Advertisement

Drugs

, Volume 65, Issue 11, pp 1481–1491 | Cite as

Drug Treatment of Haemorrhoids

  • Mahesh C. Misra
  • Imlitemsu
Therapy in Practice

Abstract

Drug treatment for various anorectal conditions has been known since ancient times. Today, modern as well as traditional drugs are being increasingly used in all grades of symptomatic haemorrhoids. These drugs (oral and local) are used as a part of conservative management or as an adjuvant to invasive outpatient procedures. Flavonoids, in the new formulation of micronised purified flavonoid fraction (MPFF) or as part of the ancient traditional medicine derivative of the Ginkgo tree, are used for relief of acute symptoms (for control of bleeding and re-bleeding in all grades of haemorrhoids). MPFF has been recommended for control of acute bleeding in patients waiting for a definitive outpatient treatment. Similarly, better known drugs such as calcium dobisilate (used in diabetic retinopathy and chronic venous insufficiency), nitrates and nifedipine have also been effective and well tolerated in the medical treatment of haemorrhoids. However, drug treatment is not aimed at curing haemorrhoids. The prime objective of drug therapy is to control the acute phase (bleeding) so that definitive therapy (banding, injection sclerotherapy, infrared photocoagulation, cryotherapy or surgery) can be scheduled at a convenient time.

