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Hemorrhoids and varicose veins: A review of treatment options
Abstract
Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.
... Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). ...
... Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). They can potentially use in treatment of hemorrhoids due to properties anti inflammatory, antioxidant and anti Several people are using plants in various forms, as orally or topically but only few plants are studied in scientifically (Abascal and Yarnell, 2005). ...
... Despite this decrease, plasma anal malondialdehyde and myeloperoxidase levels increased in this group. In contrast plasma catalase, glutathione peroxidase and superoxide dismutase activity and recto-anal glutathione, catalase, glutathione peroxidase and superoxide dismutase activity were anal malondialdehyde and myeloperoxidase Polygonum cognatum Meissn extract can play an anal tissue damage and oxidative stress that can be concerned with modulating of antioxidant molecule activities in rat of hemorrhoid which can be used safely for the treatment of ion of patients who do not want to undergo surgery and do not want Polygonum cognatum Meissn extract can play an anal tissue damage and oxidative stress which may be related to modulating the is an open access article distributed under the Creative Commons Attribution License, which permits Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts have been shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). ...
... Hapşırma, öksürme gibi güç sarfedilen durumlarda, bu vasküler yastıklar büyüyerek anüsün tamamen kapanmasını sağlar ve dışkı sızıntısını önleyerek fekal kontinansa yardımcı olurlar (1)(2)(3) . Lokal venöz basınç artışı, damar duvarlarında incelme, elastik dokuda azalma, intra abdominal ve intrarektal basınç artışı, genetik, kronik konstipasyon ve dışkılamada tekrarlayan zorlanmalar hemoroidal hastalık oluşumundaki multifaktöryel nedenlerdir (2,4,5) . ...
... Eksternal hemoroidler dentat hattın altında bulunur, yassı epitelle örtülüdür, tromboze olabilirler, ağrı ve kaşıntıya neden olurlar. Mikst tip ise her iki yönede uzanır (4)(5)(6)(7)(8)(9) . İnternal hemoroidler 4 evreye ayrılır. ...
... Konservatif tedavi başarısız olduğunda, lastik band ligasyonu, enjeksiyon tedavisi, skleroterapi, gibi cerrahi olmayan, minimal invaziv yöntemlerden biri veya birkaçı seçilebilir. Medikal tedaviye cevap vermeyen, büyük 3. ve 4. derece hemoroidlerde ise cerrahi tedavi olarak hemoroidektomi uygulanır (1,4,12) . ...
... The use of botanical remedies for the traditional treatment of hemorrhoids has been previously documented [13][14][15]. Available data indicate that products obtained from A. hippocastanum L. seeds (horse chestnut) and V. vinifera L. leaves (grapevine) have clinically relevant beneficial effects on the main symptoms of hemorrhoid disease [20,22]. Thus, the ...
... The use of botanical remedies for the traditional treatment of hemorrhoids has been previously documented [13][14][15]. Available data indicate that products obtained from A. hippocastanum L. seeds (horse chestnut) and V. vinifera L. leaves (grapevine) have clinically relevant beneficial effects on the main symptoms of hemorrhoid disease [20,22]. Thus, the aim of this study was to investigate the effects of several extracts obtained from horse chestnut seeds and grapevine leaves in pain and inflammation animal models, in order to establish the best extraction method for further preparation of a topical formulation with potential use as a hemorrhoids symptomatic treatment. ...
... This finding suggests that the glycerolic extract might be rich in active constituents able to interfere with the proinflammatory mechanism of carrageenan, which produces an increase in TNF-α, IL-1, nitric oxide, and PGE-2 levels [45]. Moreover, previous published studies highlighted that horse chestnut ethanolic extracts inhibit elastase and hyaluronidase, thus diminishing capillary permeability and edema [20]. However, our experimental results showed that the ethanolic extract had no significant anti-inflammatory activity, probably because of the low concentration of ethanol used for extraction. ...
The aim of this work was to assess the analgesic effect of three Vitis vinifera L. leaf extracts and the anti-inflammatory effect of three gels obtained from Aesculus hippocastanum L. seed extracts using animal models, as a preliminary study for the future development of topical preparations based on the combination of extracts with synergistic therapeutic effects on hemorrhoid disease. The analgesic effect was determined by means of the writhing test in mice. The anti-inflammatory effect was determined after administration of carrageenan or kaolin in the rat paw. Extraction using glycerol yielded the highest amounts of flavonoids for both V. vinifera leaves (37.27 ± 1.174 mg/L) and A. hippocastanum seeds (53.48 ± 0.212 mg/L). The highest total phenolic contents were registered for the V. vinifera 20% ethanolic extract (615.3 ± 34.44 mg/L) and for the A. hippocastanum glycerolic extract (247.8 ± 6.991 mg/L). The writhing test revealed that the V. vinifera ethanolic extract induced the most efficient analgesia (57.20%, p < 0.01), better than that induced by the positive control. In the carrageenan inflammation model, only the gel obtained from the A. hippocastanum glycerolic extract significantly reduced paw edema (17.27%, p < 0.05). An anti-inflammatory effect was also observed in the kaolin inflammation model but was not statistically significant (10.12%, p > 0.05). Our findings indicate that V. vinifera and A. hippocastanum extracts may have potential uses for the treatment of pain and inflammation associated with hemorrhoid disease.
... Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). ...
... Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). They can potentially use in treatment of hemorrhoids due to properties anti inflammatory, antioxidant and anti Several people are using plants in various forms, as orally or topically but only few plants are studied in scientifically (Abascal and Yarnell, 2005). ...
... Despite this decrease, plasma anal malondialdehyde and myeloperoxidase levels increased in this group. In contrast plasma catalase, glutathione peroxidase and superoxide dismutase activity and recto-anal glutathione, catalase, glutathione peroxidase and superoxide dismutase activity were anal malondialdehyde and myeloperoxidase Polygonum cognatum Meissn extract can play an anal tissue damage and oxidative stress that can be concerned with modulating of antioxidant molecule activities in rat of hemorrhoid which can be used safely for the treatment of ion of patients who do not want to undergo surgery and do not want Polygonum cognatum Meissn extract can play an anal tissue damage and oxidative stress which may be related to modulating the is an open access article distributed under the Creative Commons Attribution License, which permits Nutritional therapy and plant treatments are effective and safe therapy for hemorrhoids (MacKay, 2001), although studies have been poorly for botanical treatments of hemorrhoids (Abascal and Yarnell, 2005). Several plant extracts have been shown to improve vascular tone, capillary flow, strengthen and microcirculation connective tissue of the perivascular amorphous substrate (MacKay, 2001). ...
Prior study for hemorrhoids
... Several lifestyle changes can help alleviate symptoms and reduce the risk of developing hemorrhoids [26]. First-line conservative treatment of hemorrhoids consists of a high-fiber diet (30 to 45 g per day), fiber supplementation, increased water intake, warm water (sitz) baths, and stool softeners [26,27]. ...
... Several lifestyle changes can help alleviate symptoms and reduce the risk of developing hemorrhoids [26]. First-line conservative treatment of hemorrhoids consists of a high-fiber diet (30 to 45 g per day), fiber supplementation, increased water intake, warm water (sitz) baths, and stool softeners [26,27]. Fiber supplementation decreases the bleeding of hemorrhoids by 50-60% and improves overall symptoms. ...
... 1. Đối tượng nghiên cứu. Gồm 96 BN được chẩn đoán xác định suy TM mạn tính chi dưới dựa vào lâm sàng và kết quả siêu âm -Doppler tĩnh mạch chi dưới: Được xác định là STMCDMT khi dòng trào ngược > 500ms ở TM hiển, TM sâu cẳng chân hoặc > 1000ms ở TM đùi và khoeo [5]. ...
... Theo nghiên cứu của các nước phương Tây, STMMT là bệnh rất phổ biến, tỷ lệ mắc bệnh ở phụ nữ ước tính khoảng 25-33%, và 10-20% ở nam giới trong dân số nói chung [3]. Nhiều nghiên cứu trên thế giới đã ghi nhận mang thai là một trong những yếu tố quan trọng gây STM hoặc làm nặng nề thêm tình trạng của STM đã có trước đây [5], [7]. Trong thời gian mang thai khối lượng máu tăng lên khiến tăng áp lực tĩnh mạch chi dưới. ...
Mục tiêu: Mô tả đặc điểm lâm sàng và tỷ lệ một số yếu tố nguy cơ ở bệnh nhân suy tĩnh mạch chi dưới mạn tính đến khám và điều trị tại bệnh viện Đại học Y Thái Bình. Phương pháp: Nghiên cứu mô tả, cắt ngang với 96 bệnh nhân – cỡ mẫu tính theo công thức nghiên cứu mô tả. Kết quả: Trong tổng số 96 bệnh nhân, nữ chiếm 67,8, cao gấp 2,1 lần nam; độ tuổi trung bình 64,0 ± 15,7 (từ 32 đến 86 tuổi), không có sự khác biệt giữa nam và nữ. Có 86,5% số BN bị suy tĩnh mạch cả hai chân. Có 42,7% số BN ở giai đoạn C2, chỉ 3,1% số BN ở giai đoạn C6. 88,5 số trường hợp bị suy tĩnh mạch nông, 80,2% suy tĩnh mạch sâu và 65,6% suy tĩnh mạch xiên. Tất cả (100%) số BN có triệu chứng tức bắp chân, 84,4% số BN có triệu chứng nặng chân. Chỉ 15,6% số BN có triệu chứng đau chân. Triệu chứng phù chiếm tỷ lệ nhiều nhất với 91,7%, giãn tĩnh mạch lưới chiếm 69,8%. BN thay đổi màu da và loét tĩnh mạch chiếm tỷ lệ thấp nhất, 3,1%. Các yếu tố nguy cơ gây suy TMCD được xác định là tuổi từ 55 trở (80,2%), giới nữ, tình trạng đứng lâu và thường xuyên mang giày cao gót. Kết luận: Suy tĩnh mạch mạn tính chi dưới có biểu hiện lâm sàng tại chỗ, có nhiều yếu tố nguy cơ có thể thay đổi được, do đó có thể phòng ngừa được.
... Hamamelis virginiana L. (Hamamelidaceae) (Figure 8), also known as witch hazel, is a plant growing in the northeastern region of the North American continent. It shows important astringent, anti-inflammatory, and local hemostatic effects, which justify its ancestral tradition for the treatment of skin and mucosal diseases, such as hemorrhoids, PVD, and dermatitis [132][133][134]. The leaves and bark of Hamamelis virginiana L. are used for therapeutic purposes, and their extracts are composed of tannins, gallic acid, flavonoids (e.g., catechins, proanthocyanins), saponins and essential oils. ...
... In addition to antioxidant activity, the extract of Hamamelis virginiana L. also shows an inhibitory effect on collagenase, elastase, and alpha-glucosidase, contributing to the stabilization of the vascular wall and ameliorating the symptoms of venous disease [132,133]. ...
(1) Background: Cardiovascular disease (CVD) is a major public health concern worldwide and a key cause of morbidity and mortality in developed countries. Accumulating evidence shows that several CVD forms are characterized by significant microcirculatory dysfunction, which may both cause and be caused by macrovascular disease, often preceding clinical manifestations by several years. Therefore, interest in exploring food supplements to prevent and restore microcirculation has grown. Given the continuous need to expand the available therapeutic arsenal for CVD, the food supplements market has recently grown and is expected to continue growing. (2) Methods: We provide an authoritative up-to-date comprehensive review of the impact of food supplementation on microcirculation by analyzing the European and American legal food supplements framework and the importance of food safety/food quality in this industry. We review the main literature about food bioactive compounds with a focus on microcirculation and some main food supplements with proven benefits. (3) Results: Despite a lack of scientific evidence, diet and microcirculatory function are clearly connected. The main food supplement examples in the literature with potential beneficial effects on microcirculation are: Ruscus aculeatus, Centella asiatica, Ginkgo biloba, Salvia miltiorrhiza, Crataegus spp., Ginseng, Mangifera indica, Aesculus hipocastanum, Hamamelis virginiana, and Vitis vinifera. (4) Conclusions: Further clinical trials are necessary to better explore the effects of these food supplements, particularly on humans.
... [15] Due to the limited controllability of the equipment and the visual field, there is a risk of iatrogenic injury and complications. [16] With the development of flexible endoscopes, [17] the use of gastroscopes or flexible colonoscopy for the treatment of hemorrhoids provides controllability and high-quality imaging examinations that were not previously possible. [18,19] This article reviews the development and efficacy of various endoscopic treatment techniques for hemorrhoids. ...
