A minimally invasive, same-day procedure for hemorrhoid bleeding — performed through the wrist with no surgery, no general anesthesia, and no rectal incisions. Expert care at Mount Sinai.
Overview
Hemorrhoids are veins around the rectum and anus that become abnormally enlarged — most commonly due to chronic constipation, straining during bowel movements, pregnancy, or childbirth. More than half of Americans develop symptomatic hemorrhoids by age 50, with peak prevalence between ages 45 and 65. When hemorrhoids bleed, itch, or prolapse, they can significantly impact quality of life.
Hemorrhoidal artery embolization (HAE) is a minimally invasive, catheter-based procedure that treats symptomatic hemorrhoid bleeding by reducing blood flow to the superior hemorrhoidal arteries — the vessels responsible for engorging hemorrhoidal tissue and causing recurrent rectal bleeding.
In patients with internal hemorrhoids, persistent arterial blood flow to the hemorrhoidal plexus sustains engorgement and bleeding. HAE uses a combination of coils and microspheres delivered through a catheter to selectively reduce this arterial inflow. As blood supply diminishes, hemorrhoidal tissue shrinks and bleeding resolves — without any surgical incision in or around the rectum, and without disturbing anal continence. Hemorrhoidal tissue is left in place; only the abnormal blood supply is addressed.
The procedure is performed through a small puncture at the wrist (radial artery) under mild sedation and real-time fluoroscopic imaging guidance. There is no abdominal incision, no rectal manipulation under anesthesia, and no hospital admission. Patients are discharged the same day and typically return to full activity within 3 days.
For patients seeking a non-surgical hemorrhoid treatment in New York City — particularly those with recurrent bleeding who have not achieved lasting relief from office-based procedures, or who want a genuine alternative to hemorrhoidectomy — HAE offers a compelling, durable, and well-tolerated option at Mount Sinai.
Published data show bleeding cessation in over 70% of appropriately selected patients following HAE.
Hemorrhoids are extremely common — peak prevalence is ages 45–65, and many women develop them during pregnancy.
No overnight hospital stay. Patients recover briefly on-site and go home the same day.
Performed as an outpatient procedure under mild sedation with rapid recovery.
Dr. Fischman performs HAE via radial (wrist) access — no groin puncture, faster recovery, immediate ambulation.
The Procedure
Dr. Fischman reviews your symptom history, prior colonoscopy or endoscopy results, and prior hemorrhoid treatments to confirm you are an HAE candidate and plan the approach. Telemedicine consultations are available for out-of-state patients.
Under mild sedation and local anesthesia, a catheter is introduced through a small puncture at the wrist. Using real-time fluoroscopic imaging and contrast dye, Dr. Fischman maps the superior hemorrhoidal arterial supply before embolization.
A combination of coils and microspheres is selectively delivered to the superior hemorrhoidal arteries, reducing arterial inflow to the hemorrhoidal plexus. The goal is targeted devascularization of the hemorrhoidal tissue while preserving surrounding structures.
You recover briefly on-site and go home the same day. Because access is through the wrist, patients can walk immediately after the procedure. Most return to normal activities within 1–3 days. Bleeding typically resolves within days to weeks as the hemorrhoidal tissue shrinks.
Recovery Timeline
HAE vs. Other Treatments
Patients with symptomatic hemorrhoids typically progress through a treatment ladder — from fiber supplementation and topical agents, to office-based procedures like rubber band ligation, to surgical hemorrhoidectomy. HAE fits between office procedures and surgery: offering a durable, non-surgical option for patients with recurrent bleeding who haven't responded to simpler interventions.
| HAE Dr. Fischman · Mount Sinai |
Rubber Band Ligation | Surgical Hemorrhoidectomy | |
|---|---|---|---|
| Surgical Incision | ✓ None | None | Required |
| General Anesthesia | ✓ Not required | Not required | Usually required |
| Access Route | ✓ Wrist (radial) | Rectal | Perianal / rectal |
| Same-Day Discharge | ✓ Yes | Yes | Usually overnight stay |
| Return to Activity | ✓ 1–3 days | 1–2 days | 2–4 weeks |
| Pain Post-Procedure | ✓ Minimal | Mild discomfort | Significant — often severe |
| Durability | ✓ Durable | Recurrence common | High cure rate but significant recovery |
| Treats Bleeding Specifically | ✓ Yes — primary indication | Yes (grades I–III) | Yes, plus prolapse |
Individual outcomes vary. This comparison is for informational purposes only. Dr. Fischman will discuss your specific case and the most appropriate treatment options during your consultation.
