Nonsurgical hemorrhoid treatment with embolization is an advanced interventional radiology procedure in which the arteries supplying hemorrhoidal cushions are blocked from within the blood vessels under angiographic guidance, allowing the tissue to shrink without the need for surgery.
This modern approach is performed without any incisions, stitches, or tissue removal in the anal region. The primary goal of the treatment is to stop the high blood flow within the vessels at its source, allowing the bleeding tissues to shrink naturally.
The fact that diseased structures are not physically removed from the body allows the preservation of natural anatomical integrity and accelerates the healing process. Completely avoiding painful surgical trauma rapidly activates the body’s natural ability to repair itself.
This organ-preserving strategy offered by modern medicine provides a safe solution that respects physiological boundaries against vascular problems that significantly reduce the quality of daily life.
What Is Hemorrhoidal Disease and Why Does It Cause Bleeding?
Hemorrhoids, commonly known as piles, are actually normal structures that are naturally present in everyone’s anatomy from birth. These vascular cushions located in the anal region are highly valuable tissues that function like small seals, helping us maintain control over gas and stool. The problem is not the presence of these cushions but rather their gradual loss of structural integrity due to various factors, eventually developing into a disease. Factors such as a sedentary lifestyle, chronic constipation, the habit of sitting on the toilet for prolonged periods, pregnancy, or genetic predisposition significantly increase the pressure within the blood vessels in this region. This resembles a balloon that is continuously inflated, gradually becoming thinner as it loses its elasticity.
There is a complex network between the arteries that carry oxygenated blood to the anal region and the veins that collect deoxygenated blood. When pressure increases, the high-flow blood coming from the arteries begins to pool in the spongy venous networks. These vessels, which are constantly exposed to high pressure, gradually swell, develop edema, and cause the thin mucosal layer covering them to stretch. This stretched and thinned mucosa can easily become damaged by friction during defecation. As a result of this damage, bright red bleeding generally occurs. Bleeding may sometimes appear as drops and sometimes as more intense leakage. As long as vascular pressure remains elevated, the cushions become unable to perform their function, protrude outward under the influence of gravity, and a painful cycle accompanied by bleeding begins. Over time, this tissue may protrude outside the anus and reach a size that makes even sitting difficult for the patient.
Why Do Traditional Hemorrhoid Surgeries Frighten Patients?
For many years, the primary solution to hemorrhoidal disease has been surgical operations in which diseased tissues are cut out and removed using scissors or a scalpel. However, the anal region is one of the most sensitive areas of the human body and is particularly rich in nerve endings. Any incision made in this region can make the healing process extremely difficult and painful due to the nature of the tissue. Patients may seriously tend to avoid treatment because of conditions such as pain during bowel movements after surgery, aching that lasts for weeks, difficulties with wound dressings, and difficulty sitting. With traditional methods, the recovery period is generally long, and it may take considerable time for patients to return to their normal daily routines, social lives, or work.
In addition, certain permanent risks associated with surgical interventions increase patients’ concerns. The possibility of damage to the muscles in the anal region (sphincter muscles) during the procedure carries the risk of causing extremely uncomfortable problems such as the inability to control gas or stool in the future. Relatively minor proctological procedures, such as laser cauterization or rubber band ligation, can also sometimes cause unexpectedly severe pain because they may create localized oxygen deprivation and related wounds in the tissue. Because patients prefer to endure these difficulties rather than undergo surgery, they often continually postpone consulting a physician, causing the disease to progress and treatment options to become more limited.
What Is the Principle Behind Hemorrhoid Embolization (Emborrhoid) as a Nonsurgical Option?
Thanks to advances in medical technology, vascular diseases can now be treated with much more refined and direct interventions. Embolization is an intravascular treatment that focuses on the underlying cause of the problem rather than cutting out and removing its physical consequence, namely the prolapsed hemorrhoidal cushion. The primary problem that causes the hemorrhoidal cushion to swell, protrude outward, and bleed is the excessively high-pressure blood flow coming from the arteries supplying that region. The aim of the embolization technique is to identify this source of high pressure using angiographic methods and close it from within in a controlled manner.
Explaining this situation with an example from everyday life makes it much easier to understand. If a water pipe in your home begins to swell and leak because of excessively high pressure from the water supply, reducing the water pressure at the main valve is a much more reasonable and lasting solution than breaking open the wall, cutting the pipe, and patching it. The procedure performed during hemorrhoid embolization is similar to this. Specific arterial branches that pump blood into the anal region at a very high flow rate are identified and blocked from within. Once the source of high pressure is brought under control, blood flow into the hemorrhoidal cushion slows down, and bleeding largely stops. The enlarged and prolapsed vascular cluster gradually shrinks, approaching its former contracted and healthy form. The absence of any external incision in the anal region, the lack of stitches, and the fact that tissues are not physically damaged constitute the main advantages of this method.
How Is the Hemorrhoid Embolization Procedure Performed Step by Step?