... These studies show that ERBL has certain advantages over traditional RBL in terms of efficacy, complication rate and recurrence rate, while the latter did show advantages compared with other conservative treatment with regards to efficacy, long-term successful rate, and less complication, [16,25] but the conclusions regarding the indications for ERBL are still controversial. [38,39] RBL is more effective than sclerotherapy, and patients are unlikely to need follow-up treatment after the treatment. ...
Hemorrhoids are one of the most common diseases of the anorectal region. Previously, treatment for hemorrhoids included conservative treatment, outpatient treatment, and surgical treatment. The development of flexible reversible endoscopes has provided precise controllability and imaging, enabling further improvement and development of various endoscopic techniques to treat hemorrhoids. This article discusses several of these endoscopic techniques: rubber band ligation, sclerotherapy, and electrocoagulation. The development, efficacy, and advantages of these treatments are summarized and evaluated. It is expected that going forward, endoscopic technology will be further applied in clinical practice and may become the first-line method for the treatment of hemorrhoids.
... The warm sitz bath is the hydrotherapy is an effective noninvasive therapy for uncomplicated varicoseveins, but requires a high degree of patientcompliance [34]. ...
... Herbs: [34] • Horse chestnut ...
... Тада су се хемороиди називали "болест Светог Фијакра" (St. Fiacre) [2]. Пре 1800. ...
... Дама му је рекла да стави неколико кестенова у џеп, дошло је побољшања и оздрављење је настало после неколико дана. О овоме начину лечења Монтењ (Montaigne) је казао: "Ова средства су срâм човечанства пошто, ако збиља лече, она потврђују наше незнање, а ако не лече, потврђују наше празноверје" [2]. ...
... Animal studies have shown that the flavonoids reduce the activation of the neutrophils, mediate the inflammation, and decrease the soluble endothelial adhesion molecules (24)(25). Human trials have shown the ability of the flavonoids to improve the venous tone and the vein elasticity assessed by the plethysmography and to decrease the plasma markers of the endothelial activation (25)(26)(27). ...
... Animal studies have shown that the flavonoids reduce the activation of the neutrophils, mediate the inflammation, and decrease the soluble endothelial adhesion molecules (24)(25). Human trials have shown the ability of the flavonoids to improve the venous tone and the vein elasticity assessed by the plethysmography and to decrease the plasma markers of the endothelial activation (25)(26)(27). It has also been proven that the flavonoid fraction improves the lymphatic drainage and reduces the capillary hyperpermeability by protecting the microcirculation from inflammatory processes (28,29). ...
Introduction: Oral usage of flavonoid-based drugs can be successfully applied in the conservative treatment of internal haemorrhoids; however, its efficiency in a form of topical preparations has not been demonstrated yet. The aim of the present study was to determine the efficiency of ointment with propolis extract (containing minimally 115 mg/kg of flavonoid galangin) in relief and suppression of the symptomatic internal haemorrhoids grade 1 and 2 (bleeding, prolapse, pain, and itching).
Methods: This prospective cohort epidemiological study that included 46 participants of both genders, mean age 53.6±14.3 years, was conducted in the general practice setting in Osijek, Croatia and lasted for three months. A specially designed questionnaire was used to collect demographic data and data concerning the haemorrhoid disease symptoms and to evaluate the intensity of the latter data according to the scale defined in the research protocol.
Results: The study showed statistically significant improvements in the intensity of all the symptoms connected with the internal haemorrhoids grade 1 and 2 (p
... The warm sitz bath is the hydrotherapy is an effective noninvasive therapy for uncomplicated varicoseveins, but requires a high degree of patientcompliance [34]. ...
... Herbs: [34] • Horse chestnut • Culture Hindu. ...
... As infusões e (9)(10)(11) . O nível externo, a Hamamelis é útil no tratamento de veias varicosas, problemas circulatórios, varizes, pernas cansadas, eczema, couperose, hemorroidas, inflamação ocular, infecções e sangramento das gengivas, desinfecção de feridas, picadas e cortes na pele, e queimaduras solares ligeiras (12) . A utilização interna não é tão comum. ...
... A ingestão de elevadas concentrações de extratos de Hamamelis, em especial da casca, à semelhança do que ocorre com outras plantas ricas em taninos, poderá também não ser segura, provocando distúrbios gastrointestinais, desde náuseas e vômitos, a uma eventual hepatoxicidade, afetando o fígado e os rins. As dosagens recomendadas não devem, por isso, ser excedidas (12) . ...
As bebidas de infusão são utilizadas desde a antiguidade como medicamentos. De fatos muitos dos medicamentos que hoje fazem parte da alopatia tradicional, são provenientes de extratos vegetais. Hoje, é possível comprar em Farmácias, drogarias e, até supermercados, folhas e ervas de forma industrializada ou semi industrializada. O problema é que o produto industrializado nem sempre se apresenta “puro”, além de possibilitar o uso indiscriminado. Alguns fitoterápicos, se usados de forma inadequada podem perder as suas propriedades funcionais ou pior, podem provocar males maiores do que benefícios à saúde do usuário. Neste trabalho faremos uma analise de chá de Hamamelis virginiana L. encontrado em farmácias e drogarias e, verificaremos as condições do produto segundo as normas da ANVISA e farmacopéia brasileira e, também quanto à caracterização farmacobotânica.
... As a result, prior to obtaining informed consent, it should be thoroughly discussed with the patient. [30] Cotton SC et al. (2016) conducted a 798-person study and found that both ultrasound-guided foam sclerotherapy and endovenous laser ablation resulted in faster recovery than surgery [31]. According to Go SJ et al. (2016), who conducted a study on 17 patients who underwent endovascular laser ablation (EVLA), EVLA is an effective and minimally invasive treatment for varicose veins [32]. ...
Varicose veins are tortuous, enlarged veins that are typically found in the lower extremities. They damage blood vessels, causing painful swelling and blood clots, affecting people as they age and affecting a person's proficiency, productivity, and life quality. The main causes of varicose vein disease are prolonged standing and obesity. This review discusses the mechanisms, prevention, risk factors, complications, and treatment of varicose veins. Endovascular, surgical, and herbal treatments all improve quality of life and reduce the secondary complications of varicose veins. Aside from these treatments, varicose vein disease can be avoided by practising regular yoga/exercise and eating a variety of fruits and vegetables such as grapes, blackberries, avocados, ginger, and rosemary. Varicose veins are typically a benign process with several issues that can impact an individual's life quality and potentially lead to life-threatening complications. However, there are a variety of surgical, endovascular, and chemical treatments available to improve quality of life and reduce secondary complications associated with varicose veins. Patients with varicose veins should take an antioxidant medication from the flavonoid group to lower their arterial blood pressure, reduce their risk of developing atherosclerosis, and avoid thrombotic incidents. Important teaching
... Patients with hemorrhoidal disease may experience any of the following symptoms: bleeding, a painful anal mass, swelling, discomfort, discharge, hygiene problems, soiling, and pruritus. [3][4][5][6] Treatment of symptomatic hemorrhoids ranges from dietary advice, lifestyle modification, and pharmacological approaches to office-based procedure and radical surgery depending on their grade and severity. 7 However, treatment of hemorrhoids in modern medicine is still in its infancy. ...
This study evaluated the anti-hemorrhoidal effect of “TRI 01” hard capsule on croton oil-induced hemorrhoids model in rats. Hemorrhoids were induced by applying 6% croton oil preparation in the ano-rectal region. Then, rats were randomly assigned to groups. For the two “TRI 01” groups, “TRI 01” was orally administered at doses of 2.64 and 7.92 g/kg per day for seven days, respectively. Daflon (360 mg/kg per day) was used as reference anti-hemorrhoidal drug. Weighting of ano-rectal tissue, calculation of ano-rectal coefficient, and histology of ano-rectal tissue were conducted two hours after the last administration on the seventh day. The results indicated that treatment using “TRI 01” hard capsule significantly decreased the weight of ano-rectal tissue and the rectoanal coefficient compared to the vehicle-treated hemorrhoid group. Histological observation revealed that TRI 01-treated animals had lesser degree of inflammatory cells, degenerative changes congestion, edema along with lesser degree of necrosis in the mucosal epithelium of ano-rectal tissue as compared to croton-induced hemorrhoid group. Our study demonstrated that “TRI 01” at doses of 2.64 and 7.92 g/kg had anti-hemorrhoidal activity on croton oil-induced hemorrhoids model in rats.
... It was suggested that this pressure would easily be transmitted to the hemorrhoidal plexus as they have no valves. The valves of the lower limb veins would offer initial protection but would eventually become incompetent and expose the veins to elevated pressure [12,13] . The multinational CHORUS study [14] has shown that there is a significant correlation between HD and CVD (P = 0.004). ...
Background: Doctors are at high risk of developing hemorrhoidal disease (HD), but it’s still not clear that how much doctors aware of this problem. OASIS (dOctors AS patIentS) study was conducted to understand the prevalence, awareness, diagnosis and treatment of HD among doctors in big cities of China.
Methods: From August to October in 2020, an online survey was conducted through questionnaire among doctors from grade-A tertiary hospitals in 29 provinces across China.
Results: A total of 1227 questionnaires were collected. The prevalence of HD was 56.8%, with a significant difference between internists and surgeons (P=0.01). 15.6% doctors with HD did not know well about the chronic nature of HD. 91.5% of doctors adopted general treatment, and 83.0% doctors considered that “oral medications are used only after ineffective topical medications”. Among the oral medications, the Micronized Purified Flavonoid Fraction (MPFF) performed best on the scores of the three most valuable aspects, but only 17% doctors had received treatment with MPFF.
Conclusions: Doctors are at higher risk of developing HD, and HD is highly prevalent among Chinese doctors, but the awareness of that is not enough. There is a gap between the HD clinical practice and guideline recommendations even in doctors, such as late initiation of oral drug therapy and inadequate oral drug therapy. Therefore, awareness and standardized treatment of HD should be strengthened among Chinese doctors, and what’s more, ordinary people.
... It was suggested that this pressure would easily be transmitted to the hemorrhoidal plexus as they have no valves. The valves of the lower limb veins would offer initial protection but would eventually become incompetent and expose the veins to elevated pressure [12,13] . The multinational CHORUS study [14] has shown that there is a signi cant correlation between HD and CVD (P = 0.004). ...
Background Doctors are at high risk of developing hemorrhoidal disease (HD), but it’s still not clear that how much doctors aware of this problem. OASIS (dOctors AS patIentS) study was conducted to understand the prevalence, awareness, diagnosis and treatment of HD among doctors in big cities of China.
Methods From August to October in 2020, an online survey was conducted through questionnaire among doctors from grade-A tertiary hospitals in 29 provinces across China.
Results A total of 1227 questionnaires were collected. The prevalence of HD was 56.8%, with a significant difference between internists and surgeons (P=0.01). 15.6% doctors with HD did not know well about the chronic nature of HD. 91.5% of doctors adopted general treatment, and 83.0% doctors considered that “oral medications are used only after ineffective topical medications”. Among the oral medications, the Micronized Purified Flavonoid Fraction (MPFF) performed best on the scores of the three most valuable aspects, but only 17% doctors had received treatment with MPFF.
Conclusions Doctors are at higher risk of developing HD, and HD is highly prevalent among Chinese doctors, but the awareness of that is not enough. There is a gap between the HD clinical practice and guideline recommendations even in doctors, such as late initiation of oral drug therapy and inadequate oral drug therapy. Therefore, awareness and standardized treatment of HD should be strengthened among Chinese doctors, and what’s more, ordinary people.
... They also reduce the occurrence of rectal prolapse and the number of hemorrhoidal cushions, and fasten wound healing. Different mechanisms of action including anti-inflammatory, anti-nociceptive, venotonic, venoprotective, and stool softening activities are reported by different authors [40,41]. ...
Background
Hemorrhoids have been reported to beset human beings since the earliest history of mankind. Utilization of herbal medicines is ever increasing as the demand for natural remedies is growing. In Ethiopia, many patients commonly use herbal medicines for hemorrhoids management despite lack of organized information at country level. This systematic review was aimed to document reports about utilization of medicinal plants for hemorrhoids management in Ethiopia.
Method
A web-based systematic literature search was carried out through electronic databases like PubMed, Google Scholar, Web of Sciences, Science Direct, and websites of different organizations. All studies with complete ethnobotanical information were included in this review without regard to methodology and publication year.
Results
A total of 23 articles were included in this systematic review. Majority (41.7%) of studies were reported from Oromia region followed by Amhara (33.3%) regional state. A total of 50 medicinal plants have been reported where Fabaceae and Solanaceae represent the most commonly used families. Herbs were the most (38%) commonly used medicinal plants followed by shrubs (34%) and trees (26%). Leaf (44%) and root (24%) were the first and second most commonly used plant parts, respectively. Most of the medicinal remedies (36%) were prepared by pounding the fresh part of the plant. Besides, 56.1% of the herbal preparations were administered through topical route.
