Hemorrhoids

Also Know As Piles

Sign/Symptoms
Anus Swelling and Inflammation Lump Near The Anus Pain Anorectal Rectal Bleeding Stool With Bright Red Blood (Hematochezia)

Drugs
Senna

Treatments
Surgery Excision Hemorrhoidectomy Stapled Hemorrhoidopexy Medical Procedure Botulinum Toxin A Injection (Botox) Infrared Coagulation Sclerotherapy Rubber Band Ligation Radiofrequency Coagulation Hemorrhoidolysis Alternative Medicine Butchers Broom (Ruscus Aculeatus) Weakly in Favour Low Evidence Chamomile (Matricaria Chamomilla) Weakly Against Low Evidence Horse Chestnut Seed Extract (HCSE) No Recommendation Low Evidence Witch Hazel (Hamamelis Virginiana) No Recommendation Low Evidence Thuja (Eastern White Cedar, Thuja Occidentalis) No Recommendation Very Low Evidence Psyllium (Isphagula, Plantago Psyllium) Strongly in Favour High Evidence St Johns Wort (Goatweed, Tipton Weed, Hypericum Perforatum) No Recommendation Low Evidence Pau Darco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) Strongly Against Very Low Evidence Pokeweed Antiviral Protein (PAP) No Recommendation Very Low Evidence Lifestyle Changes Cold Compress Weakly in Favour Low Evidence Rest Weakly in Favour Low Evidence Moisturizing Cream Weakly in Favour Low Evidence High Fiber Diet Strongly in Favour Moderate Evidence Warm Bath Weakly in Favour Low Evidence Medical Therapy Botulinum Toxin A Injection (Botox) Weakly in Favour Low Evidence Excision Weakly in Favour Low Evidence Hemorrhoidolysis Weakly in Favour Low Evidence Infrared Coagulation Weakly in Favour Low Evidence Radiofrequency Coagulation Weakly in Favour Low Evidence Rubber Band Ligation Weakly in Favour Low Evidence Sclerotherapy Weakly in Favour Low Evidence Hemorrhoidectomy Weakly in Favour Low Evidence Stapled Hemorrhoidopexy Weakly in Favour Low Evidence

Attributes
Incidence is approximately 1 in 23 people

Further Tests
Fecal Occult Blood Test Fecal Blood (Increased)

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 45, 46, 47]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: No recommendation (There is insufficient evidence to support claims that Thuja helps to treat hemorrhoids)

Grade of Evidence: Very low quality of evidence

St John's Wort (Goatweed, tipton weed, Hypericum Perforatum) [19, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that St Johns Wort can help to treat hemorrhoids)

Grade of Evidence: Low quality of evidence

Psyllium (Isphagula, Plantago Psyllium) [19, 28, 29, 30, 31, 32, 33]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Strongly in favor (Clinical trials have shown that Psyllium is effective in treating hemorrhoids)

Grade of Evidence: High quality of evidence

Pokeweed Antiviral Protein (PAP) [19, 23, 24, 25, 26, 27]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Warning! All parts of the plant, Pokeweed (Phytolacca Americana), is poisonous and should not be ingested. Thoroughly cooking the plant reduces that toxicity. The effects of the improperly prepared plant include vomiting, diarrhoea, cramps, headache, confusion, convulstions, low blood pressure, heart block and death. Only plant extracts (PAP) or thoroughly prepared plants should be ingested, and even then, under professional medical guidance.

Recommendation: No recommendation (There is insufficient evidence to support claims that PAP helps to treat hemorrhoids)

Grade of Evidence: Very low quality of evidence

Pau D'Arco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) [19, 22]:

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat hemorrhoids. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: Very low quality of evidence

Chamomile (Matricaria Chamomilla) [19. 20, 21]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (Available evidence does not support claims that Chamomile helps treat hemorrhoids. In addition, allergic reactions and side effects like cramps, itching, rashes and difficulty breathing can be relatively common)

Grade of Evidence: Low quality of evidence

Black Walnut (Juglans Nigra):

Recommendation: No recommendation (Available evidence does not support claims that Black Walnut helps to treat Hemorrhoids)

Grade of Evidence: Low quality of evidence

Horse-Chestnut Seed Extract (HCSE) [48, 49]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: No recommendation (There is insufficient evidence to support claims that HCSE helps to treat hemorrhoids)

Grade of Evidence: Low quality of evidence

Witch Hazel (Hamamelis Virginiana) [50]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that witch hazel helps to treat hemorrhoids)

