rutin and Hemorrhoids

Haemorrhoids are variceal dilatations of the anal and perianal venous plexus and often develop secondary to the persistently elevated venous pressure within the haemorrhoidal plexus (Kumar 2005). Phlebotonics are a heterogenous class of drugs consisting of plant extracts (i.e. flavonoids) and synthetic compounds (i.e. calcium dobesilate). Although their precise mechanism of action has not been fully established, they are known to improve venous tone, stabilize capillary permeability and increase lymphatic drainage. They have been used to treat a variety of conditions including chronic venous insufficiency, lymphoedema and haemorrhoids.Numerous trials assessing the effect of phlebotonics in treating the symptoms and signs of haemorrhoidal disease suggest that there is a potential benefit.. The aim of this review was to investigate the efficacy of phlebotonics in alleviating the signs, symptoms and severity of haemorrhoidal disease and verify their effect post-haemorrhoidectomy.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library 2011 issue 9 , MEDLINE (1950 to September 2011) and EMBASE (1974 to September 2011).. Only randomised controlled trials evaluating the use of phlebotonics in treating haemorrhoidal disease were used. No cross-over or cluster-randomized trials were included for analysis and any trial which had a quasi-random method of allocation was excluded.. Two authors independently extracted the data and analysed the eligibility of the data for inclusion. Disagreements were resolved by meaningful discussion.. We considered twenty-four studies for inclusion in the final analysis. Twenty of these studies (enrolling a total of 2344 participants) evaluated the use of phlebotonics versus a control intervention. One of these twenty studies evaluated the use of phlebotonics with a medical intervention and another study with rubber band ligation.The remaining four studies included two which compared different forms of phlebotonics with each other, one study which evaluated phlebotonics with a medical intervention and one study which compared the use of phlebotonics with infrared photocoagulation. Eight studies were excluded for various reasons including poor methodological quality.Phlebotonics demonstrated a statistically significant beneficial effect for the outcomes of  pruritus (OR 0.23; 95% CI 0.07 to 0.79) (P=0.02), bleeding (OR 0.12; 95% CI 0.04 to 0.37) (P=0.0002), bleeding post-haemorrhoidectomy (OR 0.18; 95% 0.06 to 0.58)(P=0.004), discharge and leakage (OR 0.12; 95% CI 0.04 to 0.42) (P=0.0008) and overall symptom improvement (OR 15.99 95% CI 5.97 to 42.84) (P< 0.00001), in comparison with a control intervention. Although beneficial they did not show a statistically significant effect compared with a control intervention for pain (OR 0.11; 95% CI 0.01 to 1.11) (P=0.06), pain scores post-haemorrhoidectomy (SMD -1.04; 95% CI -3.21 to 1.12 ) (P= 0.35) or post-operative analgesic consumption (OR 0.54; 95% CI 0.30 to 0.99)(P=0.05).. The evidence suggests that there is a potential benefit in using phlebotonics in treating haemorrhoidal disease as well as a benefit in alleviating post-haemorrhoidectomy symptoms. Outcomes such as bleeding and overall symptom improvement show a statistically significant beneficial effect and there were few concerns regarding their overall safety from the evidence presented in the clinical trials.However methodological limitations were encountered. In order to enhance our conclusion further, more robust clinical trials which take into account these limitations will need to be performed in the future.

