(726) 216-2246

Mucus, discharge, trouble staying clean · Free consultation

Mucus and discharge are what prolapsing hemorrhoids do. It is treatable at the source.

Internal hemorrhoids that slip down carry the moist lining of the rectum with them — that is the mucus, the dampness, the trouble staying clean no matter how careful you are. Shrink the hemorrhoid and the lining goes back where it belongs. HAE does that through a pinhole in the thigh, with nothing entering the anal canal. Pick a time below. The consultation is free and private.

Step 1 of 2

Select your day and time.

Hemorrhoid consultations are on Mondays, Tuesdays, and Thursdays. After you book, a confirmation text goes to your phone — that’s step 2, and it takes one tap. Booking outside office hours? It’ll reach you when we open.

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Rather book by phone — or not seeing a time that works? Call (726) 216-2246.

Before you come in

A short video on what your visit will actually look like — so nothing on the day is a surprise.

What happens next

After you pick a time.

  1. A confirmation text arrives. Tap it to confirm and your appointment is locked in — if you booked outside office hours, it comes through when we open. That’s all the booking asks of you.

  2. We verify your insurance benefits before you come in — complimentary, done for you. Hemorrhoid artery embolization is a covered benefit under most insurance plans, and you’ll know exactly where you stand before you decide anything.

  3. Your visit: about thirty minutes. A conversation with a provider in a private room, a review of your history, and a brief, professional exam — it takes minutes, and our team does it every day. Then a straight answer: whether HAE fits your situation, and what to do if it doesn’t.

Before your visit

Common questions.

“Is the consultation really free?”

Yes — booked through this page, the consultation (normally $245) costs you nothing, and it comes with a complimentary check of your insurance benefits. It’s how we’d want to be treated: find out whether the procedure fits you before any money enters the conversation.

“Do I need a referral?”

Not for your consultation — book directly. If your insurance plan requires a referral for treatment itself, we’ll identify that during the benefits check and help you get it.

“Does anything go into my rectum during the procedure?”

No. That is the single biggest difference between HAE and every other hemorrhoid procedure. Nothing enters the anal canal at all — no scope, no band, no instrument. The entire treatment happens inside the arteries, reached through a pinhole in your upper thigh. The only time anyone examines you is at the consultation, briefly and privately, to confirm which hemorrhoids are causing the trouble.

“Will I be awake? Does it hurt?”

You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia. The access point in your thigh is numbed first. Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. In the published series it showed up in roughly a third to most patients, eased over a few days, and needed nothing more than ibuprofen and Tylenol. We’ll tell you to expect it so it doesn’t worry you.

“How long does the whole thing take?”

The procedure itself takes about an hour. Afterward you rest with us — most of the time about an hour under observation while we watch you and give you fluids, occasionally a bit longer — then you go home. Plan on three to four hours at our office all told, then home the same day. An afternoon, not a hospital stay.

“What if I’m not a candidate?”

Then we’ll tell you, and we’ll point you to the treatment that actually fits — including a surgical referral when that’s genuinely the right answer. We turn away patients who aren’t candidates for what we do. Routinely.

Ready for non-surgical relief?

If you want the full picture first

Everything about the procedure, for anyone who reads before they book.

What HAE actually does, how it compares with banding and surgery, what it can and cannot fix, and who does it. The calendar stays at the top of this page whenever you’re ready.

The procedure

What HAE actually does.

Internal hemorrhoids are cushions of blood vessels inside the lower rectum — everyone has them. They become a problem when the blood flowing into them outruns the blood flowing out: the cushions swell, slide downward, and bleed. The arteries feeding them are branches of one vessel, the superior rectal artery, and in people with symptomatic hemorrhoids those branches carry more flow than they should. That extra inflow is the supply line that keeps the swelling and the bleeding alive.

HAE goes at that supply line directly. Through a pinhole in your upper thigh, a catheter thinner than a phone-charger cord travels to the small branches feeding the hemorrhoids. There, an interventional radiologist places tiny coils and microscopic particles, and turns the excess inflow down. The hemorrhoidal tissue stays exactly where it is — nothing is cut or removed — but with its supply reduced, it shrinks over the following weeks and the bleeding eases. Because the rectum has more than one blood supply, the healthy tissue around the hemorrhoids keeps the flow it needs.¹

Notice what HAE is not: it’s not a procedure done at the anus at all. Banding, sclerotherapy, and surgery all work from inside the anal canal — on the tissue itself. HAE works on the arteries upstream, from the inside. That’s why the muscle that gives you control is never touched, why there’s no wound to heal where you sit, and why it can help people whose banding didn’t hold.¹

The supply line, seen live Dye flowing through the superior rectal artery during an HAE at ARVC — the hemorrhoidal blush is the fine vessels filling below the tangle at the top. This is the map the doctor navigates.
A fingertip pointing to the tiny pinhole access site at the top of a patient’s thigh after hemorrhoid artery embolization
The access, actual size This is the extent of the access in the groin — less than 24 hours after the procedure.

