difference); satisfaction 94% grade 1–2 vs 84% grade 3 (Zakharchenko 2016); tenesmus 35% (Sun 2018) to 50–87% (Küçükay 2021, particle sizes); small ischemic ulcerations with 500–700 µm particles (Küçükay 2021); anal tone preserved, no direct anorectal trauma, outpatient, return to daily routine the following day; authors call for larger randomized trials with longer follow-up. Full citation and page-claim traceability in the ARVC evidence file.
Candidacy
We turn away patients who aren’t candidates for what we do. Routinely.
Your care team
Hemorrhoid artery embolization at ARVC is performed by our Board Certified Vascular and Interventional Radiologists, in our own angiography suite — quietly, by a team that does embolization every day. Ask any of them anything. There is nothing you could say that they haven’t heard.
After your procedure
When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.
And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure.
A follow-up appointment is scheduled to check your recovery and your response to the treatment — part of the procedure here, not an extra.
Before you leave, you’ll get this card
Your procedure:
On-call doctor:
Cell phone: written by hand, before you walk out
Call me if anything worries you.
Straight answers
No. Hemorrhoid embolization has been performed and published since 2014, with results from roughly 250 patients across a dozen studies reviewed in the radiology literature by 2022 — and no serious complications reported in any of them.¹ What is transparently true: the trials so far are smaller and younger than the ones behind, say, knee embolization, and there is not yet a head-to-head trial against banding or surgery. We say so on this page. And it passes the test skeptics rightly apply to newer procedures: it’s a covered benefit under most insurance plans.
No. That is the single biggest difference between HAE and every other hemorrhoid procedure. Nothing enters the anal canal at all — no scope, no band, no instrument. The entire treatment happens inside the arteries, reached through a pinhole in your upper thigh. The only time anyone examines you is at the consultation, briefly and privately, to confirm which hemorrhoids are causing the trouble.
You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia. The access point in your thigh is numbed first. Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. In the published series it showed up in roughly a third to most patients, eased over a few days, and needed nothing more than ibuprofen and Tylenol.¹ We’ll tell you to expect it so it doesn’t worry you.
The procedure itself takes about an hour. Afterward you rest with us — most of the time about an hour under observation while we watch you and give you fluids, occasionally a bit longer — then you go home. Plan on three to four hours at our office all told, then home the same day. An afternoon, not a hospital stay.
Light activity for the first 48 hours — then your normal routine. Published reviews describe patients returning to daily life the day after the procedure.¹ Bleeding typically settles within one to two weeks, and the full improvement builds over four to six weeks as the hemorrhoids shrink. Driving waits until the next day: the sedation means you’ll need a driver to take you home, no exceptions.
Tiny coils and microscopic particles — we typically use both, placed only in the small artery branches feeding the hemorrhoids. Yes, they stay; that’s the point. The coils are a few millimeters long, made of the same stainless steel that has been used inside blood vessels for decades, and they never touch the anal canal. Nothing is removed from your body and nothing is left where you sit.
It isn’t designed to, and this is where HAE most clearly differs from surgery. Nothing is done at the anus itself, so the sphincter muscle — the muscle that gives you control — is never cut, stretched, or touched. The published reviews describe HAE as preserving anal tone precisely because there is no direct anorectal trauma.¹
Banding treats hemorrhoids one at a time, from inside the anal canal, and larger (grade 3) hemorrhoids often aren’t good candidates. HAE works from inside the blood vessels — nothing enters the anal canal — and treats the supply feeding the whole hemorrhoidal cushion at once. If banding didn’t hold for you, or you couldn’t face a second round, that doesn’t mean this won’t work.
Surgery removes the hemorrhoidal tissue, which leaves a wound in a place that has to keep working every day — that’s where the recovery stories come from. HAE removes nothing. It turns down the blood supply that keeps the tissue swollen and bleeding, and the tissue stays where it is and shrinks. No wound, no packing, no first bowel movement to dread. The transparent other half: for grade 4 hemorrhoids that stay prolapsed, surgery is still the right treatment, and we’ll refer you for it.
No — external hemorrhoids have a different blood supply, and HAE wasn’t designed for them. Many people have both kinds, though, and the internal ones usually can’t be seen. A brief exam at the consultation tells us which ones are actually causing your symptoms. If external hemorrhoids are your only problem, we’ll say so and point you to the right care.
Possibly — if you haven’t had one recently, or your symptoms have changed dramatically since your last one. Rectal bleeding has more than one possible cause, and hemorrhoids are only the most common. Before treating, we make sure the serious causes — including colorectal cancer — have been ruled out. If you’re due, we’ll help you get it scheduled.
Yes. Re-bleeding is the main way HAE falls short, and in the published series about 1 patient in 7 had a second embolization session for it — often to treat a small feeding branch that wasn’t reached the first time.¹ A repeat is done the same way, through the same pinhole. And HAE doesn’t burn any bridges: banding and surgery remain available afterward if they’re ever needed.
HAE is done by interventional radiologists — a different specialty with a different referral network. Nobody hid it from you; it just lives outside the world of scopes and operating rooms you’ve been seeing. The research is published in journals every specialty can read, and we’ll gladly share it with your doctor.
Yes — hemorrhoid artery embolization is a covered benefit under most insurance plans, and we’re in-network with most plans. We still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.
Free patient guide
Our free patient guide explains hemorrhoid artery embolization end to end — how it works, what the day is actually like, the transparent risks, and what recovery looks like. Written by our physicians. No appointment, no phone call, no questions asked.
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You’ll sit with a provider in a private room, discuss your options, and get a straight answer about whether HAE fits your situation. Call us directly, or send this form and we’ll call you to schedule. We do a complimentary benefits check before any procedure. No surprises.
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3212 Napier Park, San Antonio, TX 78231
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