Embolization Is a New Treatment Option for Hemorrhoids

James Faber is an avid rock and mountain climber, which requires constant lifting and straining. Over time, he developed hemorrhoids. For a few years, Faber controlled the issue with a change in diet, but eventually things got worse, to the point that walking up steps was uncomfortable for him.

“When I finally looked into treatment options, I found out that a new procedure had been brought to UNC,” says Faber, 72. “The emborrhoid technique, or hemorrhoid embolization, is a real game changer.”

Faber, an emeritus professor in the UNC School of Medicine’s Department of Cell Biology and Physiology, used his decades of research experience to review scientific literature on hemorrhoid embolization. Based on the good results presented in the research and his consultation with UNC Health interventional radiologist David Mauro, MD, he pursued the minimally invasive outpatient procedure.

“I had it the day before Thanksgiving,” Faber says. “Normally, I’m the sous chef to my wife on Thanksgiving, but with all of the kids and grandkids coming over, I figured she’d have help if I needed to rest. But not only was I able to help as much as anyone, I enjoyed a full meal! It was truly remarkable.”

Faber is recovering well and is eager for others to know about this procedure, which is becoming more widely available.

“I waited a year and a half for treatment because I didn’t know about this option. Had I waited longer, my hemorrhoids would have progressed so much that the procedure would no longer have been an option,” he says. “It’s important that people ask their physicians about it before things get too bad. Some doctors may not have heard of it because it was developed and reported on only in the last several years.”

Dr. Mauro and Faber provide additional insight into the procedure.

What are hemorrhoids?

About half of adults older than 50 have hemorrhoids, which are swollen and enlarged veins in the anus or lower rectum. In addition to becoming more common with age, hemorrhoids may result from pregnancy, obesity, repeatedly lifting heavy weights, frequent constipation or diarrhea, or straining during bowel movements.

Some hemorrhoids are external, in the area around the anus, and might cause itching, pain, discomfort and bleeding, while others are internal, in the rectum. Internal hemorrhoids can lead to bleeding during or after bowel movements; these hemorrhoids also may prolapse, or push through the anus, causing pain or irritation and bleeding.

Internal hemorrhoids are graded based on how much they protrude:

  • Grade 1 hemorrhoids do not prolapse outside the anus.
  • Grade 2 hemorrhoids protrude through the anus during straining or bowel movements but return to place on their own.
  • Grade 3 hemorrhoids might have to be manually pushed back into place.
  • Grade 4 hemorrhoids remain prolapsed outside the anus.

Some hemorrhoids go away on their own. You can treat hemorrhoids with topical medications and with high-fiber diets that promote soft stools, decreasing the need to strain during bowel movements. Prolapsed hemorrhoids and hemorrhoids that cause bleeding, however, often require medical treatment. Standard treatments include nonsurgical procedures that use banding around the hemorrhoids or cauterization of the hemorrhoids to cut off blood supply, and surgical removal for advanced hemorrhoids.

What is hemorrhoid embolization?

Using embolization to treat hemorrhoids emerged after the first results of the technique were published in 2016.

“This procedure is a newer development in interventional radiology,” Dr. Mauro says. “The research supports using this procedure as a safe and highly effective treatment for hemorrhoids.”

To perform hemorrhoid embolization, doctors access an artery through a pinhole in the skin in the wrist or near the groin. As they guide a catheter (a thin, flexible tube) through the artery’s branches, doctors create high-quality images that allow them to see which branches are feeding the hemorrhoids. Once they identify the arterial branches, they can deliver an embolization agent that blocks blood flow to the hemorrhoid, causing it to shrink back into place.

The procedure takes 90 minutes to two hours and is done with light sedation.

“I was conscious during the procedure and could ask questions,” Faber says. “Afterward, while still on the surgical table, I spoke with the surgical fellow who assisted Dr. Mauro about his research, which dovetailed with some of my work. Our ability to talk about research should give you an idea of how light the sedation is.”

Faber’s symptoms, which included bleeding from the hemorrhoids, stopped immediately, which Dr. Mauro says is typical for this procedure. Dr. Mauro anticipates that hemorrhoid embolization will become more widespread as providers and other people learn of its effectiveness.

What are the benefits of hemorrhoid embolization?

Dr. Mauro says embolization is effective and easier than other treatments for hemorrhoids, and these were Faber’s main reasons for pursuing the procedure.

“The current research shows that embolization solved the problem for 65 to 85 percent of patients,” Faber says.

If hemorrhoid embolization does not resolve the symptoms, the procedure can be repeated, and other treatments, including banding and surgery, remain an option.

Is hemorrhoid embolization a risky procedure?

“Anytime you nick the skin, there’s a risk of bleeding and infection,” Dr. Mauro says. “There is also a risk that the intervention could damage the blood vessels. The risk of these is very low.”

Dr. Mauro says that embolizing the blood vessels does not affect general blood flow in the area.

For Faber, the benefits far outweighed the risks, and he is glad he didn’t wait any longer to get the treatment.

“The key is to know that you should ask about this procedure,” he says. “Ask your doctor if it’s available near you.”

If you have hemorrhoids, talk to your doctor about your treatment options. Need a doctor? Find one near you.