First, the part nobody explained

Everyone has hemorrhoids. They only become a problem when the plumbing backs up.

Hemorrhoids are not something you caught or something you did wrong. They are normal cushions of blood vessels that sit at the end of the rectum and help seal it. You were born with them. Everyone has them.

The trouble starts when more blood flows in than drains out. The cushions swell, and they stay swollen. Swollen tissue bleeds easily, and it can slip down out of place.

Where they sit changes everything. Internal hemorrhoids form above a line inside the canal where there are almost no pain nerves — which is why they can bleed a great deal and still not hurt. External ones form below it, where the nerves are, so they hurt but rarely bleed much. That is why bleeding without much pain is usually internal, and why what works for one kind often does nothing for the other.

Diagram of the anal canal showing an internal hemorrhoid above the pectinate line and an external hemorrhoid below it
Internal hemorrhoids sit above the pectinate line, where there are almost no pain nerves. External ones sit below it.

How doctors describe them

Hemorrhoids are graded one to four.

The internal kind — the ones that bleed — get a number. It is not a severity score for how bad you feel, but a description of how far the tissue has slipped, and it decides which treatments are even on the table for you.

  • Grade 1Stay inside. They may bleed, and often do not hurt at all.
  • Grade 2Come down when you go, then go back on their own.
  • Grade 3Come down and have to be pushed back by hand.
  • Grade 4Stay outside and cannot be pushed back.

The procedure we do treats internal hemorrhoids at grades 1 to 3, and works best when bleeding is the main complaint. Grade 4 usually needs surgery — and if that is what you have, we will tell you so and point you to the right person. One more thing that is not optional: bleeding needs a colonoscopy to rule out other causes before anyone treats it. We do not skip that step.

Chart showing internal hemorrhoid grades one through four

What the options actually involve

Four roads. They ask very different things of you.

Fiber, water, ointments, less time on the toilet

The right place to start, and often enough on its own for mild cases. Keep these habits whatever else you do — they are what keeps hemorrhoids from coming back, including after a procedure, ours very much included. What they cannot do on their own is change the blood supply that is already overfilling the cushions.

Rubber band ligation

A band is placed through the anal canal and tightened around the hemorrhoid to cut off its blood supply until the tissue dies and comes away. It is sometimes done in the office, but commonly under sedation during a colonoscopy. Expect pressure, aching and some bleeding as it separates over the following days. It often has to be repeated, and one banding rarely covers everything — because the arteries that overfilled the cushions in the first place are still doing it.

Surgery — hemorrhoidectomy

The one people write the recovery stories about. It cuts tissue away from one of the most nerve-dense areas of the body, and then leaves an open wound there. That is the part nobody warns you about properly: every bowel movement passes over it, for weeks. Patients go home on stool softeners and still describe those first trips to the bathroom as the worst of it. The other risks are worth knowing too: bleeding, infection, narrowing of the opening as it heals, and — less often — lasting trouble controlling gas or stool. For grade 4 hemorrhoids this is the right answer, and we will say so. At grades 1 to 3, it should not be the first thing you are offered.

A physician holding an anatomical model of the anal canal, with the scalpel crossed out
Cutting tissue away through the anal canal — the part most of our patients come here to avoid.
What we do

Hemorrhoid artery embolization (HAE)

Works upstream instead. Through a pinhole at the top of the thigh, the arteries feeding the swollen cushions are turned down, so the tissue shrinks where it sits. Nothing enters the anal canal, and nothing touches the muscle that controls your bowels. Home the same day, and back to your routine without a wound to heal around. Risks are minimal, and the side effects are temporary and self-limiting: cramping and a feeling of pressure for two to three days, which most patients call mild. You return to physical activity as you tolerate it, right away.

Dr. Samy Al-Bayati guiding a catheter with a syringe during a hemorrhoid artery embolization at ARV Centers
Samy A. Al-Bayati, M.D., board-certified interventional radiologist — a catheter through the top of the thigh, not a scalpel.