Grade of Evidence: Low quality of evidence

Butchers Broom (Ruscus Aculeatus) [51, 52, 53]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Studies show that butchers broom may be beneficial to those hemorrhoids as it supports a healthy circulatory system. More studies are needed)

Grade of Evidence: Low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. http://www.ncbi.nlm.nih.gov/pubmed/16405552?dopt=Abstract

2. http://www.ncbi.nlm.nih.gov/pubmed/15981059?dopt=Abstract

3. http://www.ncbi.nlm.nih.gov/pubmed/11432512?dopt=Abstract

4. http://www.ncbi.nlm.nih.gov/pubmed/18373905?dopt=Abstract

5. http://www.ncbi.nlm.nih.gov/pubmed/18176936?dopt=Abstract

6. http://www.mrw.interscience.wiley.com.ezproxy.library.uwa.edu.au/cochrane/clsysrev/articles/CD005034/frame.html

7. http://www.ncbi.nlm.nih.gov/pubmed/9030078?dopt=Abstract

8. http://www.ncbi.nlm.nih.gov/pubmed/19513028?dopt=Abstract

9. http://www.ncbi.nlm.nih.gov/pubmed/8835901?dopt=Abstract

10. http://www.ncbi.nlm.nih.gov/pubmed/18844269?dopt=Abstract

11. http://www.ncbi.nlm.nih.gov/pubmed/15064544?dopt=Abstract

12. MacKay D (2001). "Hemorrhoids and varicose veins: a review of treatment options" (PDF). Altern Med Rev 6 (2): 126–40. PMID 11302778

13. Pizzorno JE and Murray MT, eds., ed (1998). Encyclopedia of Natural Medicine (revised 2nd ed.). CA: Prima Publishing. pp. 829.

14. Rudofsky G (1989). "[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress]" (in German). Fortschr. Med. 107 (19): 52, 55–8. PMID 2668140

15. Cappelli R, Nicora M, Di Perri T (1988). "Use of extract of Ruscus aculeatus in venous disease in the lower limbs". Drugs Exp Clin Res 14 (4): 277–83. PMID 3048951

16. Pittler MH, Ernst E (1998). "Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review". Arch Dermatol 134 (11): 1356–60. doi:10.1001/archderm.134.11.1356

17. Diehm C, Trampisch HJ, Lange S, Schmidt C (1996). "Comparison of leg compression stocking and oral Horse-chestnut seed extract therapy in patients with chronic venous insufficiency". Lancet 347 (8997): 292–4

18. Longman RJ, Thomson WH (2006). "A prospective study of outcome from rubber band ligation of piles". Colorectal Dis 8 (2): 145–8. doi:10.1111/j.1463-1318.2005.00873.x

19. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

20.http://www.abchomeopathy.com/r.php/Cham

21. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html

22. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pau-d-arco

23. http://www.cbif.gc.ca/pls/pp/ppack.info?p_psn=12&p_type=all&p_sci=sci&p_x=px

24. http://www.pfaf.org/user/Plant.aspx?LatinName=Phytolacca+americana

25. http://www.ncbi.nlm.nih.gov/pubmed/315368

26. http://www.nlm.nih.gov/medlineplus/ency/article/002874.htm

27. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pokeweed

28. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-psyllium.html

29. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601104.html

30. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed&part=A17913

31. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/psyllium

32. http://www.mayoclinic.com/health/cholesterol-lowering-supplements/CL00013/METHOD=print

33. http://www.ageless.co.za/herb-psyllium.htm

34. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/st-johns-wort

35. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-stjohnswort.html

36. http://www.ncbi.nlm.nih.gov/pubmed/18843608

37. http://www.ncbi.nlm.nih.gov/pubmed/11939866

38. http://nccam.nih.gov/health/stjohnswort/ataglance.htm

39. http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm

40. http://www.nimh.nih.gov/health/publications/depression/how-is-depression-detected-and-treated.shtml

41. http://www.ncbi.nlm.nih.gov/pubmed/11939872

42. http://www.ncbi.nlm.nih.gov/pubmed/12132963

43. http://www.ncbi.nlm.nih.gov/pubmed/16423519

44. http://jama.ama-assn.org/cgi/content/full/299/22/2633

45. http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm

46. http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf

47. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0

48. https://nccih.nih.gov/health/horsechestnut

49. https://www.nlm.nih.gov/medlineplus/druginfo/natural/1055.html

50. https://umm.edu/health/medical/altmed/condition/hemorrhoids

51. http://www.ncbi.nlm.nih.gov/pubmed/11152059

52. http://www.ncbi.nlm.nih.gov/pubmed/12040966

53. http://www.drugs.com/npc/butcher-s-broom.html

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