Conclusion and recommendations
Numerous medicinal plants from various families have been documented in this review as anti-hemorrhoidal remedies. Further studies could be anticipated in the search for new, effective, and safe plant-based medications from medicinal plants discussed in this review.
... Обнаружено, что биологически активные вещества гамамелиса проявляют противовирусную активность против вирусов гриппа А и папилломы, также установлена их цитотоксическая активность [2,3]. Лекарственные препараты гамамелиса применяются в общей практике при лечении геморроя и варикозного расширения вен [4][5][6]. Гомеопатические лекарственные препараты Таблица 1. Гомеопатические лекарственные препараты на основе гамамелиса виргинского на основе гамамелиса виргинского имеют более широкий диапазон показаний к применению, в том числе нарушение венозного кровообращения 4 , различные травмы, ожоги и воспалительные заболевания, в частности, воспаление яичка, вен семенного канатика 5 и придатка яичка, невралгия яичек, невралгия и воспаление яичников, дисменорея у женщин [7,8]. ...
According to the authors’ analysis of regulatory documents for homoeopathic medicines of Virginian witch hazel (Hamamelis virginiana L.), there is a need to transform quality assessment approaches and to unify analytical procedures for identification and assay tests.
The aim of the study was to determine approaches to identification and assay of homoeopathic mother tinctures of Virginian witch hazel leaves and bark and medicinal products based on the tinctures.
Materials and methods : in order to select quality evaluation procedures, the authors analysed scientific literature, Russian and foreign pharmacopoeias and regulatory documentation regarding homoeopathic medicines of Witch hazel. The authors performed practical evaluation of the selected procedures based on thin-layer chromatography, spectrophotometry, qualitative reactions, and titrimetry, using samples of homoeopathic mother tinctures of Witch hazel leaves and bark, as well as corresponding homoeopathic medicinal products in various dosage forms.
Results : the authors proposed identification and assay procedures for the studied active pharmaceutical ingredients (APIs) and homoeopathic medicinal products and prepared the drafts of pharmacopoeial monographs Hamamelis virginiana e foliis (Hamamelis, Folium) homoeopathic mother tincture and Hamamelis virginiana (Hamamelis) homoeopathic mother tincture. The unified procedures were included in the draft monographs for homoeopathic medicinal products Hamamelis, homoeopathic drops; Hamamelis D1, homoeopathic ointment; Hamamelis, folium D1, homoeopathic ointment; Hamamelis virginiana e foliis D1, rectal homoeopathic suppositories.
Conclusions : the developed procedures are compatible with the principle of holistic, end-to-end standardisation, as they make it possible to carry out identification tests and assays using the same class of biologically active compounds throughout the whole range of homoeopathic medicines from APIs to finished products. The authors proposed the methodology for assessing homoeopathic medicinal products’ quality, taking into account the degree of dilution of the homoeopathic tinctures used.
... Pharmaceutical extracts or distillates are mainly obtained from the bark or the leaves. Due to their anti-inflammatory and astringent properties, these extracts are often used in skin care for the treatment of small wounds, local inflammation [152][153][154] or hemorrhoids [155]. In addition, antimutagenic and antioxidative properties have been described [156][157][158]. ...
As the number of viral infections and in particular resistant viral strains increasing, existing remedies need to be improved and brought into line with the discovery of new antiviral agents to fight persistent viral infections. It is generally believed that the gene pool of medicinal plants is valuable and endowed with precious compounds to treat metabolic and infectious disorders. The purpose of this review is to gather the facts and investigate into the therapeutic potential of medicinal plants, herbs and spices in the administration of various viral diseases. COVID-19 infections are treated with available antiviral therapy with unsatisfactory clinical results. Persistent viral infections that are resistant to the available antivirals are terrifying threats and a serious health problem like influenza infection. SARS CoV 2 remains a major threat to animal and human health, which urgently requires effective antivirals. Due to the increasing frequency of viral infections and particularly resistant viral strains, the available therapeutic facilities must be improved, compensated by the discovery of new antiviral agents to fight against refractory viral infections. The treatment of herbal remedies as readily available alternatives for their compatibility with the body and fewer side effects compared to synthetic chemical treatments has become popular worldwide. Introduction:
... Prior to the 1800s hemorrhoids were treated simply by poultice, bed rest or in case severe cases, by the application of a red hot poker (Mackay, 2001). Surgery is the initial treatment of choice in patients with symptomatic grade IV hemorrhoids or those who have strangulated internal hemorrhoids. ...
Abstract
Medicinal plants are world widely used for health-promoting effects.
Phytochemicals are the significant metabolites of plants to impede other
plants, animals, insects, microbial pests and pathogens. These indispensable
bioactive compounds are available for curative purpose since old times, with
low side effects than modern medicine. The potent phytochemicals have
properties to modulate key cellular enzyme function. Numerous kinds of
phytochemicals are attributed to their anti-inflammatory, anti-mutagenic, anti�cancer and anti-oxidant properties. The main four classes of phytochemicals
are; terpenes, alkaloids, glycosides, and polyphenols. Research on poly
phenols and flavonoids received an added impulse with the discovery of their
antitumor, antioxidant property and lowering the mortality rate in CHD. The
qualitative and quantitative measurement of the phytochemicals from
spectrophotometric analysis to latest technologies are detailed in this chapter
i.e. LCMS, GCMS, HPLC (ESI-HR-Q-TOF) and (UPLC-PDA-ESI-MS/MS).
Biological properties and efficacy of important phytochemicals in the
pharmacology is splendidly narrated. The important bioactives of plants
revealed remarkable cure in anti-cancer therapy, neuropharmacology
(neurodegenerative disorders), anti-microbial growth, inflammatory reactions
and revealed new miles stones of pharmacology and toxicology in
phytomedicine.
Keywords: phytochemicals, antioxidant, anticancer, phenols, flavonoids
... Hemorrhoidal disease and chronic venous disease may have a common cause in the form of loss of vascular integrity, [16] though there are few published papers on the coexistence of these two disorders [17]. An early review of epidemiologic evidence for a link between HD and CVD hypothesized that chronic constipation associated with a low fiber diet was involved in both these diseases by increasing intra-abdominal pressure [17]. ...
... Stwierdzono że preparaty zawierające ekstrakty z oczaru wpływają pozytywnie na naczynia krwionośne i poprawiają ukrwienie tkanek [5,19,27,31,32]. Ze względu na to działanie oraz łagodzenie podrażnień preparaty oczaru znalazły szerokie zastosowanie w leczeniu guzków krwawniczych odbytu [5,25,26,35,36]. ...
... Haemorrhoids are dilated veins occurring in relation to the anus. [1][2][3] It is common in both the sexes. 4 At least 50% of population experience problem of symptomatic haemorrhoids during their life, with around 5% of the population suffering at any given time. ...
Introduction: Haemorrhoids are one of the most common anorectal disorders encountered in the general population. Haemorrhoids are the most common (30-40%) cause of lower G.I. bleeding in India. The present study has been designed to validate the effect of Unani formulation in the management of Bawaseer-e-ghaira (Internal haemorrhoids of Grade-I and II degree) on scientific parameters. The ingredients of Unani formulation are- Bisfaij, Zarnabad, Rasaut, Muqil, Maghztukhm Neem and Gulab.
Materials & Methods: This study was open observational clinical study. Thirty diagnosed Patients of Grade-I and II degree internal haemorrhoids who fulfilled the protocol criteria were selected for the study. Ethical clearance was taken from the IEC. Patients were given 2 Pills (500mg each) twice a day for 45 days after taking written informed consent as per the study protocol. The outcomes were analysed using appropriate statistical test.
Results: There was 100% relief in bleeding with p-value<0.001 and 85.7% relief in prolapse of mass with p-value 0.033 in the subjective parameters.Out of 30, 28 patients exhibited total number of 50 pile masses at baseline which, at endpoint of study, reduced to 6 (p<0.001). Out of 30, 14 patients showed total number of 20 pile masses of grade-II, which at endpoint of study reduced to 6 (p<0.05).
Conclusion: The study concludedthat Unani formulation (Bisfaij, Zarnabad, Rasaut, Muqil, Maghztukhm Neem and Gulab) is aefficacious formulation for internal haemorrhoids in respect of efficacy and safety.
Keywords: Bawaseer-e- ghaira; Internal haemorrhoids; Anal cushion; Unani Medicine.
... Botanical treatments and nutritional therapy are safe and effective therapy for hemorrhoids and also varicose veins (Douglas, 2001), although botanical treatments for hemorrhoids have been poorly researched. The two herbs are popularly used in Oghe traditional phytomedicine, but eventually, there are not sufficient scientific studies fist as most medicinal plants are not taken beyond proof of concept stage. ...
Abstract: Vitex doniana plant root (uchakili) and Phyllanthus amarus leave (enyikwonwa) in Oghe Community traditional medicine is
of value in the management of hemorrhoids (pile) as stool softner that significantly reduce hemorrhoids symptoms and as an antiinflammatory, an astringent, and a diuretic and tissue healer. This article specifically examines the isolation, quantification, thin-layer
and column chromatography analysis of flavonoid, anthraquinone and alkaloid contents using photocolorimeter, thin-layer
chromatographic (TLC) and column chromatographic (CC) analysis. The results revealed that the yield of the total flavonoids extracted
were 0.3% and 0.05% for Vitex doniana root and phyllanthus amarus leave respectively. While the photocolorimetric quantification of
total flavonoid shows that Vitex doniana root gave 0.15mg/100ml and Phyllanthus amarus leave gave 0.25mg/100ml respectively.
Results of the TLC analysis showed that Vitex doniana root and Phyllanthus amarus leaves had 2 spots each (RF values 0.3, 0.43 and
0.51, 0.53) respectively using Ethyl acetate/methanol/formic acid/water (50:2:3:6) solvent system. Two compounds were isolated in
column chromatographic analysis using chloroform/methanol (8:2) eluting solvent. The result of anthraquinone glycoside revealed that
n-butanol (2.13% and 3.36% respectively for Vitex doniana root and Phyllanthus amarus leave) is a better extracting solvent than ethyl
acetate (1:38% and 1.81% respectively for Vitex doniana root and Phyllanthus amarus leave extracts). The TLC analysis of the
Phyllanthus amarus leave extract gave two spots for n-butanol extraction (RF-values = 0.58 and 0.68) and non for ethyl acetate extract.
No glycoside appeared in both n-butanol and ethyl acetate extracts of Vitex doniana. The results also revealed that the alkapoids yield
of the extract were 0.08% and 0.12% for morphine alkaloids and 0.1% and 0.40% for non-morphine alkaloids of Vitex doniana root
and Phyllanthus amarus leave respectively. The results showed that there were four and three spots observed in the TLC chromatogram
developed for morphine alkaloids in Vitex doniana root and Phyllanthus amarus respectively, while four spots each were observed for
the non-morphine alkaloids of the two plant material respectively using various solvent system. The results of the column
chromatography gave two fractions each for morphine and non-morphine alkaloids and two and three fractions for morphine and nonmorphine alkaloids of Vitex doniana root and Phyllanthus amarus leave respectively. Various plant agents are used for the medical
management of hemorrhoids (pile), but few of these have been adequately studied. Nigerian medicinal plants have demonstrated
promising efficacy but the characterization and potentials of these plants are not taken beyond proof of concept stage. It is hoped that
this article would stimulate future studies because of the paucity of knowledge in this area
... Botanical treatments and nutritional therapy are safe and effective therapy for hemorrhoids and also varicose veins (Douglas, 2001), although botanical treatments for hemorrhoids have been poorly researched. The two herbs are popularly used in Oghe traditional phytomedicine, but eventually, there are not sufficient scientific studies fist as most medicinal plants are not taken beyond proof of concept stage. ...