Ready for non-surgical relief?

What HAE is not

Three limits, stated before any results.

It’s for internal hemorrhoids only

External hemorrhoids have a different blood supply, and HAE wasn’t designed for them. Many people have both kinds; a brief exam at the consultation tells us which ones are actually causing your symptoms — and whether this is the right tool.

It isn’t for grade 4

HAE treats internal hemorrhoids graded 1 through 3. A hemorrhoid that stays prolapsed and won’t go back in — grade 4 — still needs surgery, and we’ll refer you for exactly that rather than sell you the wrong procedure.

It isn’t a guarantee

In the published studies, roughly 2 in 3 to 9 in 10 patients got lasting relief, and about 1 in 7 needed a second session for bleeding that came back.¹ The full numbers are below, uncropped.

Limits first, results second — that’s the order you deserve. Now the results.

See it for yourself

The supply line — before and after.

These are angiograms — X-ray pictures taken while dye flows through the arteries — from a hemorrhoid artery embolization performed here at ARVC. In the “before” images, the dark tangle at the top of each picture (arrow) is the cluster of vessels feeding the hemorrhoids, flooding in with the dye. In the “after” images, minutes later: the tangle no longer fills, the tiny coils are visible where they were placed, and the main artery is still flowing. Nothing in these pictures went anywhere near the anal canal.

Before

Angiogram before embolization: the left branch of the superior rectal artery, with a dense tangle of vessels feeding the hemorrhoids filling with dye

After

Angiogram after embolization of the left branch: the tangle no longer fills; small coils are visible in the treated branches and the artery above still carries dye
The left branch, minutes apart — before, the tangle of vessels feeding the hemorrhoids floods in with the dye; after, it no longer fills. The small squiggles are the coils, each a few millimeters long. The main artery above them is still open.

Before

Angiogram before embolization: the right branch of the superior rectal artery in the same patient, with the tangle of hemorrhoidal vessels filling with dye

After

Angiogram after both branches were treated: a wider view of the pelvis with coils in place on both sides and no hemorrhoidal blush filling
The right branch, then both sides together — the same patient. Hemorrhoids are usually fed from both sides, so both are treated. The final picture is a wider view of the pelvis: coils on both sides, and no blush left to fill.

The treatment itself, step by step

Watch one branch get turned down.

The pairs above are before and after. These four runs show the treatment itself — one branch, at ARVC, in the order it was done. Nothing here goes anywhere near the anal canal.

The blush, selectivelyThe left superior rectal artery’s anterior division, catheterized on its own. The dark cloud filling below the catheter is the hemorrhoidal blush — the excess flow feeding the cushions, with nothing else in the picture to hide it.
The first microspheresMicroscopic spheres go in to slow that flow. Watch the fine vessels running down the middle: less of the blush fills than it did a moment ago.
More, after a re-checkThe doctor shoots the picture again to see what is still filling, then adds more spheres to keep closing down the flow to the hemorrhoidal cushions.
The coils go inCoils finish the job. They keep the treated branch from reopening later — what doctors call recanalization, the vessel growing its way back to the cushions.

Angiograms from a hemorrhoid artery embolization performed at ARV Centers, San Antonio. Patient identifying information removed. Individual results vary — the study data below is the fairer way to set expectations.

The published evidence

What the studies show.

A fanned stack of published journal papers on hemorrhoid embolization
The published research behind this page — among them the 2022 systematic review our figures come from, a US outpatient outcomes study, and an angiographic analysis of 242 embolizations. Full citation below.

93–100%

of published procedures were technically successful — the doctors reached and treated the branches feeding the hemorrhoids.¹

63–94%

clinical success across the published studies — roughly 2 in 3 to 9 in 10 patients got lasting relief of their symptoms.¹

Zero

serious complications reported across every published study reviewed — roughly 250 patients. Minor, temporary side effects do happen; they’re listed below.¹

1 in 7

patients — 34 of about 250 — had bleeding return and were treated with a second embolization session.¹

Start with what the evidence is: a dozen published series from France, Italy, China, Russia, Turkey, and Hungary, reviewed together in the radiology literature in 2022, covering roughly 250 patients with grade 1–3 internal hemorrhoids who had already failed creams, fiber, or banding.¹ Every one reported that the procedure was safe. None reported a serious complication.

