Foam Endosclerosis for Hemorrhoids
Foam endosclerosis. The hemorrhoid retracts during the procedure, in front of you.
Endosclerosis with foam for hemorrhoidal disease at Palazzo Manzoni in Brescia, performed by Prof. Edoardo Cervi. A sclerosing foam injected directly into the hemorrhoidal cushion produces an immediate retraction of the swelling and a progressive obliteration of the underlying vessel. Ambulatory, no general anaesthesia.
Endosclerosis with foam (endosclerosi con schiuma) at Palazzo Manzoni in Brescia is performed by Prof. Edoardo Cervi, general and vascular surgeon. A sclerosing agent in foam form is injected directly into the hemorrhoidal cushion through a fine instrument; the foam produces an immediate visible retraction of the cushion and a progressive obliteration of the underlying vessel. The procedure is ambulatory, takes 10 to 20 minutes, does not require general or spinal anaesthesia, and is described by most patients as indolent. Most patients return to normal daily activity the same day.
Immediate retraction
Visible during the procedure itself.
Ambulatory, indolent
No general or spinal anaesthesia.
One session, often sufficient
Two or three for more advanced grades.
Same-day return to your life
Work, walking, normal activity.
Empathy + The Quiet Stakes
You have lived around this longer than the conversation has needed to last.
You have adapted. The drive that begins with a quick risk assessment. The flight you booked an aisle seat for, for a reason. The meal the day before that you have planned around. The acute episode three years ago when you swore you would deal with it, then it settled, then you went on. The bleeding that you have tracked silently, hoping it would stop. The cream in three drawers.
If you have reached this page, the working-around-it phase is over. What you need now is a specialist who will examine the area properly, in privacy, with the dignity the conversation deserves, grade the disease, and tell you honestly what each technique would do for you.
For most patients today, the right first answer is endosclerosis with foam. About half the adult population has, at some point, dealt with hemorrhoidal disease. Today the right first answer is rarely a surgical operation. It is a fifteen-minute ambulatory injection of sclerosing foam, performed in a quiet outpatient setting.
What Foam Endosclerosis Actually Does
The foam closes the vessel, the cushion retracts, the symptoms resolve
A hemorrhoidal cushion is a venous structure of the rectal wall. When it becomes pathological, the vessels inside dilate, the cushion swells, and the typical symptoms (bleeding, prolapse, the feeling of weight, called tenesmo) appear. The principle of foam endosclerosis is to close the diseased vessel from inside.
A sclerosing agent in foam form (a microfoam produced by mixing the liquid sclerosing agent with sterile air through a closed system) is injected directly into the hemorrhoidal cushion through a fine instrument introduced via an anoscope. The foam displaces the blood inside the cushion, stays in prolonged contact with the vessel wall, and produces a controlled inflammatory reaction that closes the vessel.
The cushion is visibly retracted during the procedure itself, and the underlying vessel is progressively obliterated over the following weeks. The procedure is ambulatory, takes 10 to 20 minutes, requires no general or spinal anaesthesia, and is described by most patients as indolent.
01
Closed from inside the vessel
The foam stays in contact with the wall and closes the diseased vessel.
02
Retraction you can see
The cushion is visibly retracted during the procedure itself.
03
No anaesthesia, no incision
Ambulatory, 10 to 20 minutes, performed by Prof. Edoardo Cervi.
How It Works, Step By Step
From consultation
to same-day return.
Step 01
Proctological consultation
A focused history (pattern of bleeding, prolapse, pain, duration of the symptoms), an examination, and anoscopy or rectoscopy where indicated. The disease is graded. Other causes of rectal symptoms are excluded clinically.
Step 02
The plan
You leave the first visit with a clear grading, the recommended technique (foam endosclerosis for grade I to III, sometimes combined with elastic ligation; radiofrequency where the indication is better suited), and an estimate of how many sessions to plan for.
Step 03
The procedure
Ambulatory. The patient is positioned. The anoscope is introduced. The foam is prepared in real time and injected directly into the hemorrhoidal cushion through a fine instrument. The retraction is visible during the procedure. Total procedure time, 10 to 20 minutes. No general or spinal anaesthesia.
Step 04
Same-day return
The patient returns home within the hour. Normal daily activity, including work, from the same day. Pain, where present, is mild and well controlled. Most patients return to office work the day of the procedure or the day after.
Who Foam Endosclerosis Is For
Is foam endosclerosis
right for your picture?