Patient Selection
HAE is primarily a treatment for hemorrhoid bleeding. It is most appropriate for patients with recurrent or persistent rectal bleeding from internal hemorrhoids who want to avoid surgical hemorrhoidectomy. Dr. Fischman evaluates each patient individually at Mount Sinai, reviewing clinical history and prior treatment before recommending any procedure.
Note: HAE is most effective for bleeding. It is generally not recommended as primary treatment for symptomatic hemorrhoid prolapse. If prolapse is your primary concern, Dr. Fischman will discuss the most appropriate management options during your consultation.
Dr. Fischman's team will review your clinical history, prior treatments, and any existing imaging or endoscopy to determine whether HAE is appropriate for you. Telemedicine consultations are available for patients outside New York.
Office: Mount Sinai Health System
5 East 98th Street, 12th Floor
New York, NY 10029
Phone: (212) 241-4046
Request a ConsultationInsurance
Insurance coverage for HAE is variable and evolving. Dr. Fischman's team will perform a detailed insurance review and prior authorization assessment before your procedure so there are no surprises.
Frequently Asked Questions
Internal hemorrhoids bleed because they are fed by high-pressure arterial blood flow from the superior hemorrhoidal arteries. HAE selectively reduces this arterial inflow using a combination of coils and microspheres delivered through a catheter in the wrist. As blood supply diminishes, hemorrhoidal tissue shrinks, venous pressure drops, and the bleeding resolves — without any surgical cutting or manipulation of the rectal tissue.
Dr. Fischman is a pioneer of radial (wrist) artery access for interventional procedures. For HAE, radial access offers several advantages: patients can walk immediately after the procedure, there is no need for prolonged bed rest, groin hematoma risk is eliminated, and patient comfort is significantly improved. The wrist access site heals quickly with a small bandage. This approach reflects Dr. Fischman's broader philosophy of minimizing procedural burden while maximizing patient outcomes.
HAE is primarily effective for hemorrhoid bleeding. It works by reducing arterial blood flow to the hemorrhoidal plexus, which shrinks the hemorrhoidal tissue over time. For patients with significant prolapse as their primary symptom, or for patients with primarily external hemorrhoid pain, other treatments may be more appropriate. Dr. Fischman will help you determine whether HAE is the right fit for your specific symptoms during your consultation.
Yes. Prior rubber band ligation, sclerotherapy, infrared coagulation, or other office-based hemorrhoid procedures do not disqualify you from HAE. In fact, HAE is often most relevant for patients who have had recurrent bleeding despite multiple rounds of these procedures. Because HAE works through the vascular system and not via direct rectal manipulation, prior office treatments do not complicate the technical aspects of HAE.
HAE has a favorable safety profile in published literature. Common post-procedure symptoms include mild rectal discomfort or a low-grade fever in the first few days, which resolve spontaneously. Serious complications are rare. As with any catheter-based procedure, there are small risks of access site bruising, contrast allergy, and non-target embolization — all minimized by careful angiographic mapping under fluoroscopic guidance prior to embolization. Dr. Fischman will review all risks and benefits in detail during your consultation.
Yes. Dr. Fischman welcomes patients from across the United States and internationally. Initial consultations can be conducted via telemedicine, and HAE itself is a same-day outpatient procedure — many out-of-state patients travel to New York City and return home the same day or the following morning. Our team coordinates closely with referring physicians and can assist with logistics for traveling patients. Contact our office at (212) 241-4046 to get started.
Insurance coverage for HAE is variable and evolving. Dr. Fischman's team at Mount Sinai will conduct a thorough insurance verification and prior authorization review for every patient before scheduling the procedure. Contact our office at (212) 241-4046 to begin the coverage assessment process.
Schedule a consultation with Dr. Fischman at Mount Sinai, New York City — in person or via telemedicine.
More Procedures
Minimally invasive treatment for enlarged prostate (BPH) — no surgery, no catheter, same-day discharge. Dr. Fischman pioneered the wrist-access technique for PAE.
Learn About PAE →Non-surgical treatment for chronic knee, shoulder, and hip pain from osteoarthritis. Targets the abnormal vessels driving joint inflammation without replacement surgery.
Learn About GAE →Varicocele embolization, interventional oncology, uterine fibroid embolization, and more — comprehensive minimally invasive care at Mount Sinai.
View All Services →