What is HAE (Hemorrhoid Artery Embolization)?
HAE is a minimally invasive procedure used to treat internal hemorrhoids without surgery. It is performed by Viva Eve’s expert Interventional Radiologists under local anesthesia.
How is HAE Performed?
A very small opening is made in the groin or wrist, and a thin tube (catheter) is guided through the blood vessels to the arteries supplying the hemorrhoids. Using live X-ray imaging, tiny coils are placed to reduce blood flow to the swollen tissue, helping to relieve pressure and shrink the hemorrhoids.
If hemorrhoids are present on both sides, the procedure can be repeated through the same opening.
What is Hemorrhoidal Disease (HEM)?
Hemorrhoids are small cushions of tissue and blood vessels in the anus that help keep the anus closed and working properly. They can become irritated, swollen, or inflamed, often due to straining or constipation.
When these cushions are enlarged or inflamed, it is called hemorrhoidal disease. This is the most common anal condition, affecting about 5%–40% of people at some point in their lives.
What Are the Symptoms of Hemorrhoids?
- Bleeding is the most common symptom because hemorrhoidal tissue has a rich blood supply. When internal hemorrhoids bulge out (prolapse) through the anal canal, the tissue can become irritated and cause bright red bleeding.
- Itching and irritation may occur when internal hemorrhoids cause moisture or inflammation around the anus.
- Leaking or soiling can happen if prolapsing tissue makes it harder for the anus to fully close.
- External hemorrhoids usually don’t cause symptoms unless they become swollen or form a blood clot (thrombosis), which can lead to a painful lump near the anus.
What Causes Hemorrhoids?
Hemorrhoids are very common, affecting about 50% of people at some point in life, most often between ages 45 and 65. They are caused by increased pressure in the lower rectum, which can result from straining during bowel movements, chronic constipation or diarrhea, sitting for long periods, spinal cord injury, anal intercourse, family history, or excessive exercise.
How Hemorrhoidal Disease (HEM) is Diagnosed
- Medical History: Viva Eve’s doctor will ask you about symptoms such as bleeding, pain, itching, or swelling to understand the condition.
- Visual Inspection: A look at the outside of the anus can identify external hemorrhoids or other abnormalities.
- Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to feel for internal hemorrhoids, swelling, or other issues.
- Anoscopy: A small tube (anoscope) is used to inspect the lower rectum and visualize internal hemorrhoids.
- Flexible Sigmoidoscopy: A thin, flexible tube with a camera examines the rectum and lower colon (sigmoid) to check for hemorrhoids or other conditions.
- Colonoscopy: If needed, a colonoscopy allows inspection of the entire colon for bleeding or other bowel problems.
When is Hemorrhoidal Artery Embolization (HAE) the Best Option?
HAE is recommended for internal hemorrhoids that haven’t improved with diet changes, hygiene, exercise, medications, or other non-surgical treatments, or if previous surgery didn’t help.
Who Should Not Have HAE?
HAE may not be suitable for patients with very severe hemorrhoids, sudden hemorrhoid complications, a history of colorectal surgery or chronic anal fissures, or an allergy to the contrast dye used during imaging.
What are the advantages of HAE?
- Highly effective – Proven to significantly reduce bleeding, pain, and swelling caused by internal hemorrhoids. Most patients experience lasting relief.
- Minimally invasive – Performed through a tiny pinhole, with no large incisions or stitches.
- Less pain and faster recovery – Most patients return to normal routines within a few days, with far less discomfort than traditional surgery.
- Safe and repeatable – Can be safely performed again if symptoms return.
- Performed in Viva Eve’s specialized surgical facility and conducted by an Interventional Radiologist in a modern, well-equipped setting.
- Local anesthesia – Usually done under local anesthesia with light sedation, avoiding the risks of general anesthesia.
How do you prepare for HAE?
Preparing for Hemorrhoid Artery Embolization (HAE) involves several steps to ensure the procedure goes smoothly and to minimize any potential risks. Your Viva Eve provider will give you detailed instructions during your initial consultation.
Here’s what patients typically need to do:
1. Consultation and Assessment
- Medical History Review: Before the procedure, your Viva Eve healthcare provider will review your medical history, including any current medications, allergies, or underlying health conditions.
- Before HAE, a CT angiography or similar scan is done to map the blood vessels and confirm that the procedure is suitable. This helps the provider plan the procedure.
2. Pre-Procedure Instructions
- Medications:
- Avoid Blood Thinners: If you’re taking blood thinners or medications that increase bleeding risk (like aspirin or nonsteroidal anti-inflammatory drugs), your provider may ask you to stop taking them for a few days before the procedure
- No Alcohol: Avoid alcohol consumption for at least 24 hours before the procedure, as it can increase bleeding risk and affect healing.
- Patients should fast for 8 hours prior to HAE, but approved medications can be taken with small sips of water. Staying well hydrated the day before by drinking 6–8 glasses of water is important.
3. Day of the Procedure
- Comfortable Clothing: Wear loose, comfortable clothing and leave your jewelry at home.
4. Post-Procedure Arrangements
- Rest and Activity: Plan for a relaxed day after the procedure. Walking and light movement are fine, but avoid heavy lifting, strenuous exercise, or intense activity for 5–7 days.
- Transportation & Supervision: A responsible adult must accompany the patient to and from the surgical center and stay with them for 24 hours after the procedure.
- Work: Plan to stay home from work for 5–7 days, depending on the physical demands of the job.
- Comfort: Wear loose, comfortable clothing and avoid any strenuous activity during recovery.
- Monitoring: Watch for any unexpected bleeding, severe pain, or other concerning symptoms, and contact your Viva Eve doctor if these occur.
5. Follow Specific Provider Instructions
- Your Viva Eve healthcare provider may give you additional specific instructions based on your individual case, so it’s important to follow their guidance closely.
6.. Follow-Up:
- A follow-up appointment may be scheduled to monitor your progress and determine if further treatment is needed.
What are the potential risks for HAE?
HAE is generally safe and minimally invasive, but like any procedure, there are some possible risks:
- Bleeding or bruising at the catheter insertion site in the groin.
- Pain or discomfort around the treatment area for a few days.
- Infection, though this is rare.
- Allergic reaction to the contrast dye used during imaging.
- Blood vessel injury or blockage in a nearby artery, which is uncommon.
- Persistent or recurring hemorrhoid symptoms may require repeat treatment.
What are the results of HAE?
- Effective symptom relief: Most patients experience significant reduction in bleeding, swelling, and discomfort caused by internal hemorrhoids.
- Long-lasting improvement: Many patients notice lasting relief, though some may require a repeat procedure if symptoms return.
- Minimally invasive benefit: Because it’s done through a tiny opening with no large cuts, recovery is faster and less painful than traditional surgery.
- Quick return to normal activities: Most patients can gradually resume daily activities within a few days, while avoiding heavy lifting or strenuous exercise for about a week.
