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Vascular and Interventional Specialists of America

Chronic Hemorrhoids

Approximately half of all Americans will experience hemorrhoids at some point. Also referred to as “piles” this condition causes veins around the anus and lower rectum to swell and become inflamed. They can be uncomfortable and itchy, and they cause bleeding during bowel movements. If hemorrhoids last longer than three months they are considered “chronic” hemorrhoids and may require treatment.

What causes chronic hemorrhoids?

Hemorrhoids can form for a number of reasons including straining during bowel movements, chronic constipation or diarrhea, lifting heavy objects, pregnancy, a low fiber diet, genetics, prolonged sitting, being overweight, anal fissures (small tears in the anus) and other factors. They are similar in nature to varicose veins.

Chronic Hemorrhoids treatment
HAE Patient Brochure

What are my treatment options for chronic hemorrhoids?

At first, physicians recommend treating hemorrhoids with conservative methods, such as diet changes, topical creams, sitz baths and pain relievers. If the symptoms persist and do not respond to conservative treatment, and the hemorrhoids are internal (meaning they remain inside the body) there are several approaches to treat them.

Hemorrhoidectomy is a surgery to remove chronic hemorrhoids. Unfortunately, surgery carries risks and potential complications that can include infection, bleeding, rectal prolapse and more. Recovery can be more difficult than other types of surgery because regular bowel movements can put pressure on the surgical site, causing pain. Although it is effective, this surgery is associated with intense postoperative pain and a prolonged time to return to normal activities.1,2

A less invasive treatment called Rubber Band Ligation is sometimes recommended to treat hemorrhoids. This involves wrapping a small rubber band around the base of a hemorrhoid, which cuts off blood, causing it to shrink and fall off within a few days. However, this approach is also associated with pain and complications, especially for those taking antiplatelet or anticoagulant medication, who have a higher risk of hemorrhage and infectious complications.3

A new and minimally invasive option offered by the doctors at VISA is called Hemorrhoidal Artery Embolization or HAE. It is safe and effective4, and achieves similar outcomes to surgery but with far less pain5 and a much shorter recovery.

  1. Ganz RA. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol 2013; 11:593–603.
  2. Nienhuijs SW, de Hingh IH. Pain after conventional versus Ligasure haemorrhoidectomy. A meta-analysis. Int J Surg 2010; 8:269–273.
  3. Andreia Albuquerque Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg. 2016 Sep 27; 8(9): 614-620
  4. Sandeep Bagla, MD et al. Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center. Journal of Vascular and Interventional Radiology. February 1, 2023.
  5. Priscilla Mina Falsarella, MD et al. Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial. J Vasc Interv Radiol 2023; 34:736–744

For more information about chronic hemorrhoids and other treatment options offered by VISA, please visit our treatments page or contact us today to schedule a consultation.

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