Vitex doniana plant root (uchakili) and Phyllanthus amarus leave (enyikwonwa) in Oghe Community traditional medicine is of value in the management of hemorrhoids (pile) as stool softner that significantly reduce hemorrhoids symptoms and as an anti-inflammatory, an astringent, and a diuretic and tissue healer. This article specifically examines the isolation, quantification, thin-layer and column chromatography analysis of flavonoid, anthraquinone and alkaloid contents using photocolorimeter, thin-layer chromatographic (TLC) and column chromatographic (CC) analysis. The results revealed that the yield of the total flavonoids extracted were 0.3% and 0.05% for Vitex doniana root and phyllanthus amarus leave respectively. While the photocolorimetric quantification of total flavonoid shows that Vitex doniana root gave 0.15mg/100ml and Phyllanthus amarus leave gave 0.25mg/100ml respectively. Results of the TLC analysis showed that Vitex doniana root and Phyllanthus amarus leaves had 2 spots each (RF values 0.3, 0.43 and 0.51, 0.53) respectively using Ethyl acetate/methanol/formic acid/water (50:2:3:6) solvent system. Two compounds were isolated in column chromatographic analysis using chloroform/methanol (8:2) eluting solvent. The result of anthraquinone glycoside revealed that n-butanol (2.13% and 3.36% respectively for Vitex doniana root and Phyllanthus amarus leave) is a better extracting solvent than ethyl acetate (1:38% and 1.81% respectively for Vitex doniana root and Phyllanthus amarus leave extracts). The TLC analysis of the Phyllanthus amarus leave extract gave two spots for n-butanol extraction (RF-values = 0.58 and 0.68) and non for ethyl acetate extract. No glycoside appeared in both n-butanol and ethyl acetate extracts of Vitex doniana. The results also revealed that the alkapoids yield of the extract were 0.08% and 0.12% for morphine alkaloids and 0.1% and 0.40% for non-morphine alkaloids of Vitex doniana root and Phyllanthus amarus leave respectively. The results showed that there were four and three spots observed in the TLC chromatogram developed for morphine alkaloids in Vitex doniana root and Phyllanthus amarus respectively, while four spots each were observed for the non-morphine alkaloids of the two plant material respectively using various solvent system. The results of the column chromatography gave two fractions each for morphine and non-morphine alkaloids and two and three fractions for morphine and non-morphine alkaloids of Vitex doniana root and Phyllanthus amarus leave respectively. Various plant agents are used for the medical management of hemorrhoids (pile), but few of these have been adequately studied. Nigerian medicinal plants have demonstrated promising efficacy but the characterization and potentials of these plants are not taken beyond proof of concept stage. It is hoped that this article would stimulate future studies because of the paucity of knowledge in this area.
... Extract of Ruscus aculeatus has been documented to be effective in increasing venous tone because of its anti-inflammatory and astringent properties. 15 ...
Hemorrhoids are commonly reported in women. However, despite the high prevalence of hemorrhoids in women and the major impact of this condition on quality of life, specific evidence and recommendations on the treatment of hemorrhoids in women are scant. This paper reviews various options in current therapy for hemorrhoids in women-namely, medical intervention (topical and systemic drug therapy)-and discusses the available clinical evidence for an appropriate use of over-the-counter topical formulations for the symptomatic treatment of hemorrhoids. Its focus is on a medical preparation containing tribenoside + lidocaine, available as a rectal cream (tribenoside 5%/lidocaine 2%) and a suppository (tribenoside 400 mg/lidocaine 40 mg) and marketed under the brand Procto-Glyvenol® (Recordati, SpA, Italy). Given its rapid comprehensive efficacy on all the different symptoms of hemorrhoids, the tribenoside + lidocaine combination can find a place in the treatment of this hemorrhoidal disease. Importantly, its efficacy and tolerability have been formally evaluated in several well-conducted studies, some of which were specifically conducted in women. In particular, tribenoside + lidocaine can be safely administered in postpartum women and in pregnant women after the first trimester of pregnancy. In pregnant women, the tribenoside/lidocaine combination significantly improved both subjective and objective symptoms of hemorrhoids. Fast onset of symptom relief was reported from 10 minutes after administration, lasting up to 10-12 hours. On these bases, tribenoside + lidocaine can represent a fast, effective, and safe option to treat hemorrhoids when conservative therapy is indicated, and it deserves consideration as a first-line treatment of this disease in clinical practice.
... Interference with venous return in the internal hemorrhoidal plexuses and saphenous veins may be a common anatomical mechanism. 7 Given the paucity of information on the profiles of patients with HD, the aim of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was to provide current, global data on patients presenting with HD in clinical practice and to explore the frequency of its coexistence with CVD and their shared risk factors. ...
Background and aim:
The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice, and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors.
Methods:
This international, non-interventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD.
Results:
A total of 5617 patients were analyzed. Symptoms commonly reported were: bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%) and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were: older age, higher CVD CEAP class, constipation and male gender (all P<0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P<0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%) and surgery (23.5%).
Conclusions:
CHORUS provides a snap shot of current profiles, risk factors and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present.
... The use of oral flavonoids offers an effective approach for the treatment of hemorrhoids. Early intervention with conservative therapies may prevent timeconsuming and expensive complications of hemorrhoids [16,17]. ...
Aims: To evaluate and compare the efficacy of Hilo® and Daflon® 500 mg, in the treatment of hemorrhoids. Study Design: It is a multicentric, randomized, comparative clinical trial conducted for the period of 15 days. Place and Duration of Study: Janta Hospital and Maternity Centre, Varanasi; King George Memorial Hospital, Lucknow; Vijan Hospital and Research Centre, Nasik and Santosh Hospital, Bangalore between May 2018 and December 2019. Methodology: 201 patients were screened and 200 patients with hemorrhoids (proctoscopy proven Grade I to III) were randomly assigned to receive either Hilo® capsules (n = 99) or Daflon® 500 mg tablets (n = 101). Assessment of hemorrhoidal symptoms was carried out in all patients on Day 7 and Day 15. Proctoscopic examination was carried out before the start of treatment i.e. on day 0 and at the end of treatment duration i.e. on day 15. Results: The patients treated with Hilo® showed a statistically significant improvement in the clinical symptoms of bleeding, pain, itching, soiling, tenesmus, irritation after defecation and constipation on day 7 and day 15 as compared to baseline. The “mean total symptom score” reduced by 4.55 ± 2.07 vs 3.44 ± 2.00; P < .0001 on day 7 and 7.56 ± 2.40 vs 6.22 ± 2.55; P < .0001 on day 15 in the patients treated with Hilo® and Daflon® respectively. In Hilo® Group, 82.83% of patients assessed that the treatment with Hilo® made them ‘A lot better’ as compared to only 48.51% in Daflon® group. In the Hilo® group 20.2% of patients’ treatment outcome was assessed as ‘Excellent’ by the investigators as compared to only 0.99% of patients in Daflon® group. No major adverse events were reported in the study with the use of either product. Conclusion: Hilo® is found to provide better reduction in clinical symptoms of patients suffering from hemorrhoids as compared to Daflon®.
... Otherwise, topical preparations for relieving symptoms or different non-surgical modalities are prescribed. In case a non-surgical approach fails, the patient is usually referred to a surgeon [35]. In order to improve the effectiveness of conservative therapy and to avoid the need for uncomfortable non-surgical treatments or surgery, oral dietary supplementation in the treatment of hemorrhoids is becoming increasingly popular. ...
Background: Oral dietary supplementation is becoming increasingly popular as an addition to classical approaches for the prevention and treatment of hemorrhoidal disease. Aim: To examine the effect of orally administrated alpha lipoic acid (ALA), known for its antioxidant and anti-inflammatory properties, in the treatment of patients with permanent symptoms of hemorrhoidal disease. Methods: Patients with second- and third-degree hemorrhoids (n = 100) were enrolled into a randomized, open label, single-center trial. The study group (n = 50) was treated with 200 mg of orally administered ALA once a day during the 12-week period, the control group (n = 50) did not receive any treatment. Results: There were no significant differences in demographics, diagnosis, or exposure to major risk factors between the study and placebo group at baseline. ALA significantly improved subjective efficacy variables, such as pain and discomfort (p < 0.01) as well as objective signs of the disease, such as bleeding (p < 0.01), in comparison to the control group. Furthermore, the 3-month treatment significantly reduced the number of patients with positive C-reactive protein (CRP) value (serum CRP > 5 mg/L) from 18% before to only 2% after the treatment (χ2 = 4.65; p < 0.01). Average leukocyte count has also been significantly reduced in the treatment group (p < 0.01) from 7.29 × 109/L before to 6.18 × 109/L after treatment. Conclusions: The obtained results indicate that ALA is effective in the treatment of second- and third-degree hemorrhoids. Larger, double-blind controlled trials are needed to confirm the results and to investigate optimal treatment regimens.
... The active biochemical constituent is proposed to be the saponin glycoside ruscogenin.Herbalists of various cultures have historically used Ruscus aculeatus for the treatment of varicose veins and hemorrhoids. There is an increasing body of scientific literature to support these traditional folk medicine uses [9]. ...
... Yüzyıllardır bilinen ve çaresi aranan bir hastalık olarak, hayatın herhangi bir döneminde toplumun %30'undan fazlasını etkileyebilmekte ve her iki cinsiyette de görülebilmektedir. 1 Hemoroid oluşumuna yönelik ana teoriler arasında superior ve orta hemoroidal venlerin dallarından oluşan örgü yapısındaki pleksusun anormal dilatasyonu, anal yastıkçıklarla aynı lokalizasyondaki arteriovenöz anastomozların aşırı distansiyonu, anal yastıkçıkların aşağı doğru yer değiştirerek prolapsusu ve çevre bağ dokunun zamanla harabiyeti sayılabilir. Etiyolojide genetik faktörler ve anatomik yapı, beslenme alışkanlıkları, konstipasyon ve karıniçi basıncı artıran faktörler (aşırı ıkınma, multipl gebelik, kronik öksürük) suçlanmaktadır. ...
... It has been used for many years and its use remains controversial. Several studies show great results for low grade uncomplicated hemorrhoids (MacLeod 1982;MacKay 2001;Guindic and Frank 2014). There are different devices made by different companies, all anatomically designed for the direct application of cold on both external and internal hemorrhoids components. ...
... In grade 3 and 4 Haemorrhoids, haemorrhoidectomy is the authoritative treatment [7,8] . But, conventional approaches and some surgical procedures used in modern practice in grade 1 and grade 2 Haemorrhoids are associated with potential complications [6]. ...
Piles or Bawaseer (Haemorrhoids) is the most prevalent anorectal disorder and the most common cause of bleeding with stool. Patients with first degree (1 0) or second degree (2 0) Haemorrhoids may experience acute attacks of discomfort, pain and/or bleeding. The conventional approaches and some surgical procedures used in modern practice in grade 1 and grade 2 Haemorrhoids are associated with potential complications. To assess the efficacy of Hamdoroid capsule in combination with Hamdoroid ointment on symptomatic first and second degree internal Haemorrhoids, a double blind placebo controlled clinical trial was carried out. Hamdoroid combination therapy provided marked improvement in mild to severe grades of symptoms in these patients. The improvement produced by the drug was significantly superior to that of placebo. The drugs were well accepted by the participants in this study and no noticeable side effects were detected.
... It has been used for many years and its use remains controversial. Several studies show great results for low grade uncomplicated hemorrhoids (MacLeod 1982;MacKay 2001;Guindic and Frank 2014). There are different devices made by different companies, all anatomically designed for the direct application of cold on both external and internal hemorrhoids components. ...
Hemorrhoids are a common condition affecting the anorectum. The clinician must accurately diagnose the condition and exclude more sinister causes responsible for the same symptoms. A focused history and thorough examination help in establishing a differential diagnosis. The treatment modality is guided by the degree of the hemorrhoids. Conservative measures should be employed, including dietary advice and toileting techniques, to treat acute inflammation and as a long-term method of reducing symptom recurrence and worsening disease. A wide range of out-patient therapies are available and all have been shown to be effective in experienced hands and when used in the correct clinical context. Here we present an approach to out-patient treatment methods including conservative treatments, medical therapies, and simple interventions.
... The word ""haemorrhoid" is derived from the Greek word "haema" (blood) and "rhoos" (flowing), and it was probably Buqrat (Hippocrates 460 BC) who was the first to apply this name to the flow of blood from the veins of the anus. [1] The term ""piles"" is derived from the Latin "pila" (a ball) and was widely used by the public at the time of John of Arderne (born: 1307 AD). In his treatise of 1370 he mentioned that the "common people call them piles, the Aristocracy call them haemorrhoids and the French call them figs (figer, to clot). ...
... Improved conditions of patients suffering from chronic heart failure (Michalsen et al., 2003), decreased number of spasms in patients with severe brain injury (MacKay, 2001), faster recovery of injured sportspeople (Hamlin, 2007), decreased exhaustion (Ghafari, Ahmadi, Nabavi, & Kazemnezhad, 2008), decreased levels of pain in patients with Osteoarthritis and Rheumatoid Arthritis (March & Stenmark, 2001), and improved life quality of patients with Multiple Sclerosis (Sintay, 2011) are among the positive effects of hydrotherapy. In the study conducted by Malekzade, Ghasemi, and Mirnasuri (2014), to determine the effect of one period of hydrotherapy on the performance and life quality of patients with Knee Osteoarthritis, it was found that hydrotherapy exercises can improve these patients' performance and life quality in an effective and safe way (Malekzadeh et al., 2014). ...
Living to an old age is considered by many elderly women to bring about a decreased quality of life.