The transparent half: these are small studies with short follow-up, and there is no randomized trial yet comparing HAE head-to-head against banding or surgery — the review authors say so plainly, and so do we. Re-bleeding is the main way HAE falls short: about 1 patient in 7 needed a second session, often to treat a small feeding branch that wasn’t reached the first time.¹ Grade matters, too. In one series, 94% of grade 1–2 patients were satisfied with their improvement against 84% of grade 3 patients — both good, but not the same.¹ We’ll tell you which group your hemorrhoids are in.

The side effects, all of them: a pressure sensation like needing the restroom (tenesmus), reported in roughly a third to most patients depending on the study, lasting up to a few days and managed with ibuprofen and Tylenol; temporary abdominal or rectal discomfort; and, in one study of particle sizes, small sores at the anorectal junction with the smallest particles — graded minor, needing no more than routine care.¹ That is the list from the published series, and nothing on it involves the sphincter or bowel control.

What we won’t claim: a cure, permanence, or a number for your hemorrhoids. What we will say: for internal hemorrhoids that bleed, HAE addresses the source with no cutting and no wound, the published safety record is clean, and if it ever isn’t enough, it takes nothing off the table — a repeat, banding, and surgery all remain available afterward.

Sources: 1. Talaie R, Torkian P, Dooghaie Moghadam A, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: a review of current evidences. Diagn Interv Imaging 2022;103(1):3–11 — systematic review of 12 published studies (2008–2021), ~250 patients, coils and/or particles in the superior rectal artery branches: technical success 93–100%; clinical success 63–94%; no serious complications reported; 34 of ~250 patients re-bled and were re-embolized; coils vs coils + particles 63% vs 68% (Moussa 2020, no significant difference); satisfaction 94% grade 1–2 vs 84% grade 3 (Zakharchenko 2016); tenesmus 35% (Sun 2018) to 50–87% (Küçükay 2021, particle sizes); small ischemic ulcerations with 500–700 µm particles (Küçükay 2021); anal tone preserved, no direct anorectal trauma, outpatient, return to daily routine the following day; authors call for larger randomized trials with longer follow-up. 2. Bagla S, Pavidapha A, Lerner J, Kasimcan MO, Piechowiak R, Josovitz K, Marathe A, Isaacson A, Sajan A. Outcomes of hemorrhoidal artery embolization from a multidisciplinary outpatient interventional center. J Vasc Interv Radiol 2023;34(5):745–749 — retrospective analysis of 134 outpatients (mean age 54.9, mean Goligher grade 2.1) embolized August 2021–June 2022 with spherical particles and microcoils: at least one hemorrhoidal artery embolized in 133 of 134 (99%); clinical success 93% (124 of 134) at one month, 10 patients re-embolized; significant improvement in hemorrhoid symptom score (11 to 7.8), hemorrhoid-related pain (4.1 to 1.3), quality of life (2.2 to 0.8), French bleeding score (4.4 to 2.2) and hemorrhoid grade (2.3 to 1.2); no severe adverse events. Full citations and page-claim traceability in the ARVC evidence file.

Ready for non-surgical relief?

Candidacy

Who this is for — and who it isn’t.

HAE may be right for you if:

  • You have internal hemorrhoids — grade 1, 2, or 3
  • Bleeding is your main symptom — on the paper, in the bowl, or enough to leave you anemic or tired
  • Creams, fiber, and lifestyle changes haven’t been enough
  • Banding didn’t hold — or you couldn’t face a second round
  • You’ve been offered surgery and want a real alternative first
  • You’ve been told surgery is risky for you — because of blood thinners, liver disease, or other health conditions
  • You can’t afford weeks off work or away from your family for a surgical recovery

It may not be right if:

  • Your hemorrhoids are external only (we’ll check — many people have both)
  • You have a grade 4 hemorrhoid that stays prolapsed — that needs surgery, and we’ll refer you
  • Your bleeding hasn’t been evaluated yet — a colonoscopy may need to come first
  • You have certain circulation problems or advanced kidney disease

We turn away patients who aren’t candidates for what we do. Routinely.

The part nobody likes to talk about

The real reason many people wait years: nobody wants the exam.

Here’s what the consultation actually involves: a conversation, a review of your history, and yes — a brief, private, professional examination. It takes minutes. Our team does this every day; to us it’s as routine as listening to your heart. There is nothing you could show us or tell us that we haven’t seen, and nothing about it will be treated as anything other than ordinary medicine.

If it helps: many of our patients tell us the exam they dreaded for years was the easiest part of finally getting this fixed.

A private consultation and exam room at ARV Centers
A private consult room Where your conversation and exam happen — door closed, one patient at a time.

