09 April 2010

Getting to the Bottom of Hemorrhoids

When a patient has hemorrhoids (most prevalent in males over 50) then it is always important to evaluate hydration and dietary fiber intake because constipation contributes to risk (1). Sufficient regular water intake and fiber helps to encourage regular bowel movement and alleviate symptoms of constipation.

One can't get to the bottom (excuse the pun) of hemorrhoids, however, without also evaluating the patient's level of activity. A sedentary lifestyle is a major risk factor (spicy foods and alcohol intake are also risk factors) (2). Sitting too long in an office chair, an automobile, in front of the TV, or on a toilet increases pressure on veins in the anus. Exercise promotes circulation and alleviates pressure on the veins, which helps to shrink hemorrhoids and prevent them in the future.

I am also a fan of flavonoids (in particular, micronized purified flavonoids, or Daflon at 500mg) for use with hemorrhoid therapy. There has been at least a few double-blind, placebo-controlled trial that showed flavonoids relieved symptoms associated with hemorrhoids and reduced frequency and severity of hemorrhoid flare-ups (1-4). The evidence behind use of flavonoids, I realize, is limited because of methodological errors and possible bias (5), but in my experience (which I will not explain) they work well.


1. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. 2005 Dec;29(12):1270-4. Available at http://www.em-consulte.com/article/100126.
2. Jiang ZM, Cao JD. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin. 2006 Jun;22(6):1141-7.
3. Danielsson G, Jungbeck C, Peterson K, Norgren L. A randomised controlled trial of micronised purified flavonoid fraction vs placebo in patients with chronic venous disease. Eur J Vasc Endovasc Surg. 2002 Jan;23(1):73-6.
4. Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 2003;63(1):71-100.
5. Struckmann JR. Clinical efficacy of micronized purified flavonoid fraction: an overview. J Vasc Res. 1999;36 Suppl 1:37-41.
6. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, Guyatt G. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006 Aug;93(8):909-20.

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