Hydrotherapy allows individuals to engage in certain physical activities that cannot be done outside the water.
The purpose of this study was to explore elderly women’s experience of the role of hydrotherapy in their health
and was conducted in selected pools of Guilan province in Iran in 2015-2016. Twenty-three elderly women
were selected using a purposeful sampling strategy. The data was gathered through semi-structured interviews;
Researchers used a qualitative design, based on a content analysis approach. Analysis results were identified as
3 main themes and 12 subthemes. Improved physical health: reduced consumption of painkillers, improved
balance, pleasant breathing, easy menopause; Moving toward ability: increased independence, role fulfillment,
application of efficient strategies, will to health; Psychological and social relief: sense of liveliness, reduced
stress, peaceful sleep and re-emergence in society. “Competence development” was identified as the central
code. Results indicate that participation in hydrotherapy by elderly women supported the benefit of advising
them to participate in hydrotherapy sessions, as well as government’s cooperation with regard to creating
proper conditions for improving the health and life quality of this valuable population
... Further, they reduce and prevents varicose veins on the ley, help in discolouring the varicose vein and also participate in healing and antiulcer effect. This product may also help in boosting the immune system and help in building new cells [3][4][5][6][7][8][9][10][11][12][13][14]. Images of the two products and more information on their therapeutic effect can be found below. ...
Background:
Hemorrhoid disease (HD) is an anal-rectal ailment that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue. It is generally associated with bleeding, prolapse, pruritus, and discomfort, which results in a diminished quality of life and well-being.
Objective:
To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.
Method:
Reported literature available on Scopus, PubMed, Science Direct, Clinicaltrails.gov, and from many reputed foundations has been studied to summarize the recent development and clinical studies for the management of hemorrhoids.
Results and conclusion:
The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed. This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.
Background: Spasm of internal anal sphincter is responsible for pain aft er haemorrhoid surgery
(haemorrhoidectomy). Topical use of a calcium channel blocker, 2% Diltiazem (DTZ),
may be eff ective in reducing pain aft er haemorrhoidectomy.
Objectives: To evaluate the mean pain scores on visual analogue scale on second post
operative day aft er haemorrhoidectomy in patients using 2% DTZ versus patients using
placebo ointment along with standard treatment for pain relief.
Methodology: Th is was a randomized control trial conducted at Kulsoom Bi Valika Social
Security (K.V.S.S.) SITE Hospital, Karachi, for a period of six months from 01st August 2011
to 31st January 2012 . Eighty patients, who had undergone Milligan Morgan haemorrhoidectomy,
were randomly assigned to receive 2% DTZ ointment (group D - study group) or a
placebo ointment (group P - control group) post-operatively. Forty patients were included
in each group. Mean postoperative pain scores were recorded using aisual analogue score on
second postoperative day. SPSS version 16 was used for statistical analysis.
Results: Mean age was 38.79±14.86 years. Sixty fi ve (81.3%) patients were male whereas
fi ft een (18.7%) were female, with male to female ratio being 4:1. Patients using 2% DTZ ointment
had signifi cantly less pain aft er surgery. Mean postoperative pain score in those using 2%
DTZ was 4.20±1.09, while in placebo group it was 7.53±0.81, on the second postoperative day
(p<0.0001).
Conclusion: Perianal application of 2% DTZ ointment aft er haemorrhoidectomy is eff ective
in reducing pain on second postoperative day.
Ethnopharmacology relevance
Graptophyllum pictum (L.) Griff., known as “handeuleum” in West Java and “Daun Ungu” in Indonesia, is traditionally used to cure hemorrhoids.
Aim of the study
The purpose of this study is to prove its effectiveness scientifically using anorectal histological parameters in Croton oil-induced hemorrhoid mice.
Materials and methods
In vivo tests were performed by observing histomorphologic changes in mice anorectal tissue induced by croton oil. In addition, in vitro assay was performed for evaluating antioxidant activity, astringency property, and hemostasis-associated activity. The antioxidant activity was measured using a DPPH radical scavenging assay. The total flavonoid and phenolic contents were also determined spectrophotometrically.
Results
The in vivo assay showed that the oral-topical combination use of the ethanolic extract of G. pictum leaves demonstrated significant improvement on the croton oil-induced anorectal damage better than the single application by oral or topical application.
Conclusion
These results showed that G. pictum has potent anti hemorrhoid activity, especially for the combinational use of oral and topical administration.
Objectives
The homoeopathic remedy, Hamamelis , has been extensively used to treat varicose veins. However, scientific research conclusively proving its utility is lacking. This study was performed to ascertain the remedy’s therapeutic utility and efficacy in treating varicose veins and its complications using the revised venous clinical severity score (VCSS) tool and Doppler studies.
Materials and Methods
A prospective uncontrolled experimental study with purposive sampling was performed; the subjects were selected from the outpatient department. A total of 32 cases, fulfilling the inclusion and exclusion criteria were clinically examined. The VCSS and Doppler test before and after treatment with Hamamelis 30 were performed.
Results
The Wilcoxon signed-rank test was applied and the change in the median VCSS was found to be statistically significant. P -value of the pre score was 5.53 ± 4.15 and that of the post score was 3.45 ± 2.36 with a mean change of 2.09 ± 2.87 and 37.69% improvement with P -value of 0.000 < 0.01. The Doppler study showed no significant change or improvement.
Conclusion
This study revealed that the homoeopathic remedy Hamamelis 30 is effective in the management of varicose veins and its complications by ameliorating symptoms and improving the VCSS. However, the Doppler study reports showed no changes or improvement perhaps due to the short period of treatment.
Real clinical practice is currently characterized by a significant increase in clinical situations, when it is already difficult to talk about the presence of only one disease in a patient, and in most clinical cases the patient has a combined or concomitant pathology.Hemorrhoidal disease has been known since ancient times and remains one of the most common human diseases. In the acute and initial stages of chronic hemorrhoids, conservative treatment is carried out. Its main goal is to relieve pain and inflammation, normalize blood circulation in the rectum. Given the high prevalence of hemorrhoids and the main risk factors for its development, which are simultaneously important in the development of other diseases and pathological conditions, a patient with hemorrhoids should be considered as a comorbid patient. Drug therapy for a comorbid patient always carries the risk of harm to the patient’s health by the drug itself, designed to resist the disease.Homeopathic medicines should be considered as a drug of choice for topical therapy in the management of uncomplicated forms of external haemorrhoids. In the presented review, the effects of the main components (Calendula officinalis, hamamelis virginiana, Aesculus hippocastanum, Mentholum, Zinci oxydum) of the ointment are considered and it is noted that the main medicinal properties of the combined preparation are anti-inflammatory, regenerating, disinfecting, drying effects. In conclusion, 2 clinical examples are given, indicating the effectiveness of the ointment in comorbid patients in acute and early stages of chronic hemorrhoids.
Background: Pilonidal disease (PD) is a common condition of the
skin and subcutaneous tissue. The optimal technique is yet to be
established and surgical procedures for PD management are associated with high morbidity. We aim to study outcomes of surgical
treatment of PD.
Materials and Methods: We designed a retrospective study and
collected data from 215 patients with PD who underwent elective
surgical treatment over a 4-year period.
Results: Our cohort included 215 patients with a median age of 25
years; 70,7% were male. In most cases (87,4%), en-bloc resection
with primary wound closure was performed. Delayed wound closure and Limberg flap were options in 4,7% and 7,9%, respectively.
Overall complication rate was 30,7% (66 patients) and included
wound dehiscence (13%), seroma (9,8%), wound infection (6,5%)
and haematoma (1,4%). Patients who received postoperative
antibiotics had significantly less wound infection. Recurrence was
observed in 18 (8,4%) patients.
Conclusion: Surgical treatment of PD is still associated with high
morbidity. Our study showed a low recurrence rate, but we identified a need for improvement in postoperative care. In the future
we consider the inclusion of new minimally invasive procedure in
our daily practice
To determine the frequency of symptoms (bleeding, pain, rectal swelling, itching, soiling, constipation) in subjects consulting for hemorrhoidal disease and assess the possible concomitance between hemorrhoids and chronic venous disease (CVD). CHORUS is a multinational cross-sectional survey carried out in seven countries. Consecutive patients consulting for hemorrhoidal disease were screened to confirm the presence of chronic venous disease. Data collected exclusively from India is analyzed here. Of the 2511 eligible patients, 63.8% were male and the mean age was 43.3 ± 12.2 years. Overall, 95.7% patients had physician-confirmed hemorrhoidal disease. Bleeding, swelling, prolapse, and fecal incontinence were significantly associated with the presence of hemorrhoidal disease (p < 0.0001). About one third of patients (37.5%) had reported simultaneous occurrence of hemorrhoidal disease and CVD and the occurrence of hemorrhoidal disease was significantly correlated with the presence of CVD (p = 0.004). Moreover, 70.4% patients with CVD had recurrent hemorrhoidal disease (p < 0.0001). Venoactive drug was the most commonly (95.7% cases) prescribed treatment; micronized purified flavonoid fraction was the most widely used (86.2%) venoactive drug. More than one third individuals with hemorrhoidal disease in our study had CVD, which highlights the importance of investigating signs of CVD in patient with hemorrhoids during daily clinical practice which could help better understand the disease and optimize the management.
Hemorrhoids become pathological when swollen or inflamed. They can be very painful and occasionally cause serious anemia as they often break and hardly heal. Orthodox medicine usually treats hemorrhoids through surgery combined with medication containing the flavonoid diosmin. Our previous ethnobotanical and ethnopharmacological research in Bulgaria (Balkan Peninsula) revealed that Arum maculatum and possibly its relatives were more efficient to cure hemorrhoids. The aim of this study is to review the traditional use, biologically active compounds and pharmacological activities of Arum species. Biologically active compounds identified in various parts of Arum species include: alkaloids, terpenoids, phenolic compounds as well as carbohydrate-binding proteins. Arum species extracts have analgesic, antimicrobial, anti-inflammatory and anticancer properties. According to ethnobotanical data, the most frequent biological activity of several Arum species which deserves special attention is against hemorrhoids and it is still poorly studied with modern pharmacological tests.