Keywords

Isosorbide Dinitrate Horse Chestnut Chronic Venous Insufficiency Calcium Dobesilate Diosmin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The authors would like to acknowledge Ms Kavita Soni for secretarial assistance. No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Beattie GC, Wilson RG, Loudon MA. The contemporary management of haemorrhoids. Colorectal Dis 2002; 4(6): 450–4PubMedCrossRefGoogle Scholar
  2. 2.
    Nivatvongs S. Haemorrhoids. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum, and anus. 2nd ed. St Louis (MO): Quality Medical Publishing Inc., 1999: 193–215Google Scholar
  3. 3.
    Neiger A. Haemorrhoids in everyday practice. Proctology 1979: 2: 22Google Scholar
  4. 4.
    Reis Neto JA, Quilici FA, Cordeiro F, et al. Ambulatory treatment of haemorrhoids: a prospective randomized trial. Coloproctology 1992; 6: 342–7Google Scholar
  5. 5.
    Sardinha TC, Corman ML. Haemorrhoids. Surg Clin North Am. 2002 Dec; 82(6): 1153–67, viPubMedCrossRefGoogle Scholar
  6. 6.
    Cospite M. Double blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500mg in the treatment of acute haemorrhoids. Angiology 1994; 45 (6 Pt 2): 566–73PubMedGoogle Scholar
  7. 7.
    Misra MC, Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg 2000; 87(7): 868–72PubMedCrossRefGoogle Scholar
  8. 8.
    Godeberge P. Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Angiology 1994; 45 (6 Suppl.): 574–8PubMedGoogle Scholar
  9. 9.
    Thanapongsathorn W, Vajrabukka T. Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 1992; 35(11): 1085–8PubMedCrossRefGoogle Scholar
  10. 10.
    Ho YH, Tan M, Seow-Choen F. Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum 2000; 43(1): 66–9PubMedCrossRefGoogle Scholar
  11. 11.
    Ho YH, Foo CL, Seow-Choen F, et al. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. Br J Surg 1995; 82(8): 1034–5PubMedCrossRefGoogle Scholar
  12. 12.
    Buckshee K, Takkar D, Aggarwal N. Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997; 57(2): 145–51PubMedCrossRefGoogle Scholar
  13. 13.
    Meyer OC. Safety and security of Daflon 500mg in venous insufficiency and in hemorrhoidal disease. Angiology 1994; 45 (6 Pt 2): 579–84PubMedGoogle Scholar
  14. 14.
    Diana G, Catanzaro M, Ferrara A, et al. Activity of purified diosmin in the treatment of hemorrhoids [in Italian]. Clin Ter 2000; 151(5): 341–4PubMedGoogle Scholar
  15. 15.
    Basile M, Gidaro S, Pacella M, et al. Parenteral troxerutin and carbazochrome combination in the treatment of post-hemor-rhoidectomy status: a randomized, double blind, placebo-controlled, phase IV study. Curr Med Res Opin 2001; 17(4): 256–61PubMedGoogle Scholar
  16. 16.
    Annoni F, Boccasanta P, Chiurazzi D, et al. Treatment of acute symptoms of hemorrhoid disease with high-dose oral O-(beta-hydroxyethyl)-rutosides. Minerva Med 1986; 29(37): 1663–8Google Scholar
  17. 17.
    Wijayanegara H, Mose JC, Achmad L, et al. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 1992; 20(1): 54–60PubMedGoogle Scholar
  18. 18.
    Benzi G, Vanzulli A, Pozzi E, et al. Clinical study for the evaluation of the tolerability of O-(beta-hydroxy-ethyl)-rutoside in the treatment of hemorrhoids during the 3rd trimester of pregnancy and in the postpartum period. Minerva Ginecol 1992; 44(11): 591–7PubMedGoogle Scholar
  19. 19.
    Titapant V, Indrasukhsri B, Lekprasert V, et al. Trihydroxy-ethylrutosides in the treatment of hemorrhoids of pregnancy: a double-blind placebo-controlled trial. J Med Assoc Thai 2001; 84(10): 1395–400PubMedGoogle Scholar
  20. 20.
    Mentes BB, Gorgul A, Tatlicioglu E, et al. Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease. Dis Colon Rectum 2001; 44(10): 1489–95PubMedCrossRefGoogle Scholar
  21. 21.
    De Cecco L. Effects of administration of 50mg heparan sulfate tablets to patients with varicose dilatation of the hemorrhoid plexus (hemorrhoids). Minerva Ginecol 1992; 44(11): 599–604PubMedGoogle Scholar
  22. 22.
    Soullard J, Contou JF. A study on the use of ginkor in proctology (author’s transi) [in French]. Sem Hop 1978; 54(37-40): 1177–9PubMedGoogle Scholar
  23. 23.
    Hep A, Robek O, Skricka T. Treatment of hemorrhoids from the viewpoint of the gastroenterologist: personal experience with the Ginkor Fort preparation. Vnitr Lek 2000; 46(5): 282–5PubMedGoogle Scholar
  24. 24.
    Reddy SS, Nagabushanam M, Ramanuja Rao M, et al. Role of Pilex tablets and ointment in the treatment of piles and fissures. Probe 1984; XXIII(4): 213Google Scholar
  25. 25.
    Tripathy A. Comparative evaluation of Pilex with Daflon in hemorrhoids. Antiseptic 2000; 97(9): 317Google Scholar
  26. 26.
    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): 71–100PubMedCrossRefGoogle Scholar
  27. 27.
    Tajana A, Boccasanta P, Micheletto G, et al. Results of the use of topical diosmin (venosmine) in the treatment of acute hemorrhoid pathology. Minerva Med 1988; 79(5): 387–90PubMedGoogle Scholar
  28. 28.
    Wadworth AN, Faulds D. Hydroxyethylrutosides: a review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs 1992; 44(6): 1013–32PubMedCrossRefGoogle Scholar
  29. 29.