This procedure is performed not in standard operating rooms but in specialized angiography units equipped with high-resolution imaging devices. Patients generally do not need to be completely put to sleep under general anesthesia or have their legs numbed through an injection in the lower back (spinal anesthesia). The procedure is carried out using mild sedatives to help the patient remain comfortable and calm, along with local anesthesia applied only to the needle insertion site. This allows the patient to remain awake throughout the entire process and communicate with the physician without experiencing pain.
The procedure usually begins through an artery in the right groin region or, depending on anatomical suitability, through an artery in the wrist. A small opening measuring only one millimeter is made in the skin of the numbed area, and a very thin introducer sheath is placed inside the artery. Long, flexible, soft tubes called catheters are passed through this sheath and advanced through the vascular system toward the main target. During this advancement, patients do not feel any pain or stinging because the inner surfaces of blood vessels do not contain nerve endings that detect pain. This journey through the blood vessels is a completely silent and painless process for the patient.
The insides of the blood vessels are visualized like a detailed map on the screens of fluoroscopy and digital angiography devices. When the physician reaches the vessels supplying the large intestine and rectal region, a special colored liquid (contrast agent) is administered to identify the abnormally enlarged targets responsible for the bleeding. Once the problematic branches are located, highly precise microcatheters, which are slightly thicker than a strand of hair and advanced through the main catheter, are used. Thanks to these advanced technological devices, it becomes possible to reach the very ends of the vessels responsible for the bleeding with millimetric precision. The process is generally completed within a short period of approximately half an hour, in a highly comfortable manner for the patient.
Which Occlusive Materials Are Used During Hemorrhoid Embolization?
Once the terminal vessels are reached, various occlusive materials are used to stop the high-pressure blood flow. The physician determines which material to use according to the diameter of the vessel, the patient’s anatomical structure, and the severity of the problem. These occlusive materials are biocompatible, have a very low risk of causing allergic reactions, and are designed to remain safely in the treated area for a lifetime.
The main occlusive materials used are as follows:
- Microcoils
- Microspherical particles
- Liquid embolic agents
Microcoils are small, spring-shaped coils, generally a few millimeters in diameter, made from metals such as platinum that are fully compatible with the body. When released into the blood vessel, they fold onto themselves to form a cluster and stop blood flow in that region by creating a mechanical barrier. Microspherical particles are round substances that are even smaller than grains of sand and are very difficult to see with the naked eye. These are slowly injected through the catheter into thinner vascular branches to create blockage at the capillary level. In certain special cases, specific medical liquids that are injected into the vessel in liquid form but solidify into a molded structure upon contact with blood may also be preferred. Thanks to these materials, unnecessary and high-volume blood flow to the hemorrhoidal cushions is stopped. The success of the procedure is then confirmed through follow-up imaging, and the catheters are removed from the body.
Is There a Risk of Tissue Necrosis After Hemorrhoid Embolization?
When blood vessels are permanently closed from within, patients understandably wonder: “Could the tissues in the anal region become deprived of blood and undergo necrosis?” Human anatomy is equipped with an extraordinary backup system, particularly in areas with critical functions such as the rectum and anal region. Thanks to this rich anatomical structure, the likelihood of concerns such as tissue deterioration or necrosis becoming reality is quite low.
The anal region receives its blood supply not from a single vessel but from numerous different arterial networks (collateral circulation). Many vascular networks coming from the right, left, above, and below are interconnected in this region. During embolization, only specific terminal branches that carry excessive blood to the hemorrhoidal cushion and cause problems by increasing vascular pressure are closed. The normal blood flow required for the anal tissue to survive, maintain its integrity, and preserve its healthy structure continues uninterrupted through other collateral vessels.
In other words, the procedure is not intended to completely deprive the region of blood and destroy the tissue, but simply to reduce the abnormally high pressure to physiological levels. Thanks to this extensive network of collateral vessels, complications such as oxygen deprivation in the tissue, severe mucosal ulceration, or permanent tissue death are not expected. Within hours, the body establishes a new balance following the closure of these vessels, and healthy tissue nourishment continues without interruption. This mechanism is the most important scientific fact underlying the ability to apply this method safely to such a wide range of patients.
Which Patients Are the Most Suitable Candidates for Hemorrhoid Embolization?
Embolization treatment can be suitable for a wide range of patients because of its nonsurgical nature, the absence of a need for anesthesia, and the very short hospital stay. The stage of the disease, the severity of the patient’s symptoms, and their current overall health condition play decisive roles in choosing this treatment. This method is generally considered a strong option for patients who have not benefited from initial medical treatments such as creams, ointments, suppositories, or strict dietary programs.
The groups that may benefit most from this method are as follows:
- Individuals experiencing persistent bleeding
- Individuals suffering from severe anemia due to bleeding
- Individuals taking blood-thinning medications
- Patients for whom general anesthesia is considered risky
- Elderly individuals
- Individuals afraid of postoperative pain
- Individuals with recurrent disease
Surgical operations present major difficulties, particularly for patients who must continuously take blood-thinning medications because of conditions such as heart rhythm disorders, previous heart attacks, vascular occlusions, or mechanical heart valve prostheses. Discontinuing these powerful medications to undergo surgery may pose life-threatening risks. If the medications are not discontinued, uncontrolled bleeding may occur during surgery. Because the artery is accessed through only a tiny needle puncture during embolization, no large surgical incisions are made, so patients generally do not need to stop taking their blood-thinning medications. In addition, this technique has become a preferred alternative for patients with lung diseases who are considered unsuitable for general anesthesia by an anesthesiologist, employees who cannot take weeks off work after surgery, or patients concerned about damage to the anal muscles.
