Before Your Procedure
Pre-Op Instructions
What you need to know and do before your Hemorrhoidal Artery Embolization (HAE).
📅 Review as soon as possible
Important — Read Carefully
Fasting Before Your Procedure
🚫 No Solid Food
8 hours before your arrival time
✅ Clear Liquids OK
Up to 2 hours before arrival
✅ Clear Liquids Include
Water · Black coffee · Plain tea · Apple juice · Broth
💊
Medications
In general, continue ALL medications as normal. Because this procedure uses wrist (radial) access, the bleeding risk is very low. Dr. Fischman will review your specific medications at your consultation and advise of any changes. Take morning medications with a sip of water within the clear liquid window.
Exception: Do NOT take diabetic medications (insulin or oral diabetes pills) the night before or morning of the procedure.
Arrange an escort (18+). A responsible adult must escort you from the procedure area, drive you home, and stay with you for several hours. Car service or rideshare is not acceptable unless no sedation was given.
Notify us of any allergies to contrast dye, iodine, shellfish, or medications.
Notify us if you take a GLP-1 medication (Ozempic, Wegovy, Mounjaro, Victoza, Trulicity) or have sleep apnea — both affect sedation.
Notify us of any kidney disease. Contrast dye is used and special precautions may be needed.
Confirm your colonoscopy is up to date and that the source of your bleeding has been evaluated, as discussed at your consultation.
A CT scan may be ordered before your procedure to map your blood vessels. This is not always needed — Dr. Fischman will let you know if it applies to you.
Lab work is generally not required. Dr. Fischman will advise at consultation if any is needed.
Stock up on fiber and a stool softener (such as Colace) and easy-to-prepare foods for the days after your procedure.
📞
Nurse Call — Afternoon
One of our nurses will call you in the afternoon on the day before your procedure to review your instructions, answer questions, and confirm your arrival time. Please keep your phone available and charged.
Eat normally during the day. Fasting begins 8 hours before your assigned arrival time.
No alcohol for at least 24 hours before your procedure.
Shower tonight or morning of. No lotions, creams, or deodorant on the wrist area.
Wear loose, comfortable clothing. Avoid tight sleeves — the catheter will be placed through your wrist.
Leave jewelry and valuables at home.
No solid food within 8 hours of arrival. Clear liquids OK until 2 hours before — then nothing by mouth.
Take all regular medications with a sip of water, within the clear liquid window. Skip diabetic medications.
Where to go: 1468 Madison Avenue, MC Level, Room 801 — Interventional Radiology.
Arrive at the time confirmed by our nurse the afternoon prior. Late arrival may result in rescheduling.
Bring: Photo ID · Insurance card · Medication list · Any imaging not already sent to us.
Your escort (18+) must be present and able to take you home. Car service or rideshare is not acceptable unless no sedation was given.
What to Expect
Procedure Day
A step-by-step walkthrough of your HAE procedure day at Mount Sinai Interventional Radiology.
⏱️ Plan for approximately half a day
HAE (Hemorrhoidal Artery Embolization) is a minimally invasive treatment for internal hemorrhoids — especially those that cause bleeding. By reducing the blood supply to the hemorrhoidal tissue, the hemorrhoids shrink and symptoms improve over the following weeks.
Dr. Fischman accesses the rectal (hemorrhoidal) arteries through a tiny catheter inserted at your wrist — there are no incisions, no anorectal surgery, no general anesthesia, and no direct trauma to the anal area. You go home the same day.
1
Check-In & Registration
Arrive at 1468 Madison Avenue, MC Level, Room 801 — Interventional Radiology. Paperwork and insurance verification completed.
2
Pre-Procedure Prep
Nurse places your IV and reviews medical history, medications, and allergies. Vital signs monitored throughout.
3
Consent
A physician (MD) or advanced practice provider (PA or NP) will review and obtain your informed consent.
4
Sedation
IV ("twilight") sedation keeps you relaxed and comfortable. You'll be drowsy but able to respond. No general anesthesia.
5
Wrist Access
Dr. Fischman numbs your wrist with local anesthesia and inserts a small sheath into the radial artery. You will feel pressure but should not feel pain.
6
The Procedure (~1 hour)
Using live X-ray (fluoroscopy), Dr. Fischman guides a tiny catheter to the hemorrhoidal arteries and places small coils and/or particles to reduce the blood flow feeding the hemorrhoids.
7
Recovery (60–90 min)
You rest in the recovery area while vital signs and the wrist site are monitored. Because access is through the wrist, you do not need to lie flat.
8
Discharge & Home
IV removed, discharge instructions provided. Your escort takes you home the same day.
After Your Procedure
Post-Op Instructions
What to expect during recovery and how to care for yourself after HAE.
📆 Follow-up in 6 weeks
Expected After the Procedure
HAE is generally a low-pain procedure. Symptom relief — especially reduced bleeding — is gradual, with most patients improving over several weeks as the hemorrhoids shrink. The following are normal in the days afterward:
Minor rectal pain or discomfort — usually mild and temporary
Some blood in the stool may continue for a short time — this typically decreases as the hemorrhoids shrink over the coming weeks
An urge to defecate or a feeling of rectal fullness — common and expected after the procedure
Mild bruising or tenderness at the wrist access site — may take 2–3 weeks to fully resolve
Mild fatigue for 24–48 hours
Few activity restrictions. Most patients return to normal activity quickly. Listen to your body and resume activity as you feel able.
No heavy lifting (>10 lbs) for 24 hours to protect the wrist access site.
No driving for 24 hours after sedation.
Eat a high-fiber diet and stay well hydrated. Soft, regular stools reduce strain and protect your results.
Use a stool softener (such as Colace) as needed to avoid straining and constipation.
No baths, hot tubs, or pools for 5 days. Shower after 24 hours.
💊 Pain Relief (acetaminophen or ibuprofen)
Use as needed for mild discomfort. Most patients need very little. Do not exceed recommended doses. If you have kidney disease, ask before taking ibuprofen.
💊 Stool Softener / Fiber (Colace, Metamucil)
Take as directed to keep stools soft and avoid straining. Pair with plenty of water. Maintaining good bowel habits protects your long-term results.
⚠️
Blood Thinners
Please ask us about blood thinners (aspirin, Plavix, Eliquis, Xarelto, etc.) — we will advise you on when and whether to resume them.
Call Us
Fever >101°F (38.5°C) or persistent chills
Significant or increasing rectal bleeding (more than the small amount expected)
Worsening rectal or pelvic pain not controlled by medication
Inability to have a bowel movement or worsening constipation
Redness, swelling, or discharge at the wrist site
Any symptoms that concern you or feel unexpected
Call 9-1-1 or Go to ER
Heavy or uncontrolled rectal bleeding
Uncontrolled bleeding from the wrist that won't stop with 15 minutes of firm pressure
Pain, numbness, coolness, or blue discoloration of the hand/wrist
Chest pain or sudden shortness of breath
Severe allergic reaction: hives, throat tightening, face swelling
Severe abdominal pain, or loss of consciousness
🗓️ 6 Weeks
Follow-up appointment with Dr. Fischman — available in-person or via telemedicine — to review your symptoms and recovery.
📈 When to Expect Results
Symptom relief is gradual. Most patients notice reduced bleeding and improvement over several weeks as the hemorrhoids shrink. Maintaining a high-fiber diet and good bowel habits supports lasting results.