Venotonics in Hemorrhoid Therapy – Results of a Systematic Review
Hemorrhoids are among the most common pathological findings in the anorectal area, and their incidence increases with age. Various modalities are used in the treatment of this condition, which has unpleasant health and psychological complications, aiming to alleviate the symptoms. Widely used and very popular are so-called venotonics, a large group of drugs and dietary supplements, mostly of natural origin, including diosmin.
Introduction
Hemorrhoids are knot-like expanded venous plexuses in the area of the rectum and anal canal, usually arising secondarily due to persistent elevation of venous pressure in the hemorrhoidal venous plexuses. Various modalities are used in hemorrhoid therapy, including dietary and lifestyle adjustments, local symptomatic treatment, systemic pharmacotherapy, and surgical procedures.
In the context of pharmacotherapy, venotonics or substances that increase the tone of venous walls are popular and widely used drugs. Despite their name, their action is generally much more complex, and venotonics also represent a heterogeneous group of drugs and dietary supplements. The most commonly used venotonic is the flavonoid diosmin, but several other substances are available on the market, whose effects have been verified in numerous studies. The aim of the Cochrane systematic review was to verify the effectiveness of venotonics in alleviating the signs, symptoms, and severity of hemorrhoids.
Evaluated Studies
The final analysis included 24 randomized controlled clinical trials, of which 8 studies were subsequently excluded due to insufficient methodological quality. Most studies examined the use of venotonics with a control intervention (in 4 studies, the use of venotonics was compared with hemorrhoidectomy, in 1 study with hemorrhoid ligation, and in the remaining studies with a placebo). The remaining studies compared the effects of individual venotonics. In the largest number of studies (n = 13), diosmin was used as the active treatment.
Results
Compared to the control intervention, venotonics showed significant improvement in itching parameters (odds ratio [OR] 0.23; 95% confidence interval [CI] 0.07–0.79; p = 0.02), bleeding (OR 0.12; 95% CI 0.04–0.37; p = 0.0002), bleeding post-hemorrhoidectomy (OR 0.18; 95% CI 0.06–0.58; p = 0.004), discharge and stool leakage (OR 0.12; 95% CI 0.04–0.42; p = 0.0008) and overall symptom improvement (OR 15.99; 95% CI 5.97–42.84; p < 0.00001).
Venotonics also showed a benefit in other parameters, albeit without reaching the level of statistical significance, specifically in pain alleviation (OR 0.11; 95% CI 0.01–1.11; p = 0.06), pain score post-hemorrhoidectomy (standardized mean difference –1.04; 95% CI –3.21 to 1.12; p = 0.35) and consumption of analgesics post-surgery (OR 0.54; 95% CI 0.30–0.99; p = 0.05).
Conclusion
Available evidence supports the favorable effect of venotonics, especially those based on diosmin, in the therapy of hemorrhoids in terms of various clinical parameters, including itching, bleeding, discharge, and stool leakage.
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Source: Perera N., Liolitsa D., Iype S. et al. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 2012; 8: CD004322, doi: 10.1002/14651858.CD004322.pub3.
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