Topics: Calcium Dobesilate; Diosmin; Flavonoids; Hemorrhoids; Hemostatics; Humans; Hydroxyethylrutoside; Ligation; Plant Extracts; Postoperative Care; Randomized Controlled Trials as Topic; Vasoconstrictor Agents

Haemorrhoids (piles) are swollen veins at or near the anus, normally asymptomatic. They do not constitute a disease, unless they become symptomatic. Pregnancy and the puerperium predispose to symptomatic haemorrhoids, being the most common ano-rectal disease at these stages. Symptoms are usually mild and transient and include intermittent bleeding from the anus and pain. Depending on the degree of pain, quality of life could be affected, varying from mild discomfort to real difficulty in dealing with the activities of everyday life. Treatment during pregnancy is mainly directed to the relief of symptoms, especially pain control. The so-called conservative management includes dietary modifications, stimulants or depressants of the bowel transit, local treatment, and phlebotonics (drugs that cause decreased capillary fragility, improving the microcirculation in venous insufficiency). For many women, symptoms will resolve spontaneously soon after birth, and so any corrective treatment is usually deferred to some time after birth. Thus, the objective of this review is to evaluate the efficacy of conservative management of piles during pregnancy and the puerperium.. To determine the possible benefits, risks and side-effects of the conservative management of symptomatic haemorrhoids during pregnancy and the puerperium.. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 June 2004).. Randomised-controlled trials comparing any of the conservative treatments for symptomatic haemorrhoids during pregnancy and the puerperium (such as dietary modifications, stimulant/depressant of the bowel transit, local treatments, drugs that improve the microcirculation in venous insufficiency) with a placebo or no treatment.. Two review authors independently performed a methodological assessment for deciding which studies to include/exclude from the review and extracted data.. From 10 potentially eligible studies, two were included in this review (150 women). Both compared oral rutosides against placebo. Rutosides seem to be effective in reducing the signs identified by the healthcare provider, and symptoms and signs reported by women, of haemorrhoidal disease. For the outcome no response to treatment: relative risk 0.07, 95% confidence interval 0.03 to 0.20. Regarding perinatal outcomes, one fetal death and one congenital malformation (possible not related to exposure) were reported in the control and treatment group respectively.. Although the treatment with oral hydroxyethylrutosides looks promising for symptom relief in first and second degree haemorrhoids, its use cannot be recommended until new evidence reassures women and their clinicians about their safety. The most commonly used approaches, such as dietary modifications and local treatments, were not properly evaluated during pregnancy and the puerperium.

Topics: Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Randomized Controlled Trials as Topic; Vasoconstrictor Agents

We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease in the short and medium time.. One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded.. Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher's grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003).. Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.

Topics: Adult; Aged; Diosmin; Double-Blind Method; Drug Combinations; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Hesperidin; Humans; Hydroxyethylrutoside; Italy; Male; Middle Aged; Prospective Studies; Quercetin; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult

The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy.. One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend.. Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture.. The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.

Topics: Acute Disease; Adult; Aged; Analgesics; Anticoagulants; Chi-Square Distribution; Diosmin; Drug Combinations; Edema; Epidemiologic Research Design; Female; Hemorrhoids; Hesperidin; Humans; Hydroxyethylrutoside; Male; Middle Aged; Pain Measurement; Prospective Studies; Rectal Prolapse; Research Design; Thrombosis; Young Adult

The aim of this study was to assess the clinical efficacy, compliance and safety of Ginko biloba--Troxerutin-Heptaminol Hce in the treatment of patients with acute hemorrhoidal attacks in Thailand.. In a prospective clinical study on hospital outpatients, the authors studied the effect of Ginko biloba--Troxerutin-Heptaminol Hce for a week in adults (18-70 years old) with acute hemorrhoidal attacks.. Twenty-two patients, with a mean age of 41.7 years were included in the study. The male to female ratio was 1 : 1.2. Most patients (77%) had grade 1 and 2 hemorrhoids with an average duration of attacks of 3 days. On intention to treat analysis, bleeding, pain, tenesmus and discharge were significantly improved. Treatment was well accepted and safe.. In the short-term, Ginko biloba--Troxerutin-Heptaminol Hce is effective, acceptable and safe in the treatment of patients with acute hemorrhoidal attacks.