Hemorrhoids can occur normally as part of the vasculature of the anal canal, however; in some patients they can also be the source of a number of bothersome perianal problems. These problems encompass a condition referred to as hemorrhoidal disease. The cardinal features of this condition include anal pruritus, prolapse, bleeding, and pain in the case of thrombosis. Symptomatic hemorrhoids have a prevalence ranging from 4.4% in the general population, to 36.4% in the population attending general practitioners (Johanson and Sonnenberg, Gastroenterology 98:380–386, 1990), and are known to have an increased prevalence during pregnancy and postpartum (Johanson and Sonnenberg, Gastroenterology 98:380–386, 1990). Medical treatment of hemorrhoidal disease include the treatment of the associated disorders like constipation and the active treatment of hemorrhoidal disease. The therapy for hemorrhoidal associated constipation is discussed in Sect. 2. Briefly, constipation is a common and sometimes disabling condition worldwide, above all among patients presenting hemorrhoids. A variety of traditional and novel treatment options are nowadays available. Fiber has been indiscriminately recommended for the treatment of constipation. As a matter of fact, an increase in the amount of dietary fiber is an almost universal recommendation in the primary care management of constipation and more in general in the management of hemorrhoids. Insoluble fibers appear to have the greatest impact on stool frequency and output. Traditional laxatives are effective at inducing bowel movements, but data for their role in long-term management and on efficacy on constipation-associated abdominal symptoms are limited. Long-term studies are available for polyethylene glycol (Macrogol), confirming sustained efficacy. The critical importance of the enteric microbiota to intestinal and, especially, colonic function, together with some limited clinical evidence to suggest some changes in the flora in the constipated subject provide a rationale for the use of probiotics and prebiotics in constipation. However, with the exception of the constipated IBS subject, clinical trial data on these agents in constipation, per se, is very scanty. Large-scale, high-quality, trials are indicated and are clearly feasible given the prevalence of the complaint. When patients fail to respond to standard therapy, the colonic secretagogue lubiprostone, or the 5-HT4 agonist prucalopride, or linaclotide, a GC-C receptor agonist, are available as the next step in management. In controlled trials in chronic constipation, these drugs were shown to significantly improve constipation and its associated symptoms, and both seem to have a favorable safety record, although a high incidence of nausea was reported with lubiprostone. Among the new therapeutic agents Plecanatide, another GC-C agonist, has been proven to be effective in the treatment of constipation, although its long-term risks and benefits remain to be determined. The accessibility of multiple drugs with different mechanisms of action will continue to benefit patients suffering from chronic constipation as well as the hemorrhoids-associated one. The treatment of constipation has become easier with the exciting development of new medications and effective biofeedback therapy over the past decade. Other therapies on the horizon should further improve health care providers’ ability to effectively treat symptoms of hemorrhoids and its complications. The active therapy for hemorrhoidal disease is discussed in Sect. 3. Briefly, conservative approaches are recommended in particular for low-grade internal hemorrhoids and nonthrombosed external hemorrhoids (grade I hemorrhoids), which can generally be effectively treated with dietary and lifestyle modifications. The main goal of medical treatment is to control hemorrhoidal symptoms. Several drugs are available in various forms including tablet, suppository, cream, and wipes. Oral therapy is based on flavonoids, mesoglycan, calcium dobesilate, and herbal extracts. Local therapy is based on corticosteroids, analgesics, vasoconstrictors, and barrier cream including several active ingredients such as sodium hyaluronate, aloe vera, and other herbal extracts. Flavonoids are a heterogeneous class of drugs with venotonic properties, capable of increasing vascular tone, reducing venous capacity, decreasing capillary permeability, and facilitating lymphatic drainage in addition to having anti-inflammatory effects. Mesoglycan is a set of glycosaminoglycans of venous vascular diseases due to its fibrinolytic effect. Calcium dobesilate is a venotonic drug, which is capable of controlling symptoms of a hemorrhoidal attack, reducing microvascular permeability, decreasing platelet aggregation, and having antioxidant properties. Oral supplementation with herbal extracts as Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, and Hamamelis virginiana may help control hemorrhoidal symptoms. Pharmacological mechanisms of action are very similar to those of the flavonoid drug class, by improving circulation and reducing inflammation. Several dietary factors including a low-fiber diet, spicy or fatty foods, coffee, alcohol, and others may be implicated in the pathogenesis of hemorrhoidal disease, but reported data in most cases is inconsistent or conflicting. Increasing dietary fiber intake and oral fluids are both recommended to manage hemorrhoidal disease and reduce the likelihood of recurrence. Spicy food is one of the most important dietary risk factors for hemorrhoidal crisis. Alcohol is another possible risk factor for hemorrhoidal disease, and although reliable data in the literature is sparse, patients should still avoid alcohol consumption during a hemorrhoidal crisis. Smoking is not associated with an increased risk of hemorrhoid. Local anesthetics reduce hemorrhoidal symptoms by exerting a local anesthetic effect, which eliminates the burning and itching associated with hemorrhoidal prolapse. They have less of an effect on bleeding, although they are frequently used for this indication. Antispasmodic agents, glyceryl trinitrate (GTN), and nifedipine are used to relieve symptoms associated with anal sphincter spasm and high resting anal canal pressures. Topical GTN treatment has also resulted in a decrease rectal bleeding, an improvement of anal pain, throbbing, itching, and irritation. Nifedipine ointment has good efficacy particularly in the treatment of acute thrombosed external hemorrhoids and chronic anal fissures. Phenylephrine is a vasoconstrictor which provides temporary relief of acute symptoms of hemorrhoids, such as bleeding and pain on defecation. Anti-inflammatory topical therapy is based on hydrocortisone acetate or 5-aminosalicylic acid (5-ASA), both with similar anti-inflammatory effects, and suppository forms are more useful than cream to treat internal hemorrhoids. Several botanical extracts have been shown to improve hemorrhoidal symptoms. Aloe vera is one of the most commonly used extracts for treating acute and chronic wounds. The gel of aloe vera reduces the pain, swelling and itching of burns, and skin irritation. Topical therapy with herbal extracts, such as Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, and Hamamelis virginiana, may also help control hemorrhoidal symptoms, these are often prescribed in clinical practice due to their effectiveness and the very few reported side effects.
To determine the prevalence of varicose veins and chronic venous insufficiency (CVI) in the general population.
Cross sectional survey.
City of Edinburgh.
Men and women aged 18-64 years selected randomly from age-sex registers of 12 general practices.
In 1566 subjects examined, the age adjusted prevalence of trunk varices was 40% in men and 32% in women (p < or = 0.01). This sex difference was mostly a result of higher prevalence of mild trunk varices in men. More than 80% of all subjects had mild hyphenweb and reticular varices. The age adjusted prevalence of CVI was 9% in men and 7% in women (p < or = 0.05). The prevalence of all categories of varices and of CVI increased with age (p < or = 0.001). No relation was found with social class.
Approximately one third of men and women aged 18-64 years had trunk varices. In contrast with the findings in most previous studies, mainly conducted in the 1960s and 1970s, chronic venous insufficiency and mild varicose veins were more common in men than women. No evidence of bias in the study was found to account for this sex difference. Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease.
Centella asiatica is a medicinal plant that has been in use since prehistoric times. Its active constituents include pentacyclic triterpene derivatives. Studies have been conducted in particular to investigate the madecassosides and asiaticosides. In common with most traditional phytotherapeutic agents, Centella asiatica is used in folk medicine to treat a wide range of indications. In contrast to other medicinal plants, however, Centella asiatica has been subjected to quite extensive experimental and clinical investigations. Studies done in accordance with standardized scientific criteria have shown it to have a positive effect in the treatment of venous insufficiency and striae gravidarum. Centella asiatica also appears to be effective in the treatment of wound healing disturbances. At the present time, clinical studies aimed at investigating the sedative, analgesic, antidepressive, antimicrobial, antiviral and immunomodulatory effects that have been demonstrated experimentally, are still lacking. However, the therapeutic potential of this plant in terms of its efficacy and versatility is such that further detailed research would appear worthwhile.
This study attempts to determine whether or not prolonged standing at work involves an excess risk for the occurrence of varicose veins.
A cohort of 1.6 million 20-to-59-year-old Danes gainfully employed in 1991 were followed for 3 years according to first hospitalization due to varicose veins of the lower extremities. The exposure data came from a representative sample of the baseline population. Altogether 5940 people were interviewed about occupational exposure and confounding factors.
For men working mostly in a standing position, the risk ratio for varicose veins was 1.85 [95% confidence interval (95% CI) 1.33-2.36] in a comparison with all other men. The corresponding risk ratio for women was 2.63 (95% CI 2.25-3.02). The results were adjusted for age, social group, and smoking.
Working in a standing position is associated with subsequent hospitalization due to varicose veins for both men and women.
Endotelon, a product consisting of oligomeric procyanidolic extracts of the lignified tissues in grapes, was administered to 13 men and 33 women with capillary fragility in a clinical trial of its efficacy. Very good results were achieved in 67% of them, good in 17% and moderate in 13%. No result was achieved in 2%. The agent was clinically and biologically perfectly tolerated by these elderly subjects.
Compression therapy is a powerful method for the treatment of all sorts of swollen extremities. Its effects depend on several factors, including: underlying disease, exerted pressure and body position, and compression material.
Triterpene and steroid saponins and sapogenins of medicinal plants (Aesculus hippocastanum L., Hedera helix L., Ruscus aculeatus L.) are claimed to be effective for the treatment/prevention of venous insufficiency. In this work we evaluated the inhibitory effects of these plant constituents on the activity of elastase and hyaluronidase, the enzyme systems involved in the turnover of the main components of the perivascular amorphous substance.
The results evidence that for Hedera helix L., the sapogenins only non-competitively inhibit hyaluronidase activity in a dose-dependent fashion, showing comparable IC50 values (hederagenin IC50 = 280.4 μM; oleanolic acid IC50 = 300.2 μM); both the saponins hederacoside C and α-hederin are very weak inhibitors.
The same behaviour is observed for serine protease porcine pancreatic elastase: the glycosides are devoid of inhibitory action, while genins are potent competitive inhibitors (oleanolic acid IC50 = 5.1 μM; hederagenin IC50 = 40.6 μM). Constituents from Aesculus hippocastanum L. show inhibitory effects only on hyaluronidase, and this activity is mainly linked to the saponin escin (IC50 = 149.9 μM), less to its genin escinol (IC50 = 1.65 μM).
By contrast, ruscogenins from Ruscus aculeatus L., ineffective on hyaluronidase activity, exhibit remarkable anti-elastase activity (IC50 = 119.9 μM; competitive inhibition). The mechanism of elastase inhibition by triterpene and steroid aglycones, with a nitroanilide derivative as substrate, is discussed.
High-fiber diet in the treatment of symptomatic hemorrhoids in 51 patients was evaluated in a double-blind placebo-controlled
trial. Bleeding and pain at defecation were significantly reduced during six weeks' treatment with Vi-Siblin® (P<0.025), and this effect was still recognizable three months later.
The elimination, metabolism and distribution of14C-Total Flavanolic Oligomers (OFT), vitamin P factors extracted from “Vitis vinifera”, has been described, in the rat, as a function of time. This study was carried out using [U-14C]-OFT, [A-14C]-OFT and [B-14C]-OFT.
After a single oral administration of 50 mg/kg [U-14C]-OFT, about 70% of the administered dose is eliminated in the first 24 hours: 6% of the dose is excreted as14CO2 in expired air, 19% is eliminated in urine and 45% in faeces. The major urinary metabolites are hippuric acid, ethylcatechol and m-hydroxyphenylpropionic acid. The major faecal metabolite is ethylcatechol. The major biliary metabolites are vanillic acid and m-hydroxyphenylpropionic acid.
The degradation of OFT is dependent on the activity of the microflora in the gut.
The distribution of radioactivity in rat tissues shows that there are two kinds of target tissues for OFT: connective tissues and tissues of the adrenal-thyroid-pituitary axis.
An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized 'cushions' of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacement.
The effects were studied of the total triterpenic fraction of Centella asiatica on serum levels of the uronic acids and lysosomal enzymes involved in mucopolysaccharide metabolism (beta-glycuronidase, beta-N-acetylglucosaminidase, arylsulfatase) in patients with varicose veins. The basal levels of uronic acids (467.7 +/- 69.3 micrograms/ml) and of lysosomal enzymes (beta-glycuronidase 1.8 +/- 0.4 microM/min/l, beta-N-acetylglucosaminidase 23.1 +/- 0.4 microM/min/l, arysulfatase 0.078 +/- 0.003 microM/min/l) were elevated, indicating an increased mucopolysaccharide turnover in subjects with varicose veins. During treatment with Centella asiatica extract (60 mg/day for three months), these levels fell progressively. At the end of treatment the serum uronic acid (231.8 +/- 51.5 micrograms/ml), beta-glycuronidase (1.2 +/- 0.05 microM/min/l), beta-N-acetylglucosaminidase (17.7 +/- 0.7 microM/min/l) and arysulfatase (0.042 +/- 0.003 microM/min/l) levels were highly significantly lower than the basal levels (p less than 0.01). The results of this trial provide an indirect confirmation of regulatory effects of the extract of Centella asiatica on metabolism in the connective tissue of the vascular wall.
The variation of capillary filtration rate (CFR), ankle circumference (AC), and ankle edema (AE) was evaluated in three groups of patients with venous hypertension (ambulatory venous pressure > 42 mmHg) and in a group of normal subjects before and after treatment for four weeks with Total Triterpenic fraction of Centella Asiatica (TTFCA), a venoactive drug acting on the microcirculation and on capillary permeability. Group A (20 patients) was treated with TTFCA 60 mg tid; Group B (20 patients) was treated with 30 mg tid; Group C (12 patients) was treated with placebo; and Group D (10 normal subjects) was treated with TTFCA 60 mg tid in an open study.
Capillary filtration rate was assessed by venous occlusion plethysmography, ankle edema by a new system called AECT (Ankle edema coin tester). Subjective symptoms of venous hypertension were assessed by an analogue scale line considering four symptoms: swelling sensation, restless lower extremity, pain and cramps, and tiredness. CFR, AC, and AE were significantly higher in patients in comparison with normal subjects.
After four weeks of TTFCA treatment there was a significant decrease of the abnormally increased CFR, AC, and AECT time in patients.
This was also greater in the higher dose group. No significant change was observed in the placebo group and in normal subjects treated with TTFCA. Symptoms were also significantly improved in the two groups treated with the active drug according to the dose. No significant changes were observed in the placebo group.
In conclusion the improvement of symptoms by TTFCA observed in patients with venous hypertension was well correlated with the improvement of CFR and ankle edema, and dose ranging showed that 180 mg/day is more effective in improving both symptoms and CFR.
The VSC (vacuum suction chamber) device, a new system to evaluate local capillary permeability, was used with laser Doppler flowmetry to study varia tions of permeability and of the microcirculation in 10 normal subjects; in 22 patients with moderate, superficial venous hypertension; and in 12 patients with postphlebitic limbs and severe venous hypertension. All these patients had distal (ankle and foot edema) in the evening.
After a first assessment these subjects were studied again after two weeks without treatment and after two weeks' treatment with total triterpenic fraction of centella asiatica (TTFCA), tablets, 60 mg, tid.
The VSC produces a wheal on the skin of the perimalleolar region that dis appears (in average) in less than sixty minutes in normal subjects. The disap pearance time (DT) is greater in conditions of increased capillary filtration and permeability.
The three groups of subjects (normal and those with superficial and severe venous hypertension) had significantly different, increasing disappearance time of the wheals at the first observation.
There were no significant changes after two weeks' observation, but after 2 weeks' treatment with TTFCA, there was a significant decrease of DT both in limbs with superficial and with deep venous incompetence.
The improvement (decrease) of the abnormally increased capillary permea bility was associated with a significant improvement of the microcirculation and symptoms (studied by an analogue scale line).
In conclusion this study showed a combined improvement of the microcircu lation and capillary permeability after treatment with TTFCA and the possibil ity of using the VSC to evaluate the effects of drugs (or other treatment) on local capillary permeability in patients with venous hypertension.
Infrared photocoagulation therapy was used on a total of 302 patients. Approximately 20% of the patients experienced minor bleeding; however, two required surgery, and 30% of the patients experienced discomfort during a 14-day period following the procedure. Good results were obtained in patients with first- and second-degree hemorrhoids. Heater probe coagulation therapy was conducted in a total of 264 patients. Good results were achieved in 90% of patients with first- and second-degree hemorrhoids, minor pain and bleeding occurred in approximately 10% of these patients, and one patient with third-degree hemorrhoids who was treated with this technique failed to respond and required surgery. Ultroid d.c. current therapy was utilized in 192 patients, and follow-up results were good in 95% of these cases. Minor bleeding occurred in four patients. It is concluded that all three techniques, performed on an outpatient basis with little or no sedation, are effective modalities for first- and second-degree hemorrhoids, but that Ultroid d.c. current therapy is associated with less discomfort and fewer complications and that Ultroid therapy may yield good results in some patients with third- or even fourth-degree hemorrhoids.
Hemorrhoid disease is one of the most frequently occurring, disabling conditions of man. We report the results of 120 patients with symptomatic internal and mixed hemorrhoid disease treated with direct current (d.c.) via a dual-tipped disposable needle probe (negative electrode). Evaluation and treatment utilized an operative anoscope which visualized one-eighth of the anal canal. Five hundred ninety segments revealed hemorrhoid disease (grade 1 = 114, 2 = 222, 3 = 178, 4 = 76). One or more segments (highest grade) were treated per office visit. Symptoms, frequency, and mean number of treatment applications per patient for complete symptom resolution were: bleeding, 85%, 4.0; protrusion, 58%, 3.9; pain, 52%, 3.6; and pruritus, 49%, 3.9. Ablation of hemorrhoid disease grade was directly correlated with milliampere current and time of application. No major complications occurred. All patients were successfully treated and remained symptom-free at a mean duration of follow-up of 23 months. Direct current electrotherapy is an effective, painless, and safe outpatient treatment approach to all grades of internal and mixed hemorrhoid disease.
The mechanism of action of the total triterpenoid fraction extracted from Centella Asiatica (TTFCA) was evaluated using human skin fibroblasts cultures as the experimental system. In particular its influence on the biosynthesis of collagen, fibronectin and proteoglycans was considered. The presence of TTFCA (25 micrograms/ml) does not seem to affect cell proliferation, total protein synthesis or the biosynthesis of proteoglycans in a significant way. A statistically important increase was observed in the percentage of collagen and, as revealed by immunofluorescence measurements, in cell layer fibronectin. This effect on collagen and fibronectin may help to explain the action of TTFCA in promoting wound healing, and suggests an interesting working hypothesis for its action on basal endothelia.
It is remarkable that the pathogenesis of a condition with as long a history and as much morbidity as hemorrhoids is incompletely understood, but various theories still contend for acceptance. The classification, presentation, symptoms, and complications of hemorrhoids are discussed, and various treatment options--injection sclerotherapy, rubber band ligation, manual anal dilatation, sphincterotomy, cryotherapy, infrared photocoagulation, bipolar diathermy, and the galvanic generator and probe--are reviewed.
Rubber band ligation is an efficacious and cost-effective alternative to conventional hemorrhoidectomy for symptomatic internal hemorrhoids. Even though the well-recognized complications of bleeding and thrombosis occur infrequently, far more serious septic complications have only recently been described, as evidenced in five of our patients: four cases were serious enough to necessitate surgical intervention, and one patient died. Pain followed by urinary dysfunction with or without toxic symptoms should alert the physician to the probability of localized perianal or systemic sepsis. Acute awareness of these rare but potentially life-threatening complications and immediate aggressive treatment is mandatory if death is to be prevented. Rubber band ligation of internal hemorrhoids need not be abandoned; however, the indications should be clear, the technique mastered, and a close patient follow-up maintained.
The epidemiology of varicose veins was examined in 3,822 adults in the Framingham Study. Findings indicate that the incidence of varicose veins is higher among women than men, with no clear age differences. Compared to women without varicose veins, women with varicose veins were more often obese (p less than .01), had lower levels of physical activity (p less than .001) and higher systolic blood pressure (p less than .001), and were older at menopause (p less than .001). Women who reported spending eight or more hours in an average day in sedentary activities (sitting or standing) also had a significantly higher incidence of varicose veins than those who spent four or fewer hours a day in such activities (p less than .05). For men, varicose veins coexisted with lower levels of physical activity (p less than .05) and higher smoking rates (p less than .05). While men and women with varicose veins had a higher incidence of atherosclerotic cardiovascular disease than those without varicose veins, only the excess risk of coronary heart disease in women was statistically significant (p less than .05). However, this finding was not significant after controlling for body mass and systolic blood pressure. These results suggest that increased physical activity and weight control may help prevent varicose veins among adults at high risk, and reduce the overall risk of atherosclerotic cardiovascular disease as well.
Ninety-four patients suffering from venous insufficiency of the lower limbs participated in a multicenter, double-blind versus placebo study. After randomization, they were allotted for a treatment period of two months to one of three groups: TECA 120 mg/day, TECA 60 mg/day, or placebo. A significant difference (p less than 0.05) in favor of TECA was shown for the symptoms of heaviness in the lower limbs and edema, as well as for the overall evaluation by the patient. The venous distensibility measured by a mercury strain gauge plethysmograph at three occlusion pressures was improved for the TECA groups but aggravated for the placebo group.
Of fifty-three consecutive patients with hemorrhoids referred to a rectal clinic forty-seven completed a trial designed to compare the results of anal dilatation with those of rubber band ligation.
Venous tone in the lower limbs can be measured by venous occlusion gas plethysmography before and after giving venotropic drugs. Four groups, each of which included ten patients with widespread varicose veins, were given different medications. Each patient was studied by plethysmography during the first five hours following drug ingestion. In untreated controls, venous tone decreased during rest. A reference drug was uneffective. Increase in venous tone induced by 150 mg of procyanidolic oligomers was comparable to that which followed ingestion of a high dose of hamamelis-hydrastis mixture.
Procyanidol oligomers and (+) catechin bound to insoluble elastin markedly affect its rate of degradation by elastases. Insoluble elastin pretreated with procyanidol oligomers (PCO) was resistant to the hydrolysis induced by both porcine pancreatic and human leukocyte elastases. The quantitative adsorption of pancreatic elastase was similar on either untreated or PCO-treated elastin suggesting that the binding of this compound to elastin increases the non-productive catalytic sites of elastase molecules. (+) Catechin-insoluble elastin complexes were partially resistant to the degradation induced by human leukocyte elastase but were hydrolysed at the same rate as untreated samples by a constant amount of pancreatic elastase. In addition, the coacervation profile of kappa-elastin peptides as a function of temperature is greatly modified in presence of these flavonoids. We conclusively evidenced that PCOs bind to skin elastic fibres when injected intradermally into young rabbits. As a result, these elastic fibres were found more resistant to the hydrolytic action of porcine pancreatic elastase when injected to the same site. These in vivo studies further emphasized the potential effect of these compounds in preventing elastin degradation by elastase(s) as occurred in inflammatory processes.
Extract of Ruscus aculeatus is used in treatment of venous insufficiency. In the present study, we used the hamster cheek pouch preparation and investigated in vivo the effects of an alpha 1 and alpha 2 adrenoceptor antagonists, a calcium blocker, Ruscus extract, and their combination on increased microvascular permeability induced by histamine. Experiments were performed on male hamsters; 30 min after completion of the cheek pouch preparation, fluorescein-labeled dextran (molecular weight 150,000) was given intravenously (i.v.). Histamine, applied topically, increased the number of fluorescent vascular leakage sites from postcapillary venules, evidence of an increase in macromolecular permeability, which was quantified by ultraviolet light microscopy as the number of leaky sites in the prepared area. Prazosin (alpha 1-adrenoceptor antagonist), diltiazem (calcium blocker), and Ruscus extract applied topically dose-dependently inhibited the macromolecular permeability-increasing effect of histamine. Rauwolscine (alpha 2-adrenoceptor antagonist), also applied topically, had no effect on histamine-induced permeability increase. Inhibition of the histamine-induced permeability increase evoked by Ruscus extract could be blocked by prazosin and by diltiazem but not by rauwolscine. These results indicate that any variation in the transmembrane flux of calcium impairs formation of microvascular leaky sites by histamine. Our results show that Ruscus extract has a protective effect against the leakage of FITC-dextran in hamster cheek pouch after administration of histamine that is modulated by calcium and selectively by alpha 1-adrenoceptors.
Rectal pain and/or bleeding are common complaints among the general population. Hemorrhoids are the most common etiology for these complaints, but the family physician should always be alert to the possibility of other pathologic explanations, such as fissure, abscess, fistula, condyloma or cancer. Feelings of embarrassment or apprehension about surgery may make patients reluctant to discuss anorectal symptoms with their physician. A variety of outpatient methods is available to treat internal hemorrhoids. Rubber band ligation is widely used in the treatment of all grades of internal hemorrhoids. Infrared coagulation uses high-intensity light to treat grade I, grade II and some grade III internal hemorrhoids. Bipolar electrocoagulation is useful in all cases, while low-voltage direct current is useful in cases of more advanced hemorrhoids. Proper anal hygiene and correction of chronic constipation or diarrhea are essential to prevent recurrence of hemorrhoids.
The Ruscus extract and the flavonoid hesperidine methylchalcone (HMC) are used in treatment of venous insufficiency. In the present study, we used the hamster cheek pouch preparation and investigated the effects of these substances on increased microvascular permeability induced by bradykinin, histamine, and leukotriene B4 (LTB4) applied topically. Experiments were performed on male hamsters; 30 min after completion of the cheek pouch preparation, fluorescein-labeled dextran [molecular weight (mol wt) 150,000] was given intravenously (i.v.). Bradykinin, histamine, and LTB4 increased the number of fluorescent vascular leakage sites from postcapillary venules, evidence for an increase in macromolecular permeability, which was quantified in ultraviolet (UV)-light microscope as the number of leaky sites in the prepared area. Ruscus extract and HMC, given i.v., significantly inhibited the macromolecular permeability-increasing effect of bradykinin, LTB4, and histamine. Ruscus extract, applied topically, dose dependently inhibited the macromolecular permeability-increasing effect of histamine. Our results show that Ruscus extract and HMC have a protective effect against leakage of FITC-dextran in the cheek pouch after administration of various permeability-increasing substances, which further supports data previously reported on patients with venous insufficiency.
Horse chestnut extract (HCE), containing 70% escin, is the main active component of Veinotonyl 75. The aim of this work was to investigate pharmacological properties attempting to elucidate the efficacy of HCE in chronic venous insufficiency. Veinotonic and lymphagogue properties: HCE dose dependently contracts the canine saphenous isolated vein (cumulative doses 5 x 10(-8) to 5 x 10(-4) g/ml). Its action lasts more than 5 h. In the perfused canine saphenous vein, HCE (25-50 mg in bolus) increases the venous pressure of the normal vein and the pathological vein stenosed 8 days before, and the contractile response to noradrenaline is significantly potentiated. Moreover, during the perfusion in inverse direction of the blood stream, a clear contracting effect on the valves is also obtained with HCE. In the anaesthetized dog, HCE in situ improves the femoral vein compliance and opposes the venous distension obtained during clamping in a carotido-femoral perfusion with constant flow. In other respects, HCE significantly increases femoral venous pressure and flow, together with thoracic lymphatic flow, while respecting the arterial parameters (2.5 and 5 mg/kg i.v.). Vasculotropic action: HCE dose dependently diminishes the cutaneous capillary hyperpermeability induced either by injections of phlogistic agents as histamine and serotonin in the rat (100 to 400 mg/kg p.o.), or by an irritative agent (chloroform) application in the rabbit (50 to 300 mg/kg p.o. and 2.5 to 5 mg/kg i.v.). It significantly increases the vascular resistance in the guinea pig fed a scorbutigenic diet as measured by the petechia method (50 to 400 mg/kg p.o.). Antiedema and antiinflammatory properties: HCE decreases the formation of edemas induced in the rat's hind paw, one of lymphatic origin, the other of inflammatory origin (200 to 400 mg/kg p.o.). In an experimental model of pleurisy in the rat HCE suppresses plasmatic extravasation and leucocytes emigration into the pleural cavity (200 to 400 mg/kg p.o.; 1 to 10 mg/kg i.v.). It decreases the connective tissue formation in the subchronic model of inflammatory granuloma in the rat (400 mg/kg p.o. and 5-10 mg/kg s.c.). Antiradical mechanism of action both in vitro and in vivo: HCE dose dependently inhibits both enzymatic and non-enzymatic in vitro lipid peroxidation (5 x 10(-6) to 5 x 10(-4) g/ml).(ABSTRACT TRUNCATED AT 400 WORDS)
Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50-55 per cent; men 40-50 per cent) but fewer than half of these will have visible varicose veins (women 20-25 per cent; men 10-15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins; there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.