Foam endosclerosis is the right first answer for most patients with bleeding or reducible prolapse, but the match matters. The grade, the symptom pattern and the clinical picture, established at the consultation, determine whether it fits. Most candidates share several of the following.
Clinical profile
- Grade I to II hemorrhoidal disease, with intermittent bleeding and minimal or no prolapse
- Grade II to III with reducible prolapse, often combined with elastic ligation
- Bleeding-dominant pictures, where the foam is the workhorse technique
- No acute thrombosed external hemorrhoid and no active inflammatory bowel disease in flare
- No known allergy to the sclerosing agent
- Not pregnant and not in the immediate postpartum period
Patient profile
- Patients who specifically wish to avoid the classic surgical hemorrhoidectomy
- Patients in whom the surgical operation is unwanted, deferred, or contraindicated by comorbidities
- Those who want a same-day return to work and normal activity
- Those who have carried the problem for years and want a short, ambulatory answer
- Those who prefer a procedure with no general or spinal anaesthesia
Where it isn’t the right answer?
Foam endosclerosis is not the answer for an acute thrombosed external hemorrhoid (a different acute clinical picture, with different management), for specific advanced grade IV pictures with fixed prolapse (where surgical options are discussed), during active inflammatory bowel disease in flare, with a known allergy to the sclerosing agent, or in pregnancy and the immediate postpartum. The procedure also does not address external hemorrhoidal components, which are managed separately where present.
If foam endosclerosis fits, your consultation will confirm it. If not, the right answer for your picture still exists, and the grading will find it. For specific grade II to III pictures, foam endosclerosis is combined with elastic ligation in the same ambulatory session.
A Well-Established Technique
A clean technique, with a long track record
Endosclerosis as a technique has been used since the 19th century, with modern foam variants developed and refined over the last two decades. It has a substantial clinical track record. The classic Milligan-Morgan operation, by contrast, dates from 1937 and remains essentially unchanged: it stays the gold-standard surgical operation, but today it is reserved for the minority of advanced cases unsuitable for the minimally invasive techniques.
At Palazzo Manzoni, foam endosclerosis is performed by Prof. Edoardo Cervi, general and vascular surgeon. The same specialist who carries out the consultation carries out the procedure. What changes the outcome is not only the technique itself, but the careful grading and the experience of the hand that places the foam.
Day by Day
Same-day return, the first days, and the follow-up
The day of the procedure
The patient returns home within the hour. Normal daily activity, including work, from the same day. Pain, where present, is mild and well controlled. Most patients return to office work the day of the procedure or the day after.
The first days
Mild discomfort, a sense of pressure or fullness, and occasional small spotting are normal. Strenuous physical activity and long flights are best avoided for a few days. The bleeding from the treated cushion typically resolves within days.
The following weeks
The underlying vessel is progressively obliterated. The cushion, visibly retracted during the procedure, continues to settle. Where multiple cushions are involved, additional sessions may be required for full resolution.
Four to six weeks: follow-up
A control visit at four to six weeks confirms the response and identifies any segments that would benefit from a further session. For grade I and selected grade II disease, one session is often all that is needed.
Honest Expectations
What foam endosclerosis
doesn’t do
Foam endosclerosis is a well-established and clean technique. Honesty about its limits matters more than marketing.
One session is often sufficient for grade I and selected grade II disease. More advanced pictures benefit from two or three sessions, typically four to six weeks apart. Mild discomfort, a sense of pressure or fullness, and occasional small spotting are normal in the first days after the procedure. The procedure does not address external hemorrhoidal components, which are managed separately where present.
Recurrence is possible, particularly if the lifestyle factors that contributed to the disease (low fibre, prolonged sitting, chronic straining) are unchanged. A small minority of patients with advanced disease will still benefit from a formal surgical operation. When this is the right answer, it is said clearly at the consultation.
Who Performs the Procedure
Prof. Edoardo Cervi
General and vascular surgeon, phlebology subspecialisation. Proctological consultation, foam endosclerosis, radiofrequency, elastic ligation.
General and vascular surgeon
with phlebology subspecialisation; hemorrhoidal disease treated as the venous problem it is
Foam endosclerosis
the ambulatory injection that retracts the cushion during the procedure itself
Radiofrequency
the complementary ambulatory technique for selected grades
Elastic ligation
combined with foam endosclerosis in the same session for specific grade II to III pictures
One specialist, start to finish
the same specialist who carries out the consultation carries out the procedure
“Hemorrhoidal disease is, at heart, a venous problem of a particular district. The conversation has changed completely in the last two decades. The classic operation is not gone, but it is no longer the default. For most patients with bleeding or reducible prolapse, the right first answer is a fifteen-minute ambulatory injection of foam, with the retraction visible during the procedure. The fewer years you carry the problem, the easier the conversation becomes.”
Patient Stories
They were where
you are now
Years of working around it, then a single ambulatory session. The starting point is often the same: a bleeding or a prolapse carried in silence for far too long.
In their own words
“Bleeding for fifteen years. I’d avoided dealing with it for fifteen years. One session of foam endosclerosis, no general anaesthesia, walked out within the hour. The bleeding stopped within days.”
“Two other doctors had told me Milligan-Morgan, with the recovery that goes with it. Prof. Cervi explained why endosclerosis with foam was the right first answer for my grade. He was right. The operation didn’t have to happen.”
“I expected an event. It was a fifteen-minute injection, no anaesthesia, and I watched the swelling retract on the screen. I was back at my desk the same afternoon.”
Options
If foam isn’t the whole answer, there is a technique that fits
Foam endosclerosis is the workhorse for grade I to II bleeding-dominant disease. But the grade, the symptom pattern and the anatomy all shape the choice, and another technique sometimes fits better.
The techniques are not in competition. They are complementary tools in the same hand, chosen by indication, and in selected cases combined in a single plan.
→Radiofrequency for hemorrhoids
For selected grade II to III pictures with reducible prolapse — addresses both bleeding and prolapse in a single ambulatory session.
→Elastic ligation
A small elastic band placed at the base of the cushion under anoscopy, combined with foam endosclerosis in the same session for grade II to III pictures.
→Milligan-Morgan hemorrhoidectomy
The classic surgical operation, reserved today for the minority of advanced cases unsuitable for minimally invasive techniques.
Your proctological consultation will clarify which path, or combination, is right.
Common Questions
Common questions
about foam endosclerosis
Is the procedure painful?
The procedure is described by most patients as indolent. No general or spinal anaesthesia is required. Mild discomfort or a sense of pressure during and immediately after the injection is normal and brief.
How long does the procedure take?
The injection itself is 5 to 10 minutes; the total visit, including anoscopy and dressing, is typically 20 to 30 minutes.
Will I need to repeat the treatment?
For grade I and selected grade II disease, one session is often sufficient. For more advanced pictures, two or three sessions, four to six weeks apart, may be planned. The exact number is established at the consultation.
When can I return to my activities?
The same day. Most patients return to work the day of the procedure or the day after. Strenuous physical activity and long flights are best avoided for a few days.
Will the bleeding stop immediately?
Often within days. The cushion is visibly retracted during the procedure; the underlying vessel is closed; the bleeding from the treated cushion resolves over the following days. Where multiple cushions are involved, additional sessions may be required for full resolution.
Will I need a follow-up?
A control visit at four to six weeks confirms the response and identifies any segments that would benefit from a further session.
Can hemorrhoidal disease come back after treatment?
Recurrence is possible, particularly if the contributing lifestyle factors are unchanged. The treatment closes the diseased cushion; lifestyle adjustment reduces the probability that a new cushion develops a similar problem. The two are discussed together at the consultation.
Is rectal bleeding always hemorrhoidal?
No. This is an important caveat. Rectal bleeding can have other causes, some of them serious, and the first specialist visit is the one that excludes them clinically.
What about the classic surgical operation?
The Milligan-Morgan hemorrhoidectomy, described in 1937, remains the gold-standard surgical operation, but it is today reserved for the minority of advanced cases unsuitable for the minimally invasive techniques. The default conversation, for grade I to III disease, is no longer surgical.
How much does the procedure cost?
Cost depends on the technique and the number of sessions. A clear, transparent estimate is provided after the first consultation.
Where is Palazzo Manzoni, and do I need a referral?
Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia. No referral required.
Who performs the procedure?
Foam endosclerosis at Palazzo Manzoni is performed by Prof. Edoardo Cervi.
Take the Next Step
The problem you have been avoiding
has a short, ambulatory answer.
At Palazzo Manzoni in Brescia, your proctological consultation is thorough, honest, and conducted with the privacy and dignity the conversation deserves.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Be examined and graded by Prof. Cervi
A 20 to 30 minute visit, in privacy.
03
Move forward, with a plan
A plan that for most patients is no longer surgical.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.