Hemorrhoids are cushions of blood vessels in the lower rectum that everyone has. They become a problem when they swell, prolapse or bleed. Internal hemorrhoids, the ones above the sensitive skin of the anal canal, rarely hurt but are the usual source of bright red blood on the toilet paper or in the bowl. For most people, fiber, fluids and time settle them. For some, the bleeding continues for months, becomes frequent enough to cause anemia, or simply will not stop, and the choice has traditionally been between rubber band ligation and a hemorrhoidectomy.
Hemorrhoid artery embolization offers a third path. Internal hemorrhoids are fed by small branches of the superior rectal artery. An interventional radiologist reaches those branches through a pinhole in the wrist or groin and closes them with tiny coils or particles. With the arterial inflow reduced, the hemorrhoids stop bleeding and shrink. Nothing is done inside the anal canal, so there is no wound in the most sensitive tissue in the body, which is where the pain of hemorrhoid surgery comes from.
At NYMD Center the procedure is performed by Dr. Yosef Golowa, our fellowship-trained interventional radiologist. The evaluation beforehand is coordinated by our internal medicine physicians, because rectal bleeding has to be properly attributed to hemorrhoids before any hemorrhoid treatment makes sense.
Who it affects and the symptoms that bring people in
Hemorrhoids affect men and women across adulthood and become more common with age, pregnancy, chronic constipation, heavy lifting and long sessions on the toilet. The symptom that brings people to us for embolization is bleeding: blood streaking the stool, dripping into the bowl, or coating the paper, usually painless, recurring over weeks or months despite the usual measures.
Some patients have already tried banding or have been offered surgery and declined. Others have anemia on routine blood work traced to hemorrhoidal blood loss. A few are on blood thinners for a heart or vascular condition and cannot easily stop them, which makes the bleeding harder to control and surgery less attractive.
Embolization is designed for bleeding internal hemorrhoids. It is not the right treatment for external hemorrhoids, thrombosed hemorrhoids, anal fissures or large prolapsing hemorrhoids that need to be pushed back in, all of which have their own treatments.
How we evaluate it at NYMD Center
Evaluation begins with one of our internal medicine physicians, such as Dr. Yulya Timashpolsky, at either office. The visit covers how long the bleeding has gone on, what it looks like, what else has changed in your bowel habits, your family history, and what has been tried.
A careful examination, including anoscopy when appropriate, confirms internal hemorrhoids and their grade. Blood work through our on-site lab checks for anemia and iron deficiency.
The key question is whether the hemorrhoids are the only source of the bleeding. Rectal bleeding can also come from polyps, inflammatory bowel disease, diverticular disease and colorectal cancer, and none of those is treated by embolizing hemorrhoids. When your age, history or findings call for it, we arrange a colonoscopy before proceeding, as part of the group's cancer screening program. For most patients over 45 who have not had one, that means colonoscopy first. Once the hemorrhoids are confirmed as the cause and office measures have failed, you are referred to Dr. Golowa.
Treatment options
Diet, habits and topical treatment
Fiber, adequate fluid, avoiding straining and limiting time on the toilet resolve most hemorrhoidal bleeding and remain part of every plan. Topical creams and suppositories ease irritation but do little for bleeding from internal hemorrhoids. This is where everyone starts, and it costs nothing in recovery.
Rubber band ligation
A small band placed over an internal hemorrhoid in the office cuts off its blood supply so it withers and falls off within days. It is quick and effective for many patients, but it treats one or two hemorrhoids at a time, often needs repeat sessions, causes a sense of pressure or discomfort for a few days, and is generally avoided in patients on blood thinners because of the risk of delayed bleeding.
Hemorrhoid artery embolization
Closing the arteries that overfill the hemorrhoids, from inside the vessel. It is done under sedation through a pinhole, takes about an hour, treats all the internal hemorrhoids at once, involves no instrument in the anal canal, and is compatible with continued blood thinners in most patients. Most people go home the same day and back to work within a day or two with little or no pain. The trade-offs are that it addresses bleeding rather than prolapse, a minority of patients need a second session or another treatment, X-ray contrast is used, and the hemorrhoids can recur over time if the underlying habits continue. Banding and surgery remain fully available afterward.
Hemorrhoidectomy and stapled procedures
Surgical removal of the hemorrhoids is the most definitive treatment and the right one for large, prolapsing hemorrhoids. It is also the most painful, with a recovery of two to four weeks, and it carries small risks of bleeding, infection, narrowing of the anal canal and, rarely, changes in continence. We reserve it for patients whose problem cannot be addressed with less.
What to expect at your visit
Your first appointment is with internal medicine at the Manhattan or Forest Hills office. Bring a list of medications, especially any blood thinners, and any prior colonoscopy reports. The examination and blood work are done that day. If a colonoscopy is needed, we arrange it before anything else is scheduled.
After the evaluation you meet Dr. Golowa to review the procedure. On the day, you arrive at our Manhattan surgery center having fasted as instructed. An IV sedative keeps you comfortable, the puncture site is numbed, and the embolization takes about an hour. You rest for a few hours and go home with someone to accompany you. Most patients report mild discomfort at most; a dull ache in the pelvis for a day or two is possible. You can eat normally that evening and return to ordinary activity the next day. Follow-up is with internal medicine at a few weeks, with a repeat blood count if you were anemic.
When to seek care urgently
Rectal bleeding with dizziness, fainting, rapid heartbeat, or blood that is dark or mixed through the stool needs same-day evaluation and may need the emergency department. Severe anal pain with a firm lump suggests a thrombosed hemorrhoid, which is treated differently and best seen promptly. After embolization, call us for fever, worsening pelvic pain, or any new bleeding that is heavier than before.
Questions patients ask
How is embolization different from banding or hemorrhoidectomy?
Banding and surgery treat hemorrhoids from the anal canal: a band strangles the cushion, or a surgeon removes it. Both work on the tissue itself and both can be painful, surgery especially. Embolization works upstream, closing the small arteries that overfill the hemorrhoids so they stop bleeding and shrink. Nothing is done inside the anal canal, which is why there is little pain and no wound. It is best suited to bleeding rather than to large prolapsing hemorrhoids.
Do I really need a colonoscopy first?
Often, yes, and always if you are over 45, have never had one, have a family history of colon cancer, or have a change in bowel habits, weight loss or anemia. Rectal bleeding is usually hemorrhoids, but it is not always hemorrhoids, and embolizing hemorrhoids in someone whose bleeding comes from a polyp or cancer would delay a diagnosis that matters. Our internal medicine physicians coordinate that evaluation.
Is there a risk of damaging the rectum?
The rectum has a rich blood supply from several arteries, and embolization closes only the small terminal branches feeding the hemorrhoidal cushions. Because the other arteries continue to supply the tissue, the risk of injury to the rectal wall is low. This is part of why Dr. Golowa maps the arteries carefully during the procedure before releasing any coils or particles.
How soon does the bleeding stop?
Bleeding usually decreases within the first days to weeks after the procedure as the arterial pressure in the hemorrhoids falls. Some patients notice a difference almost immediately; for others it tapers over a few weeks. If bleeding persists beyond that, we re-examine and consider whether a second session or a different treatment is needed.
Will my hemorrhoids come back?
They can. Hemorrhoids are a consequence of straining, constipation and time, and embolization does not change those. It relieves the bleeding and reduces the size of the cushions, but if the habits that produced them continue, new symptoms can develop. Fiber, fluids and not sitting on the toilet with a phone are as much a part of the treatment as the procedure.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.