Your care team

The doctors who perform HAE here.

Hemorrhoid artery embolization at ARVC is performed by our Board Certified Vascular and Interventional Radiologists, in our own angiography suite — quietly, by a team that does embolization every day. Ask any of them anything. There is nothing you could say that they haven’t heard.

Dr. Samy Al-Bayati

Samy A. Al-Bayati, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Arabic

Dr. Arthur Joseph

Arthur S. Joseph, D.O., M.P.H.

Board Certified ·
Vascular & Interventional Radiology

Dr. Andrew Chesley

Andrew V. Chesley, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Español

After your procedure

You go home with the doctor’s cell number.

When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.

And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure.

A follow-up appointment is scheduled to check your recovery and your response to the treatment — part of the procedure here, not an extra.

Straight answers

Questions patients actually ask.

“Does anything go into my rectum during the procedure?”

No. That is the single biggest difference between HAE and every other hemorrhoid procedure. Nothing enters the anal canal at all — no scope, no band, no instrument. The entire treatment happens inside the arteries, reached through a pinhole in your upper thigh. The only time anyone examines you is at the consultation, briefly and privately, to confirm which hemorrhoids are causing the trouble.

“Will I be awake? Does it hurt?”

You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia. The access point in your thigh is numbed first. Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. In the published series it showed up in roughly a third to most patients, eased over a few days, and needed nothing more than ibuprofen and Tylenol.¹ We’ll tell you to expect it so it doesn’t worry you.

“Is it covered by insurance?”

Yes — hemorrhoid artery embolization is a covered benefit under most insurance plans, and we’re in-network with most plans. We still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.

“When can I go back to work? When does the bleeding stop?”

Light activity for the first 48 hours — then your normal routine. Published reviews describe patients returning to daily life the day after the procedure.¹ Bleeding typically settles within one to two weeks, and the full improvement builds over four to six weeks as the hemorrhoids shrink. Driving waits until the next day: the sedation means you’ll need a driver to take you home, no exceptions.

“How is this different from banding?”

Banding treats hemorrhoids one at a time, from inside the anal canal, and larger (grade 3) hemorrhoids often aren’t good candidates. HAE works from inside the blood vessels — nothing enters the anal canal — and treats the supply feeding the whole hemorrhoidal cushion at once. If banding didn’t hold for you, or you couldn’t face a second round, that doesn’t mean this won’t work.

“How is it different from hemorrhoid surgery?”

Surgery removes the hemorrhoidal tissue, which leaves a wound in a place that has to keep working every day — that’s where the recovery stories come from. HAE removes nothing. It turns down the blood supply that keeps the tissue swollen and bleeding, and the tissue stays where it is and shrinks. No wound, no packing, no first bowel movement to dread. The transparent other half: for grade 4 hemorrhoids that stay prolapsed, surgery is still the right treatment, and we’ll refer you for it.

“Will this affect my bowel control?”

It isn’t designed to, and this is where HAE most clearly differs from surgery. Nothing is done at the anus itself, so the sphincter muscle — the muscle that gives you control — is never cut, stretched, or touched. The published reviews describe HAE as preserving anal tone precisely because there is no direct anorectal trauma.¹

“Will I need a colonoscopy first?”

Possibly — if you haven’t had one recently, or your symptoms have changed dramatically since your last one. Rectal bleeding has more than one possible cause, and hemorrhoids are only the most common. Before treating, we make sure the serious causes — including colorectal cancer — have been ruled out. If you’re due, we’ll help you get it scheduled.

“Why hasn’t my gastroenterologist or colorectal surgeon mentioned this?”

HAE is done by interventional radiologists — a different specialty with a different referral network. Nobody hid it from you; it just lives outside the world of scopes and operating rooms you’ve been seeing. The research is published in journals every specialty can read, and we’ll gladly share it with your doctor.

“Is this experimental?”

No. Hemorrhoid embolization has been performed and published since 2014, with results from roughly 250 patients across a dozen studies reviewed in the radiology literature by 2022 — and no serious complications reported in any of them.¹ What is transparently true: the trials so far are smaller and younger than the ones behind, say, knee embolization, and there is not yet a head-to-head trial against banding or surgery. We say so on this page. And it passes the test skeptics rightly apply to newer procedures: it’s a covered benefit under most insurance plans.

The calendar is at the top of this page. Pick a time you know you can keep.

Ready for non-surgical relief?

Prefer the phone? Call us directly:

(726) 216-2246