Hemorrhoid Artery Embolization (HAE):
A Minimally Invasive Treatment for Symptomatic Internal Hemorrhoids
What are internal hemorrhoids?
Internal hemorrhoids are vascular structures that arise within the anus and when enlarged, can bleed or prolapse into the anal canal. This can result in lifestyle limiting symptoms such as painless rectal bleeding, intermittent protrusion of the hemorrhoid out of the anus during defecation (typically reducible), and occasionally pain if the protruding hemorrhoid becomes stuck and gets thrombosed (clotted off). There is a standard grading system that is used to determine the severity of internal hemorrhoids. This ranges from small grade 1 hemorrhoids which don’t prolapse through the anal canal, to larger grade 4 hemorrhoids which cannot be reduced back into the anal canal. Internal hemorrhoids differ from external hemorrhoids, which are located at the outer portion of the anus and are more associated with pain, as compared to internal hemorrhoids.
Internal hemorrhoids are very common in the United States, and hemorrhoid disease in general is one of the most common anorectal conditions. Higher rates of hemorrhoids are observed in individuals older than age 45, and there seems to be an association with chronic constipation, obesity, and advanced age.
What is the hemorrhoid artery embolization (HAE) procedure?
HAE is a nonsurgical, minimally invasive procedure that uses state of the art technology and imaging equipment to target and block the blood vessels causing the internal hemorrhoid(s). Blocking these blood vessels using biocompatible beads and/or microcoils causes the internal hemorrhoids to shrink and stop bleeding. The HAE procedure is performed from the artery of the groin or left wrist and using a tiny catheter and image guidance, the target blood vessels are selected for treatment. The procedure is performed on an outpatient basis using conscious (moderate) sedation and takes approximately 30-45 minutes to complete. Recovery is quick, with minimal side effects and faster recovery times when compared to surgery. One benefit to this procedure is that since there is no surgical instrumentation through the anus, the anal sphincter is preserved. The technical success rate is very high for this procedure, with studies demonstrating favorable results in the short term, and promise for long term relief. This procedure presents an attractive option for those suffering from internal hemorrhoids and not a surgical candidate or not interested in traditional surgical options.
Frequently Asked Questions
Is MIVA the right place for hemorrhoid treatment (HAE)?
Treatment of your internal hemorrhoids begins with clinical evaluation and review of any pertinent imaging. Patients who have not had improvement despite conservative measures such as increasing dietary fiber intake, avoiding straining during bowel movements, limiting time on the toilet, and ensuring adequate hydration may be a suitable candidate for HAE, especially if they are not a surgical candidate due to comorbidities or desire a non-surgical option.
Is it possible to get back up on my feet quickly?
Naturally, the length of time it takes to recover varies on the sort of therapy utilized. However, most patients report minimal recovery time. After undergoing treatment, we advise you to avoid heavy lifting for the first five days, but aside from this restriction, you are free to engage in your regular physical activity.
Is HAE a common alternative to surgical treatment for hemorrhoids?
For many patients suffering from bleeding internal hemorrhoids, the idea of surgery through the anus to treat the hemorrhoids is a daunting one. Thankfully, there is a minimally invasive option for internal hemorrhoids called hemorrhoid artery embolization (HAE), which is now being commonly performed. When conservative therapy for hemorrhoids fail, the hemorrhoid artery embolization (HAE) procedure can be a viable alternative to surgery, with shorter recovery and minimal side effects. This minimally invasive procedure involves blocking blood supply to the internal hemorrhoids, reducing their side and associated bleeding. While it may not be the right solution for everyone, HAE offers a promising option for those looking to avoid more extensive surgery and get back to their active lifestyles. As with any medical treatment, it is important to consult with a interventional radiology specialist to determine if HAE is right for you.