Deciding to move forward with hemorrhoidal artery embolization (HAE) is one step. Knowing exactly what to expect—before, during, and after—is the step that makes it feel real. If you’ve been evaluated as a candidate and you’re preparing for the procedure, this is your guide.
At Surgical Associates, we believe informed patients recover better. Here’s the timeline from pre-procedure preparation through full recovery.
Before the Procedure
Consultation and diagnosis. Before HAE is scheduled, you’ll have a consultation with Dr. Albert Chun that includes a review of your symptom history, a digital rectal exam or anoscopy to confirm your hemorrhoid grade, and a discussion of treatment options. If you haven’t had a recent colonoscopy appropriate for your age and risk factors, one may be recommended to rule out other causes of rectal bleeding.
Pre-procedure instructions. In the days before your procedure, you’ll receive specific instructions about medications (particularly blood thinners, which may need to be held or adjusted), fasting requirements (typically nothing to eat or drink after midnight before the procedure), and arranging transportation home since you’ll receive sedation.
Insurance verification. Our team handles prior authorization with your insurer. Most plans cover HAE, and we’ll give you an estimate of any out-of-pocket costs beforehand.
The Day of the Procedure
Arrival and prep. You’ll arrive at our outpatient facility, change into a gown, and have an IV placed. The nursing team will review your medical history, confirm your medications, and answer any last-minute questions.
Sedation. HAE is performed under conscious sedation (sometimes called “twilight sedation”) with local anesthesia at the access site. You’ll be comfortable and relaxed but not under general anesthesia. You’ll be able to breathe on your own throughout the procedure.
The procedure itself (60–90 minutes). Dr. Chun makes a tiny puncture—typically in the wrist (radial artery) or upper thigh (femoral artery)—and introduces a small catheter. Using real-time X-ray guidance (fluoroscopy), the catheter is navigated to the superior rectal arteries, the vessels that supply blood to the hemorrhoidal tissue.
A contrast dye injection creates a detailed angiogram showing the hemorrhoidal blood supply. Once the target arteries are identified, a microcatheter is used to deliver tiny coils or particles that block the abnormal blood flow. The goal is to reduce arterial inflow to the engorged hemorrhoidal cushions, causing them to shrink gradually over the following weeks.
The entire procedure involves no incisions in the anal canal, no rectal manipulation, and no tissue removal.
Immediately after. Once the catheter is removed, a small bandage or closure device is placed at the puncture site. You’ll spend approximately one to two hours in recovery while the sedation wears off and the access site is monitored. Most patients feel alert and comfortable within an hour.
The First Week After HAE
Day 1 (day of procedure). You’ll go home the same day, typically within a few hours of the procedure. You may have a small bandage on your wrist or groin. Mild soreness at the access site is normal and resolves quickly. Most patients do not need prescription pain medication—over-the-counter acetaminophen is usually sufficient if any discomfort is present.
Days 1–3. Most patients describe this period as remarkably unremarkable. Unlike surgical hemorrhoidectomy—which produces significant pain with every bowel movement for weeks—HAE patients in the Falsarella RCT reported a pain score of 0 at their first post-procedure bowel movement. You should eat a normal, high-fiber diet, stay well hydrated, and use stool softeners as directed to keep bowel movements comfortable. Avoid heavy lifting or strenuous exercise for 48 hours. Most patients return to work and normal activities within 1–3 days.
Days 3–7. Continue your normal routine. Some patients notice mild rectal fullness or a sense of pressure—this is typically transient and resolves spontaneously. You may notice that bleeding has already begun to decrease, though the full effect takes longer.
Weeks 2–12: When Results Build
HAE works gradually. Unlike a surgical procedure that produces an immediate physical change, embolization reduces blood flow to the hemorrhoidal tissue, which then shrinks over time. Bleeding improvement is often the first change patients notice, typically within the first one to two weeks. Hemorrhoidal tissue gradually shrinks over one to three months as the reduced blood supply takes effect. By three months, most patients have experienced their full clinical response.
Follow-Up
SACMD schedules follow-up appointments to monitor your progress—typically at one month and three months post-procedure. These visits are brief: a symptom assessment, examination if indicated, and discussion of how your results compare to expectations.
If symptoms recur (which happens in a minority of patients), HAE can be repeated. The procedure does not burn any bridges—it preserves all future treatment options, including surgical hemorrhoidectomy if ever needed.
Frequently Asked Questions
The Bottom Line
HAE is designed to be the opposite of what most people fear about hemorrhoid treatment: a same-day, outpatient procedure with virtually no pain, no rectal wounds, and a one-to-three-day recovery. Understanding the timeline helps set realistic expectations and plan your schedule around the procedure.
Schedule a consultation: Call (240) 427-1630 or visit www.sacmd.com