    Ibanez L, Ballarin E, Vidal X, et al. Agranulocytosis associated with calcium dobesilate clinical course and risk estimation with the case-control and the case-population approaches. Eur J Clin Pharmacol 2000; 56(9–10): 763–7PubMedGoogle Scholar
  30. 30.
    Marsicano LJ, Perez M, Urquiola G. Effectiveness and innocuousness of the association of calcium dobesilate, dexamethasone acetate and lidocaine versus prednisolone capronate with dibucaine clorohydrate in the treatment of hemorrhoids [in Spanish]. GEN 1995; 49(4): 296–302Google Scholar
  31. 31.
    Gorfine SR. Treatment of benign anal disease with topical nitroglycerin. Dis Colon Rectum 1995; 38(5): 453–6PubMedCrossRefGoogle Scholar
  32. 32.
    Hwang Do Y, Yoon SG, Kim HS, et al. Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemor-rhoidectomy: results of a randomized, prospective, double blind, and placebo-controlled trial. Dis Colon Rectum 2003; 46(7): 950–4PubMedCrossRefGoogle Scholar
  33. 33.
    Wasvary HJ, Hain J, Mosed-Vogel M, et al. Randomized, prospective, double blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44(8): 1069–73PubMedCrossRefGoogle Scholar
  34. 34.
    Cavcic J, Turcic J, Martinac P, et al. Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis. Dig Liver Dis 2001; 33(4): 335–40PubMedCrossRefGoogle Scholar
  35. 35.
    Coskun A, Duzgun SA, Uzunkoy A, et al. Nitroderm TTS band application for pain after hemorrhoidectomy. Dis Colon Rectum 2001; 44(5): 680–5PubMedCrossRefGoogle Scholar
  36. 36.
    Briel JW, Zimmerman DD, Schouten WR. Treatment of acute strangulated internal hemorrhoids by topical application of isosorbide dinitrate ointment. Int J Colorectal Dis 2000; 15(4): 253–4PubMedCrossRefGoogle Scholar
  37. 37.
    Van den Berg M, Stroeken HJ, Hoofwijk AG. Favorable results of conservative treatment with isosorbide dinitrate in 25 patients with fourth-degree hemorrhoids: a pilot study. Ned Tijdschr Geneeskd 2003; 147(20): 971–3PubMedGoogle Scholar
  38. 38.
    Perrotti P, Antropoli C, Molino D, et al. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum 2001; 44(3): 405–9PubMedCrossRefGoogle Scholar
  39. 39.
    Smith RB, Moodie J. Comparative efficacy and tolerability of two ointment and suppository preparations (‘Uniroid’ and ‘Proctosedyl’) in the treatment of second degree haemorrhoids in general practice. Curr Med Res Opin 1988; 11(1): 34–40PubMedCrossRefGoogle Scholar
  40. 40.
    Damianov L, Katsarova M. Our experience in using the preparation Proctosedyl from the Roussel firm in pregnant women with hemorrhoids [in Bulgarian]. Akush Ginekol (Sofiia) 1993; 32(3): 71Google Scholar
  41. 41.
    Espinosa DJ. Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies. Acta Gastroenterol Latinoam 2000; 30(3): 177–86PubMedGoogle Scholar
  42. 42.
    Dressier H, Ehmann G. Local therapy of grade 1 and 2 hemorrhoids: effectiveness of a combination preparation with standardized blood leech extract. Fortschr Med 1992; 110(16): 307–10Google Scholar
  43. 43.
    Loder PB, Kamm MA, Nicholls RJ, et al. ‘Reversible chemical sphincterotomy’ by local application of glyceryl trinitrate. Br J Surg 1994; 81(9): 1386–9PubMedCrossRefGoogle Scholar
  44. 44.
    Cundall JD, Gunn J, Easterbrook JR, et al. The dose response of the internal anal sphincter to topical application of glyceryl trinitrate ointment. Colorectal Dis 2001; 3(4): 259–62PubMedCrossRefGoogle Scholar
  45. 45.
    Nini G, Di Cicco CO. Controlled clinical evaluation of a new anti-hemorrhoid drug, using a completely randomized experimental plan. Clin Ther 1978; 86: 545–59Google Scholar
  46. 46.
    Guillaume M, Padioleau F. Venotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittelforschung 1994; 44: 25–35PubMedGoogle Scholar
  47. 47.
    Schlemm DJ, Crowe MJ, McNeill RB, et al. Medicinal yeast extracts. Cell Stress Chaperones 1999; 4(3): 171–6PubMedCrossRefGoogle Scholar
  48. 48.
    Paranjpe P, Patki P, Joshi N. Efficacy of an indigenous formulation in patients with bleeding piles: a preliminary clinical study. Fitoterapia 2000; 71(1): 41–5PubMedCrossRefGoogle Scholar
  49. 49.
    Vastrad CS, Pakkanavar RV. Clinical evaluation of PIL-28, an herbal formulation in the management of haemorrhoids. Antiseptic 2002; 99(9): 343–4Google Scholar
  50. 50.
    Nadakarni KM. Indian materia medica. Vol. I. Mumbai: Popular Prakashan Private Ltd, 1996: 167Google Scholar
  51. 51.
    Kirtikar KR, Basu BD. Indian medicinal plants. Vol. III. Derhadun: International Book Distributors, 1981: 2220Google Scholar
  52. 52.
    Nadakarni KM. Indian materia medica. Vol. I. Mumbai: Popular Prakashan Private Ltd, 1996: 480Google Scholar
  53. 53.
    Kirtikar KR, Basu BD. Indian medicinal plants. Vol. II. Derhadun: International Book Distributors, 1987: 915Google Scholar
  54. 54.
    Nadakarni KM. Indian materia medica. Vol. I. Bombay: Popular Prakashan Private Ltd, 1976: 799Google Scholar
  55. 55.
    Nadakarni KM. Indian materia medica. Vol. II. Bombay: Popular Prakashan Private Ltd, 1996: 23Google Scholar
  56. 56.
    Warrier PK, Nambiar VPK, Ramankutty C. Indian medicinal plants. Vol. 5. Madras: Orient Longman Ltd, 1997: 263Google Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Department of SurgeryAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations