If you’ve been living with hemorrhoid symptoms—recurrent bleeding, discomfort during bowel movements, the dread of another flare-up—and you’ve been searching for a solution that doesn’t involve surgery, you’ve probably come across hemorrhoidal artery embolization (HAE).
But the next question is the one that matters most: Is HAE right for me?
Not every hemorrhoid patient is a candidate for embolization, and not every patient who qualifies will benefit equally. In this article, we’ll walk through the clinical eligibility criteria used by leading programs like UCLA Health’s Interventional Radiology department, give you a self-screening checklist you can use before your consultation, and explain who may need a different treatment approach.
At Surgical Associates (SACMD), Dr. Albert Chun evaluates hemorrhoid patients across Maryland, DC, and Northern Virginia to determine whether HAE is the right fit. Here’s how to start that conversation informed.
How HAE Works — A 60-Second Overview
HAE is a catheter-based procedure performed by an interventional radiologist. Through a tiny puncture in the wrist or upper thigh, a microcatheter is guided to the superior rectal arteries—the blood vessels that supply the hemorrhoidal tissue. Using real-time imaging, the physician injects small coils or particles to reduce blood flow to the engorged hemorrhoidal cushions.
The result: the hemorrhoids shrink over the following weeks, and bleeding diminishes or stops. There are no incisions in the anal canal, no rectal wounds, and no damage to the sphincter. Patients go home the same day and typically return to normal activities within one to three days.
The Clinical Eligibility Criteria
Based on the criteria used at UCLA Health and supported by the broader clinical literature, the following factors define a strong HAE candidate:
Grade 1 to 3 internal hemorrhoids. HAE is designed for internal hemorrhoids—the type that develops inside the anal canal above the dentate line. The Goligher grading system classifies internal hemorrhoids from Grade 1 (no prolapse) through Grade 4 (irreducible prolapse). HAE has shown the strongest results for Grades 1 through 3, particularly when bleeding is the predominant symptom.
Bleeding as the primary symptom. HAE works by reducing arterial blood flow to the hemorrhoidal tissue. This makes it particularly effective for patients whose chief complaint is recurrent rectal bleeding. The Falsarella RCT showed bleeding resolution in 83% of embolization patients at 12 months.
Failure of or dissatisfaction with conservative management. This includes dietary and bowel habit modifications (increased fiber, adequate hydration), topical medications (creams, suppositories), oral medications (flavonoids, stool softeners), and office-based procedures (rubber band ligation, sclerotherapy, infrared coagulation). However, it’s important to note—as UCLA Health’s interventional radiology team has stated—that patients don’t necessarily have to have tried all other treatments before being considered for HAE. If you’re not interested in transanal procedures or surgical hemorrhoidectomy, HAE may be an appropriate first-line interventional option.
Not interested in, or not suitable for, surgical hemorrhoidectomy. Many patients who are clinically eligible for surgery choose HAE because they want to avoid the painful surgical recovery (which typically involves 2–4 weeks of significant discomfort). Others may have medical conditions that increase surgical risk—cardiac disease, bleeding disorders managed with anticoagulation, or other comorbidities that make general anesthesia less desirable.
The Self-Screening Checklist
Use this checklist to help you determine whether HAE might be appropriate for you. Check each statement that applies:
Your Symptoms:
- I experience recurrent rectal bleeding with bowel movements
- My bleeding has persisted for more than 3 months
- I’ve been diagnosed with internal hemorrhoids (Grade 1, 2, or 3)
- Bleeding is my primary or most bothersome symptom
- My symptoms are affecting my quality of life or daily routine
Your Treatment History:
- I’ve tried dietary changes (more fiber, more water) without adequate relief
- I’ve used over-the-counter creams or suppositories without lasting improvement
- I’ve had rubber band ligation or sclerotherapy, but symptoms returned
- I’ve been told I should consider hemorrhoidectomy but want to explore alternatives
Your Preferences and Circumstances:
- I want to avoid the pain and recovery time of hemorrhoid surgery
- I cannot take 2–4 weeks off work or family responsibilities for surgical recovery
- I’m on blood-thinning medication and want a procedure with lower bleeding risk
- I have medical conditions that make general anesthesia risky
- I want a same-day, outpatient procedure with minimal downtime
If you checked 4 or more boxes, you may be a strong candidate for HAE. The next step is a clinical evaluation with an interventional radiologist who can confirm your hemorrhoid grade, assess your vascular anatomy, and discuss expected outcomes.
Who May NOT Be a Candidate for HAE
HAE is not appropriate for every hemorrhoid patient. Based on current clinical guidelines and trial exclusion criteria (including the UCLA HELIOS trial, NCT07179601), the following patients may not be suitable:
External hemorrhoids only. HAE targets the arterial supply to internal hemorrhoids. External hemorrhoids—which develop below the dentate line under the skin around the anus—have a different blood supply and do not respond to this procedure. If your primary problem is external hemorrhoid swelling, skin tags, or thrombosed external hemorrhoids, surgical excision or conservative management may be more appropriate.
Grade 4 irreducible prolapse. Patients with hemorrhoids that are permanently prolapsed and cannot be pushed back into the anal canal may need surgical intervention to remove the excess tissue. HAE reduces blood flow but does not physically remove tissue, so significant prolapse may persist after the procedure.
Active anorectal infection or abscess. Active infection in the perianal or anorectal region is a contraindication for HAE. The infection must be treated and resolved before embolization can be considered.
Severe coagulopathy. While HAE is catheter-based and involves no rectal incisions, severe uncorrected bleeding disorders may increase the risk of access-site complications. Patients on anticoagulation therapy can often still undergo HAE, but this should be discussed with the proceduralist.
Pregnancy. HAE involves fluoroscopic imaging (X-rays), which exposes the patient to ionizing radiation. The procedure is not performed during pregnancy.
Known contrast allergy. HAE requires the use of iodinated contrast dye during the angiogram. Patients with known severe contrast allergies may need premedication protocols or alternative imaging approaches, which should be discussed during the consultation.
Suspected colorectal malignancy or inflammatory bowel disease. Rectal bleeding has many causes. Before HAE is considered, other causes of bleeding—including colorectal cancer, Crohn’s disease, and ulcerative colitis—must be ruled out, typically through colonoscopy.
What Happens at Your HAE Consultation in Maryland, DC, or Virginia
When you schedule a consultation at Surgical Associates, here’s what to expect:
Clinical history review. Dr. Chun will review your hemorrhoid symptoms, duration, severity, and what treatments you’ve already tried. Bring any records of prior colonoscopy results, as these are helpful for confirming your diagnosis and ruling out other conditions.
Physical examination. A digital rectal exam and/or anoscopy may be performed to assess the grade and location of your hemorrhoids. This is a brief, in-office examination.
Treatment discussion. Based on your symptom profile, hemorrhoid grade, and medical history, Dr. Chun will discuss whether HAE is appropriate—or whether an alternative approach (conservative management, rubber band ligation, or surgical referral) might be a better fit. You’ll receive an honest assessment, not a sales pitch.
Insurance and scheduling. If HAE is recommended, our team will verify your insurance coverage, handle any prior authorization requirements, and schedule the procedure at a time that works for you. Most patients can be seen within one to two weeks of their consultation.
Frequently Asked Questions
How long does the HAE procedure take? Approximately 60 to 90 minutes. Patients receive local anesthesia and light sedation and go home the same day.
When will I see results? Bleeding typically improves within the first few weeks as the hemorrhoidal tissue gradually shrinks. Full results are usually apparent by three months.
Is HAE painful? In the only randomized controlled trial comparing HAE to hemorrhoidectomy, patients reported a pain score of 0 at their first bowel movement after HAE, compared to 6 out of 10 for surgical patients. Most HAE patients describe minimal to no discomfort during recovery.
Can hemorrhoids come back after HAE? Symptom recurrence is possible, as with any hemorrhoid treatment. In the Falsarella RCT, approximately 14% of HAE patients required a secondary procedure within 12 months. If symptoms recur, HAE can be repeated, or other treatments can be considered.
Does HAE affect bowel function or continence? No. Unlike surgery, HAE does not involve any cutting or manipulation of the anal sphincter. No cases of sphincteric dysfunction have been reported in the HAE literature when microcoils are used as the embolic agent.
The Bottom Line
HAE is an excellent option for patients with bleeding-predominant Grade 1–3 internal hemorrhoids who want effective symptom relief without the pain and recovery time of surgery. It’s particularly well-suited for patients who have tried conservative treatments without success, who aren’t interested in transanal procedures, or who have medical or lifestyle factors that make surgical recovery impractical.
But it’s not for everyone. External hemorrhoids, advanced prolapse, and active infections require different approaches. The only way to know for certain whether HAE is right for you is to be evaluated by an experienced interventional radiologist.
If you’re in Maryland, DC, or Northern Virginia and want to find out whether you’re a candidate, schedule a consultation with Dr. Chun at Surgical Associates. We’ll give you a clear answer.
Schedule a consultation: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual candidacy for HAE depends on clinical evaluation. Consult with a qualified physician to determine the appropriate treatment for your condition.
References:
- UCLA Health Interventional Radiology. Hemorrhoidal Artery Embolization (HAE) — Candidate Criteria. uclahealth.org.
- UCLA Health. Hemorrhoidal artery embolization: a nonsurgical approach to internal hemorrhoids treatment. July 2025.
- UCLA HELIOS Trial (NCT07179601). ClinicalTrials.gov.
- Falsarella PM, et al. Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy. J Vasc Interv Radiol. 2023;34:736-744.
- Frontiers in Surgery. Hemorrhoidal disease: what role can rectal artery embolization play? 2024.
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.