Topics: Acute Disease; Adolescent; Adult; Aged; Drug Therapy, Combination; Female; Follow-Up Studies; Ginkgo biloba; Hemorrhoids; Heptaminol; Humans; Hydroxyethylrutoside; Male; Middle Aged; Pain Measurement; Phytotherapy; Prospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome

The safety and efficacy of Trihydroxyethylrutosides (HR) in the treatment of 53 patients with 1st-2nd degree hemorrhoids of pregnancy (16th-34th week) was investigated in a double-blind randomised, placebo controlled trial. The dosage of Trihydroxyethylrutosides was 1 tablet of 300 milligrams twice daily for the first 2 weeks. If the treatment was successful, the treatment was stopped. If the clinical signs or symptoms still persisted, the treatment was continued for another two weeks using the same dosage and re-evaluated at the end of the fourth week after initial treatment. The parameters for efficacy were symptoms (pain, bleeding, exudation and pruritus) and the objective signs on proctoscopy (bleeding, inflammation and dilatation of the hemorrhoidal venous plexus). The study revealed improvement of symptoms in the study group which was better than in the control group after 2 weeks of treatment but the clinical signs were not different. After a further 2 weeks of treatment, the result showed improvement of both clinical signs and symptoms in this study. Only one mild transient side effect was reported in the HR group and there were no drug-related problems in the pregnancies, delivery or the babies.

Topics: Administration, Oral; Adult; Double-Blind Method; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Pregnancy; Pregnancy Complications; Statistics, Nonparametric; Treatment Outcome

Flavonoids, such as troxerutin, have been shown to be safe and effective agents for the treatment of chronic venous insufficiency. The fixed combination between troxerutin 150 mg and carbazochrome 1.5 mg (Fleboside ampoules) was previously shown to have a good efficacy and safety profile in non-surgical patients with acute uncomplicated hemorrhoids. The purpose of this randomized, double-blind, placebo-controlled study was to investigate the efficacy and tolerability of the active combination in the treatment of post-hemorrhoidectomy patients. 30 patients were randomized to receive one of two treatments: troxerutin 150 mg and carbazochrome 1.5 mg, or placebo, i.m. 3 ml ampoules twice a day for five consecutive days after the surgical procedure, starting from the day of surgery. Efficacy parameters were assessed as follows: at baseline (T1), after the first administration (T2; day of surgery), the second day after the surgical procedure (T3), and the fifth day after the surgical procedure (T4); hemorrhoidal symptoms based on a visual analogue scale (VAS): pain, discharge, bleeding, inflammation, and pruritus; analgesic intake, if any; time to restore a physiological defecation; edema evaluation (based on a four-point scale: 0 = absent; 1 = mild; 2 = moderate; 3 = severe); camera pictures taken at T1 and T4 (in selected patients); and blood coagulation tests. Analysis between treatment groups revealed a highly significant difference at T3 and T4 for the total VAS score (p = 0.007 and p = 0.001, respectively) in favor of the active combination treatment. A statistically significant difference was also observed for bleeding and pruritus at T3 and for these two parameters and both inflammation and edema at T4 (p < 0.001) in favor of the active combination group. No adverse events were reported. Neither the active combination nor placebo affected blood coagulation tests. We conclude that intramuscular administration of the fixed combination of troxerutin 150 mg and carbazochrome 1.5 mg is effective, well tolerated and superior to placebo in improving hemorrhoidal and post-surgical symptoms during the five days following surgery.

