Haemorrhoid embolization — frequently asked questions

Here you will find answers to the most common questions about haemorrhoid embolization.

Haemorrhoids are arteriovenous vascular cushions, which are arranged in a ring under the rectal mucosa. Their function is to ensure the precise closure of the anus. In the case of haemorrhoidal disease, they are enlarged or deeper and cause discomfort.

Common complaints are repeated anal bleeding, anal discharges, distressing itching and stool smearing.

The disease is classified into four degrees of severity.   

First-degree haemorrhoids are not visible from the outside, they represent mildly enlarged vascular pads at the inside of the anal canal and might regress spontaneously.

Haemorrhoids of the 2nd degree are no longer capable of regression on their own. The vascular nodes protrude into the anal canal during pressing and retract by themselves.

Third degree haemorrhoids prolapse spontaneously and do not retract by themselves after pressing. It is still possible to push them in.

In 4 degree haemorrhoids, it is no longer possible to push back the enlarged vascular nodes. Third and fourth degree haemorrhoids may cause pain and a dull feeling of pressure in the anal canal.

A team of visceral surgeons, gastroenterologists and interventional radiologists is available at our hospital. This enables us to offer a tailored therapy concept to the individual patient.

Various ointments and creams as well as some lifestyle modifications may relieve complaints. In addition endoscopic rubber band sclerotherapy, ultrasound-guided haemorrhoidal artery ligation and splitting haemorrhoidopexy as well as surgical removal of haemorrhoids is possible.

The blood flow to the enlarged haemorrhoidal cushion is supplied through small arteries. A targeted closure of the supplying arteries leads to reduced blood flow and therefore reduced pressure in the haemorrhoidal system resulting in their regression and relief of complaints.

As the procedure is performed under local anaesthesia, the risks associated with general anaesthesia are eliminated.

The procedure is virtually painless for most patients. However, should slight pain occur, it is easily managable. Due to the endovascular access, the examination does not cause any direct anal trauma and may be supplemented by additional therapies if necessary.  Faecal continence is not compromised after the procedure. Due to the low invasiveness of the technique (only a small puncture in the groin artery) the patient usually recovers quickly from the procedure. Thanks to modern equipment, the radiation exposure is also very low.

First a local anaesthetic is applied to the access site in the groin. Then a catheter is inserted into the inguinal artery. Using modern imaging techniques the target vessels in the rectum can be probed with a very fine catheter.

After ensuring the correct position, metal spirals (so-called coils) are placed to close the vessels. These are well tolerated and remain in place for the entire life. The catheter is removed and the puncture site in the groin is closed by simple compression for a few minutes.  The patient lies awake on his back covered by a sterile cloth for about one to one and a half hours during the treatment.  

The procedure is not suitable for patients with very pronounced haemorrhoids that protrude far out of the anal canal and are no longer repositionable (stage IV disease).

A severe contrast agent allergy, a severe kidney dysfunction as well as a manifest hyperthyroidism are contraindications as well.

In patients where a severe arterial occlusive disease of the pelvis has already been diagnosed a computer tomography should be performed in advance to assess the accessibility of the target vessels.

The method should not be employed in patients who have suffered from rectal or anal cancer or chronic inflammation such as fistulas.

Before haemorrhoidal embolization, every patient is examined on an outpatient basis. A detailed consultation is held to determine whether the procedure is a suitable treatment method. Other diagnoses such as rectal or anal cancer or chronic inflammation which cause similar symptoms, should be excluded in advance.

After the procedure, a pressure bandage is applied to the puncture site. The bandage is removed after 6 hours of strict bed rest and slight physical strain is possible again. After 24 hours the patient can be discharged from the hospital.

In rare cases, post-operative bleeding or other complications can occur at the injection site. Critically reduced blood flow to the bowel or severe pain has not been observed so far. In very rare cases, allergic reactions to the contrast medium may occur. Possible discomfort during bowel movement usually subsides after a few weeks.

The procedure is suitable for all patients with second or third degree haemorrhoidal disease.  Especially patients with recurring troublesome bleeding may benefit from the procedure.

Patients with a high risk profile for general anesthesia due to varying medical conditions, as well as patients who cannot have surgery due to blood-thinning medication can be treated safely.

Embolization is a well suited procedure for patients who continue to suffer from haemorrhoids despite dietary measures or minimally invasive treatments such as sclerotherapy or rubber band ligation.