Daflon 500 mg* is a new flavonoid vasoprotector venotonic agent whose active principle is micronized and contains 90% diosmin and 10% flavonoids expressed as hesperidin.
In animal studies, the safety of Daflon 500 mg is shown by an LD 50 (lethal dose so) of more than 3 g/kg, ie, 180 times the daily therapeutic dose, as well as by the absence of any toxic effect after repeated oral dosing for thirteen and twenty-six weeks, using a dose representing 35 times the daily dosage, in the rate and primate.
Daflon 500 mg has no mutagenic action nor any significant effect on reproductive function. Gastrointestinal tolerance is good when administered orally in the rat. Transplacental passage and passage into breast milk are minimal. In the rat, 0.003% of the administered dose has been found in each fetus and 1% in breast milk.
Clinical trials fulfill international scientific requirements and have collected more than 2850 patients treated with Daflon 500 mg at the dosage of two tablets per day for six weeks to one year. The proportion of patients with side effects (10% of those treated), essentially of a gastrointestinal or autonomic nature and leading to a rate of only 1.1% trial dropouts, is less than described in 225 patients given a placebo (13.9%) in controlled trials. Satisfactory clinical acceptability already confirmed in the short term was equally found in long-term treatment.
Hemodynamic parameters (systolic and diastolic blood pressure) as well as laboratory parameters (hematology, liver and renal function, metabolic) were uninfluenced even by prolonged treatment for one year at the dosage of two tablets per day.
No contraindications have been found during the therapeutic use of Daflon 500 mg, even in the elderly and in pregnant women. No evidence has been found of any interference with combined drugs. Daflon 500 mg is free of any photosensitizing action.
Daflon 500 mg combines thoroughly proven therapeutic efficacy with excellent safety of use confirmed in specific and methodologically reliable toxicologic studies as well as in a large number of clinical trials with patients treated daily for six weeks to one year.
Hemorrhoidal disease (HD) is a trophic disorder of the anal canal characterized by recurrent, self-resolving acute episodes. The author reports the results of a double-blind, placebo-controlled trial of the efficacy of Daflon 500 mg in the treatment of acute and chronic symptoms of hemorrhoids. One hundred and twenty outpatients (54 men, 66 women) suffering from an acute episode of HD during the previous two months were included. They received Daflon 500 mg (group D, n = 60) or placebo (group P, n = 60) two tablets daily for two months. The patients were examined at entry (T0) and at two months (T2). At T0, the two groups did not differ in terms of age, sex, weight, height, history of symptoms of HD; 7 patients were excluded from analysis because of treatment failure (group D, n = 2; group P, n = 3), or lost to follow-up (group P, n = 2). In group D, 40% of patients had an attack during the trial with a mean duration of 2.6 days and a mean severity of 1.1 scored on a scale from 1 to 3. These values were significantly different (P < 0.01) from the corresponding values in the P group: 70%, 4.6 days and 1.6 respectively. Each symptom and sign was scored on a scale of severity. The overall symptom score, scored from 0 to 15, decreased from 6.6 (group D) and 6.1 (group P) (NS) to 1.1 and 4.0 respectively (P < 0.01) at the end of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Objective
Efficacy of treatment of acute haemorrhoidal crisis by Daflon 500 mg (D500) in comparison to a placebo (Pl).
Design
Prospective, double blind, placebo controlled trial with randomization into two parallel groups.
Setting
In- and outpatients at a University Hospital.
Patients
One hundred patients with a history of haemorrhoidal disease, suffering from an acute haemorrhoidal attack.
Interventions
Administration of Daflon 500 mg or placebo at a dose of three tablets b.i.d. for the first 4 days and two tablets b.i.d. for the following 3 days.
Main outcome measures
Improvement of symptoms and signs measured by a score and patient acceptability.
Results
Overall improvements of symptoms was greater in the D500 group than in the Pl group, from day 2 up to day 7. The clinical severity of proctorrhagia, anal discomfort, pain and anal discharge diminished in both groups, but to a greater extent in the D500 group ( p <0.001). Inflammation, congestion, oedema and prolapse were more markedly improved in the D500 group than in the Pl group. Duration and severity of the current haemorrhoidal episode, as assessed by patient self-evaluation, were less important in the D500 group compared with previous episodes. Use of analgesics and topical medications diminished in both groups, with a major reduction in the D500 group from day 4 ( p <0.001). Acceptability was good in both groups: no patient experienced major side-effects.
Conclusion
Treatment with D500 resulted in a quicker and more pronounced relief of signs and symptoms of acute haemorrhoids than with the placebo.
Fifty patients with bleeding internal hemorrhoids unresponsive to 6 weeks of standard medical therapy were randomly assigned to receive treatment with direct current or bipolar electrocoagulation. Treatment groups were similar in bleeding severity and internal hemorrhoid grade. Treatment sessions were significantly longer for direct current electrocoagulation (8.8 +/- 0.2 minutes) than for bipolar electrocoagulation (0.1 +/- 0.03 minutes) (p < 0.001). When compared to the bipolar electrocoagulation group, direct current electrocoagulation patients had more procedural pain that terminated therapy (5 of 25 patients [20%] versus 0 of 25 [0%], for a difference of 20% [95% confidence interval, 4% to 36%]; p = 0.05) and prolonged pain after the procedure (4 of 25 patients [16%] versus 1 of 25 [4%], for a difference of 12% [95% confidence interval, -4% to 28%]; p = 0.35). However, more post-treatment rectal ulcerations were seen in the bipolar electrocoagulation-treated group (6 of 25 patients [24%] versus 1 of 25 [4%], for a difference of 20% [95% confidence interval, 2% to 38%]; p = 0.10). Treatment groups did not differ in number of treatment sessions or months of follow-up. The rates of success, defined as obliteration of the hemorrhoids or cessation of bleeding with reduction of the hemorrhoids to grade 1 or less, for the direct current electrocoagulation and the bipolar electrocoagulation groups were 88% and 92%, respectively. Failures in the direct current electrocoagulation group were uncontrollable bleeding (n = 1) and refusal to continue therapy because of pain (n = 2).(ABSTRACT TRUNCATED AT 250 WORDS)
Diseases of the venous system are widespread disorders sometimes associated with modern civilisation and are among the major concerns of social and occupational medicine. This study was carried out to compare the efficacy (oedema reduction) and safety of compression stockings class II and dried horse chestnut seed extract (HCSE, 50 mg aescin, twice daily).
Equivalence of both therapies was examined in a novel hierarchical statistical design in 240 patients with chronic venous insufficiency. Patients were treated over a period of 12 weeks in a randomised, partially blinded, placebo-controlled, parallel study design.
Lower leg volume of the more severely affected limb decreased on average by 43.8 mL (n = 95) with HCSE and 46.7 mL (n = 99) with compression therapy, while it increased by 9.8 mL with placebo (n = 46) after 12 weeks therapy for the intention-to-treat group (95% CI: HCSE: 21.1-66.4; compression: 30.4-63.0; placebo: 40.0-20.4). Significant oedema reductions were achieved by HCSE (p = 0.005) and compression (p = 0.002) compared to placebo, and the two therapies were shown to be equivalent (p = 0.001); in this design, however, compression could not be proven as standard with regard to oedema reduction in the statistical test procedure. Both HCSE and compression therapy were well tolerated and no serious treatment-related events were reported.
These results indicate that compression stocking therapy and HCSE therapy are alternative therapies for the effective treatment of patients with oedema resulting from chronic venous insufficiency.
A crude hydroalcoholic extract from Hamamelis virginiana bark was subjected to ultrafiltration (UF) with a cut-off limit of 3 kDa to obtain a higher and a lower molecular weight fraction. Characterisation of the fractions was attempted with TLC, HPLC, acidic hydrolysis, and chromatography over Sephadex LH-20. The UF-concentrate was shown to consist mainly of oligomeric to polymeric proanthocyanidins (PA). This fraction was found to exhibit significant antiviral activity against Herpes simplex virus type 1 (HSV-1). In addition, the UV-concentrate displayed radical scavenging properties, inhibited alpha-glucosidase as well as human leukocyte elastase (HLE), and exhibited strong antiphlogistic effects in the croton oil ear edema test in the mouse. With the exception of the antioxidant potential and the inhibition of HLE-action the lower molecular fraction possessed weaker activities and contained mainly hamamelitannin, catechin, and further, unidentified constituents.
Purposes: (1) to prospectively evaluate efficacy and safety of direct current (DC) probe treatment of chronic anal fissures associated with internal hemorrhoids, and (2) to estimate direct and indirect costs of anoscopic treatment versus surgery.
Ten patients with chronic fissures of 11 mm (mean length) had symptoms for 5 months (mean) in spite of medical management; all had internal hemorrhoidal disease. DC coagulation was applied to two or three contiguous internal hemorrhoids per outpatient session. Eleven mA (mean) of DC current was delivered for 7 minutes (mean) per hemorrhoid segment.
All 10 patients had relief of chronic anal pain within two treatments and nine anal fissures healed within 4 weeks. One patient developed a perianal abscess and fistula requiring surgery. There were no recurrences in 20 months (mean) of follow-up with medical management. Mean direct and indirect costs (in terms of lost time from work or usual activity) of DC probe treatments were estimated to be 10% to 30% lower and 2 to 10 times less, respectively, than standard surgery for chronic anal fissures.
DC probe treatment for chronic anal fissures associated with internal hemorrhoidal disease is an important advance as an effective, safe, and cost-effective nonsurgical treatment in selected patients.
To assess the safety, efficacy and acceptability of a micronized flavonoid formulation in the treatment of internal hemorrhoids of pregnancy.
In an open study on hospital outpatients, we studied therapy with micronized diosmin 90% and hesperidin 10% for a median of 8 weeks before delivery and 4 weeks after delivery, in 50 women with acute hemorrhoids. The outcome measures were symptoms and signs of hemorrhoids; adverse effects; and acceptability of treatment.
On intention to treat analysis, 66% (95% confidence interval, range 79.1-52.9) had relief from acute symptoms by the 4th day; 53.6% (95% confidence interval, range 70-37.1, P < 0.001) fewer patients had relapse in the antenatal period. Treatment was well accepted, and did not affect pregnancy, fetal development, birth weight, infant growth and feeding.
In the short term, micronized diosmin 90% and hesperidin 10% is safe, acceptable, and effective in the treatment of hemorrhoids of pregnancy.
We investigated the effects of escins Ia, Ib, and IIb isolated from horse chestnut, the seeds of Aesculus hippocastanum L., and desacylescins I and II obtained by alkaline hydrolysis of escins on acute inflammation in animals (p.o.). Escins Ia, Ib, IIa, and IIb (50-200 mg/kg) inhibited the increase of vascular permeability induced by both acetic acid in mice and histamine in rats. Escins Ib, IIa, and IIb (50-200 mg/kg) also inhibited that induced by serotonin in rats, but escin Ia didn't. Escins Ia, Ib, IIa, and IIb (200 mg/kg) inhibited the hind paw edema induced by carrageenin at the first phase in rats. Escin Ia (200 mg/kg) and escins Ib, IIa, and IIb (50-200 mg/kg) inhibited the scratching behavior induced by compound 48/80 in mice, but escin Ia was weakest. Desacylescins I and II (200 mg/kg) showed no effect. With regard to the relationship between their chemical structures and activities, the acyl groups in escins were essential. Escins Ib, IIa, and IIb with either the 21-angeloyl group or the 2'-O-xylopyranosyl moiety showed more potent activities than escin Ia which had both the 21-tigloyl group and the 2'-O-glucopyranosyl moiety.