What Preparations Should Be Made Before Hemorrhoid Embolization?
Before medical interventions, it is extremely important to clearly establish the patient’s clinical condition and ensure that other diseases are not overlooked. Bleeding from the anal region is not always caused by simple hemorrhoids. Therefore, certain important medical examinations must be completed before the procedure to establish an accurate and definitive diagnosis. Much more serious conditions that may cause bleeding, such as colon polyps, inflammatory bowel diseases, or colorectal masses, must be ruled out.
The main preparations and tests planned before the procedure are as follows:
- Colonoscopy screening
- Complete blood count
- Blood coagulation tests
- Kidney function tests
- Ensuring fasting
Colonoscopy is a procedure in which the inner surface of the intestines is examined using a thin, flexible camera. It is an indispensable diagnostic tool for confirming that the actual source of bleeding is solely the hemorrhoidal cushions. Blood tests performed a few days before the procedure assess the patient’s overall health, the degree of anemia they are experiencing, and the functioning capacity of the kidneys. Because the colored contrast agent used during the procedure to visualize the blood vessels is expected to be filtered and eliminated from the body through the kidneys, kidney function values are preferably within normal limits. For patients with diabetes who regularly take certain medications, medication dosages are adjusted by the physician to suit the procedure. In most cases, remaining without food or drink for approximately 6 to 8 hours before the procedure, as in a routine surgical procedure, is sufficient preparation.
What Happens During the Recovery Process After Hemorrhoid Embolization?
When the procedure is completed in the angiography room, the patient is kept under observation for a short period in a recovery room or inpatient ward to monitor their general condition and control any minor bleeding at the vascular access site. If the procedure was performed through the right groin, the patient may be asked to keep the leg straight and immobile for several hours to allow the vascular entry site to close. When the procedure is performed through the wrist, the patient can stand up and walk much sooner. In both cases, the patient is generally discharged and sent home a few hours after the procedure. The absence of a prolonged hospital stay also makes the process psychologically much more comfortable for the patient.
After returning home, the most noticeable physiological change that may occur in the anal region is a type of false sensation of fullness known medically as “tenesmus.” Because the vessels have been closed, the high-volume blood flow in the hemorrhoidal cushion suddenly slows down, and a mild clotting process followed by slight edema begins in the area. This biological reaction may create a misleading sensation as though the person’s bowels are full and they constantly need to defecate. Patients may generally experience a feeling of pressure and straining when they go to the toilet. This sensation is not a sign of a problem; on the contrary, it is a reaction indicating that the treatment is working, the blood supply to the tissue has changed, and the shrinking process has begun. It generally subsides and disappears on its own within a few days. Drinking plenty of water during the first days after the procedure is very important because it helps the contrast agent used during angiography to be eliminated rapidly and safely through the kidneys. After a short rest period, patients can comfortably return to their daily routines and working lives, often without much need for painkillers.
What Lifestyle Changes Should Be Made After Hemorrhoid Embolization?
Regardless of how advanced the technology used in medical interventions may be, the disease may tend to recur in different blood vessels in subsequent years unless the fundamental habits that initially contributed to the development of hemorrhoids are changed. Eliminating factors that increase intra-abdominal pressure, strain the pelvic floor, and cause blood vessels to dilate is just as vital for lasting recovery as the embolization procedure itself. Small but consistent lifestyle changes greatly contribute to making the recovery achieved through medical treatment last a lifetime.
The following points should be considered to support the success of the treatment:
- Drinking plenty of water
- Following a fiber-rich diet
- Not postponing the need to use the toilet
- Spending only a short time on the toilet
- Avoiding straining during defecation
- Adopting a sitting position close to squatting
- Avoiding a sedentary lifestyle
Emphasizing vegetables, fruits, oats, and whole grains in the diet helps the digestive system function regularly like clockwork and keeps stools soft. Hard stools always create significant mechanical trauma to the blood vessels. Spending prolonged periods sitting on the toilet with a mobile phone, newspaper, or book, a bad habit associated with modern life, is one of the greatest risks because it increases blood pooling and the effect of gravity in the anal region. Going to the toilet promptly when the need arises and getting up immediately after finishing is the most appropriate step toward protecting vascular health again. Placing a small footstool under the feet in front of the toilet is extremely beneficial for creating a more natural and anatomically appropriate sitting position. This small device corrects the angle of the final part of the intestine, making defecation much more comfortable and possible without the need to strain. Taking regular walks throughout the day and avoiding inactivity also stimulate blood circulation in the pelvic region, preventing the formation of new hemorrhoidal cushions. These simple rules that individuals incorporate into their lives to protect their health provide the greatest assurance that the comfort offered by this method will be long-lasting.
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