What is hemorrhoid embolization?
Internal hemorrhoids are normal vascular cushions inside the lower rectum that, when chronically engorged, can bleed and prolapse. Hemorrhoid embolization works by reducing the arterial blood flow that feeds those engorged cushions. Through a small catheter advanced from a peripheral artery, an interventional radiologist navigates into the superior rectal artery — a branch of the inferior mesenteric artery — and uses tiny coils or calibrated microspheres to selectively shrink the abnormal blood supply.1 The hemorrhoidal cushions decompress, the bleeding stops, and the surrounding rectal anatomy is preserved.
Why this approach
Hemorrhoidectomy works — but it is performed at one of the most pain-sensitive parts of the body. Many patients describe the recovery as worse than the disease. Embolization sidesteps the anus entirely, addresses the same problem from the inside of the artery, and gets patients back to normal life within days.2
How the procedure works
Hemorrhoid embolization is performed in a hospital interventional suite under local anesthesia with light sedation. Through a small needle access in the wrist (radial artery) or groin (femoral artery), a thin catheter is advanced under live X-ray imaging into the inferior mesenteric artery and then super-selectively into the distal branches of the superior rectal artery feeding the symptomatic hemorrhoids.3 Microcoils or calibrated microspheres are released to reduce blood flow precisely where it’s needed, while preserving healthy circulation to the rest of the rectum. Total procedure time is typically 60 to 90 minutes. There are no incisions, no sutures, and no anal instrumentation.
Who is a good candidate?
Hemorrhoid embolization is best suited to patients with chronic bleeding from internal hemorrhoids. You may be a candidate if any of the following apply:
- Chronic bleeding from grade II or grade III internal hemorrhoids that has not responded to conservative care or office-based procedures (rubber band ligation, sclerotherapy, infrared coagulation)
- Recurrent bleeding hemorrhoids after prior surgery — hemorrhoidectomy, stapled hemorrhoidopexy (PPH), or transanal hemorrhoidal dearterialization (THD/HAL)
- You are on chronic anticoagulation or antiplatelet therapy (warfarin, apixaban, rivaroxaban, clopidogrel) and cannot safely interrupt your medication for surgical hemorrhoidectomy
- You have cirrhosis, portal hypertension, or other comorbidities that increase the risk of conventional anal surgery
- You have iron-deficiency anemia from chronic hemorrhoidal bleeding
- You want to avoid the post-operative pain associated with hemorrhoidectomy
Before embolization, your bleeding is confirmed as coming from internal hemorrhoids by a colorectal surgeon or gastroenterologist using anoscopy and, when age- or symptom-appropriate, flexible sigmoidoscopy or colonoscopy to rule out other sources such as colorectal cancer, polyps, or inflammatory bowel disease.
What it doesn’t treat
Hemorrhoid embolization treats internal hemorrhoidal bleeding. It is not designed for external hemorrhoids, acute thrombosed external hemorrhoids, prolapsed grade IV hemorrhoids that need to be surgically reduced, or anal skin tags. Those conditions are managed by colorectal surgery.
What the research shows
The largest prospective evidence comes from the EMBOAHEM trial and a growing body of multi-center series that have shown high technical success, meaningful and durable reductions in bleeding, and a safety profile favorable to surgical hemorrhoidectomy — particularly with respect to post-procedure pain and time to return to work.4 Embolization is now recognized in interventional radiology and colorectal practice as an established option for selected patients with chronic bleeding internal hemorrhoids.
Who performs hemorrhoid embolization
Hemorrhoid embolization is performed by interventional radiologists. Success depends on careful angiographic mapping of the superior rectal artery and super-selective delivery of the embolic material — both core skills of the specialty. At Florida Interventional Specialists, every emborrhoid case is delivered as part of a coordinated plan with referring colorectal surgery, gastroenterology, and primary care teams across Tampa Bay.
References
- Vidal V, Sapoval M, Sielezneff Y, et al. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization — the first 14 cases. Cardiovasc Intervent Radiol. 2015;38(1):72–78.
- Moussa N, Sielezneff I, Sapoval M, et al. Embolization of the superior rectal arteries for chronic bleeding due to hemorrhoidal disease. Colorectal Dis. 2017;19(2):194–199.
- Tradi F, Louis G, Giorgi R, et al. Embolization of the superior rectal arteries for hemorrhoidal disease: prospective results in 25 patients. J Vasc Interv Radiol. 2018;29(6):884–892.
- Sirakov A, Vladev G, Bachvarov C, et al. Superior rectal artery embolization for the treatment of internal hemorrhoidal disease: a systematic review and meta-analysis. J Vasc Interv Radiol. 2022;33(11):1300–1307.e3.
Frequently asked questions
What is the emborrhoid technique?
“Emborrhoid” is the original European name for hemorrhoid embolization — a procedure that reduces blood flow to bleeding internal hemorrhoids using tiny coils or particles delivered through a small catheter from the wrist or groin. It treats the same problem as hemorrhoidectomy, but from inside the artery rather than at the anus.
How is it different from hemorrhoidectomy?
Hemorrhoidectomy is surgery performed at the anus to remove hemorrhoid tissue. It’s effective but well known for significant post-operative pain and a recovery measured in weeks. Hemorrhoid embolization treats the problem from a small artery puncture in the wrist or groin — no anal incisions, same-day discharge, and minimal pain. The trade-off is that surgical excision may be slightly more durable in some patients; embolization is chosen for its dramatically better recovery profile.
Will it hurt?
Most patients are surprised by how comfortable the procedure is. It’s done under local anesthesia with light sedation, and because the work is from the artery (not at the anus), most people describe pressure rather than pain. Mild bruising at the small needle access site is common for a few days afterward.
Do I still need a colonoscopy first?
Yes, when age- or symptom-appropriate. Rectal bleeding always needs to be evaluated to rule out other causes — colorectal cancer, polyps, inflammatory bowel disease — that can mimic hemorrhoidal bleeding. Your gastroenterologist or colorectal surgeon will perform anoscopy and, when indicated, flexible sigmoidoscopy or colonoscopy before referring you for embolization.
Does it work for external hemorrhoids?
No. Hemorrhoid embolization treats internal hemorrhoidal bleeding by reducing arterial inflow to the internal hemorrhoidal cushions. It’s not designed for external hemorrhoids, acute thrombosed external hemorrhoids, prolapsed grade IV hemorrhoids that need to be surgically reduced, or anal skin tags. Those are managed by colorectal surgery.
What if I’m on blood thinners?
Patients on chronic anticoagulation (warfarin, apixaban, rivaroxaban) or antiplatelet therapy (clopidogrel) are often better candidates for embolization than for surgery, because conventional hemorrhoidectomy typically requires interrupting those medications — which is risky for patients with mechanical heart valves, recent stents, atrial fibrillation, or prior clot. Embolization can usually be performed without stopping blood thinners.
How long does it last?
Published series report meaningful reduction in bleeding in the large majority of patients, with durable benefit. The procedure can be safely repeated if symptoms return.
Who performs hemorrhoid embolization?
Hemorrhoid embolization is performed by interventional radiologists. Success depends on careful angiographic mapping and super-selective delivery of the embolic material.
