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Ever since Nathan* was a child, he dreamed of joining the military. As soon as he graduated from high school, he enlisted in the Air Force and made the service his career.
“When it came time to choose an occupation within the Air Force, I became an aircraft mechanic,” recounts Nathan, 62. “It was an interesting job with important responsibilities. Mechanics need to make sure all the aircraft are operationally ready by properly servicing them. We have to keep them functional and fueled at all times.
“Before I retired in 2020, I had put in 40 years. I served through three wars and saw many parts of the US from the various Air Force bases where I was stationed. My wife and I liked Florida the best, so we decided to reside here permanently after I left the service.”
Nathan and his wife intended to travel the world following his retirement. They especially wanted to visit locations of historical interest in Europe and South America. But the idea of sitting for long hours on an airplane didn’t appeal to Nathan. Symptomatic hemorrhoids was the reason.
“Sitting was extremely uncomfortable because the hemorrhoids caused terrible itching and burning,” Nathan describes. “On a scale of one to 10, with 10 being flat-out unbearable, my symptoms regularly reached an eight or nine. And when I wiped after a bowel movement, there was often bright red blood on the toilet paper. It was a real problem.”
Nathan isn’t alone. Before age 50, nearly half of all people will suffer with hemorrhoids, which are dilated veins in the rectum that typically form in response to increased pressure on the lower rectum.
That pressure can occur for a variety of reasons. In addition to age, risk factors include being pregnant, eating a low-fiber diet, having chronic diarrhea or constipation, engaging in anal sex, and straining during bowel movements.
Nathan’s concern eventually prompted a visit to his primary care physician at the Veterans Affairs medical center. After confirming that Nathan’s symptoms were related to hemorrhoids, the doctor referred him to a general surgeon.
The surgeon recommended a ligation procedure called banding, during which rubber bands are placed around the necks of the hemorrhoids. The bands cut off the blood supply to the hemorrhoids, which causes them to wither and fall off.
“But there are significant risks associated with surgery, include bleeding, infection and fecal incontinence,” Nathan informs. “Not only that, but after the surgery, you have to sit on a ‘doughnut’ cushion for six to eight weeks. I thought, I’d rather live with hemorrhoids than go through that.”
So, he passed on banding and continued to live with hemorrhoids for several months.
Damming the River
In January, he attended a presentation conducted by Derek Mittleider, MD, FSIR, RPVI, chief of vascular and interventional radiology at Vascular & Interventional Physicians in Viera.
Dr. Mittleider described a minimally invasive scalpel-free treatment called hemorrhoid arterial embolization. Unlike surgery, hemorrhoid arterial embolization has an extremely low risk for complications. It also results in an immediate recovery and no pain.
“During the procedure, we place a tiny tube, not much bigger than a human hair, into an artery in the groin,” Dr. Mittleider explains. “We use x-ray to guide the tube into the superior rectal artery, which feeds the hemorrhoids.
“Once in the artery, we release small, round beads. These beads, which are essentially benign balls of resin, lodge in the artery wall and block blood flow into the hemorrhoids. As a result, the hemorrhoids shrink and resolve over time.
“It’s like damming a river. The dam doesn’t make the water go away; it just directs its flow. With embolization, we don’t stop blood flow to the rectum. We decrease the flow to the hemorrhoids so they can heal.
“Another great thing about embolization is that it only treats the hemorrhoids. No healthy rectal tissue is disturbed, as is the case with surgery and banding. That’s why patients don’t feel any pain after the procedure.”
Hemorrhoid arterial embolization is an outpatient procedure that can be completed in less than an hour. Patients are typically up and walking again within an hour and can resume regular activities by the end of the day. The only restriction is they are asked to avoid heavy lifting and vigorous exercise for 72 hours.
“Patients typically experience results right away and generally feel better and better over the weeks following the procedure,” Dr. Mittleider notes. “Their symptoms continue to improve throughout the first year. This procedure dramatically increases quality of life.”
“I’m Thrilled” 
“After hearing Dr. Mittleider’s presentation, I thought, I should try this. It sounds so much more benign than surgery,” Nathan recalls. “So, I scheduled an appointment at Vascular & Interventional Physicians and had the procedure done in March.”
According to Nathan, the hemorrhoid arterial embolization quickly provided the relief he was seeking.
“Within a week of having this procedure done, I felt a noticeable difference in the intensity of the burning and itching I was experiencing,” Nathan confirms. “It went down to a four or five on a scale of one to 10.
“Today, the burning and itching are completely gone, and I no longer find blood on the toilet paper after a bowel movement. I’m happy to say my wife and I recently took a three-week trip to Germany, and I had no trouble sitting during the eight-hour trans-Atlantic flight. I’m thrilled I can travel again without discomfort.
“I’m grateful to Dr. Mittleider for restoring my quality of life. He’s very knowledgeable and skilled in the embolization procedure. He’s also very kind and concerned about the welfare of his patients. I highly recommend him and Vascular & Interventional Physicians to anyone with hemorrhoids.”
*Patient’s name changed at his request.
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