Topics: Adrenochrome; Adult; Chi-Square Distribution; Double-Blind Method; Drug Combinations; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Injections, Intramuscular; Male; Middle Aged; Postoperative Complications; Statistics, Nonparametric; Treatment Outcome; Vasoconstrictor Agents

An experimental clinical study was performed using heparan sulfate in order to ascertain the effects of the drug in the treatment of 2nd or 3rd degree varicose dilatation of the hemorrhoid plexus. Forty female patients, mean age 37 years and suffering from varicose dilatation of the hemorrhoid plexus, were enrolled in the study. The study was carried out in an open comparison with oxerutin using parallel groups with random access. After a run-in period of 3 days, 20 patients commenced treatment with 1 50 mg tablet of heparin sulfate 3 times daily, whereas the other 20 patients were given 1,500 mg oxerutin tablet again 3 times daily. Subsequently, treatment was continued at the following doses: 1 50 mg tablet of heparin sulfate twice a day, and 1,500 mg tablet of oxerutin twice a day, for a duration of two weeks. At pre-established times (before treatment, after 1 week, after 2 weeks), a standard questionnaire was filled in relating to each patient in order to evaluate the efficacy and tolerability of treatment. No adverse or undesirable effects were reported. Each participant was also put on a personalized and computerised diet with the same fibre intake. 55% of patients treated with oxerutin reported persistent moderate or intense pain caused by defecation compared to 45% of the group treated with heparan sulfate. Both drugs induced the remission of skin rash and itching. Compared to the control drug, heparan sulfate was more efficacious in relation to the normalisation of hyperemia and mucoid secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Dose-Response Relationship, Drug; Drug Evaluation; Female; Hemorrhoids; Heparitin Sulfate; Humans; Hydroxyethylrutoside; Random Allocation; Tablets; Varicose Veins

The safety and efficacy of 500 mg O-(beta-hydroxyethyl)rutosides given orally twice daily in the treatment of 97 patients with first-, second-, or third-degree haemorrhoids were investigated in a double-blind, randomized placebo-controlled trial. The rutosides produced a significant (P less than 0.001) improvement in patient-assessed subjective symptoms (pain, bleeding, exudation and pruritus) compared with placebo. There was also a significant (P less than 0.001) improvement in clinician-assessed subjective and objective signs (bleeding, inflammation and dilatation of the haemorrhoidal plexus) after 2 and 4 weeks' treatment compared with placebo. There were three mild, transient side-effects reported in the active treatment group and no drug-related problems in the pregnancy or delivery were observed. The results suggest that O-(beta-hydroxyethyl)rutosides provide a safe and effective treatment for women with haemorrhoids of pregnancy.

Topics: Administration, Oral; Adult; Double-Blind Method; Drug Tolerance; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Pregnancy; Pregnancy Complications, Cardiovascular

The pharmacological treatment is widely used in the therapy of haemorrhoids. An efficient treatment is particularly useful in case of haemorrhoids of 2nd, 3rd and 4th degree, when phlogosis, oedema and pain are present. Forty patients were treated with either O-(beta-hydroxyethyl)-rutosides (4 g/day orally) or placebo in a double blind randomized comparative trial. The groups of treatment were homogeneous. O-(beta-hydroxyethyl)-rutosides induced a statistically significant reduction of pain and bleeding; placebo did not induce any significant improvement. Tolerability was good and similar for both treatments. It has never been necessary to stop treatment for side effects. The results obtained in this study confirm the usefulness on administering an oral treatment, and not only a local treatment, to patients with acute symptoms of haemorrhoids, both in case of intermittent treatment and in case it is used to prepare quickly the patient for surgery.

Topics: Administration, Oral; Clinical Trials as Topic; Double-Blind Method; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Male; Random Allocation; Rutin

Topics: Adrenochrome; Adult; Aged; Drug Evaluation; Drug Therapy, Combination; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Male; Middle Aged; Rutin

Topics: Adult; Aged; Drug Combinations; Female; Hemorrhoids; Humans; Hydroxyethylrutoside; Inositol; Leg; Male; Middle Aged; Nicotinic Acids; Propylamines; Rutin; Venous Insufficiency

Topics: Capsules; Hemorrhoids; Humans; Hydroxyethylrutoside; Phlebitis; Rutin; Varicose Ulcer; Varicose Veins

Topics: Capsules; Flavonoids; Hemorrhoids; Humans; Hydroxyethylrutoside; Rutin