Hemorrhoidal disease
Symptoms from hemorrhoidal cushions: bleeding, prolapse, pain, itching. Internal (Goligher I–IV) and external hemorrhoids. ASCRS 2018 and SECC 2022 foundation therapy: stool optimization (25–30 g/day fiber, 2 L hydration), sitz baths, and topical agents. In marked symptoms, a short course of flavonoid agents (diosmin/hesperidin) is added. When conservative measures fail, minimally invasive procedures (rubber-band ligation, sclerotherapy) or hemorrhoidectomy in grade IV are next.
ICD-10 K644 drugs
Also known as: Hemorrhoids, Piles
Drugs used for this condition
- CDiosmin/hesperidinAdd-on therapy · Micronized purified flavonoid fraction, «venoactive» agentIn hemorrhoidal flares, used short-term to reduce pain, bleeding, and edema. The Alonso-Coello 2006 meta-analysis of flavonoids in hemorrhoids showed relative risk of no response of 0.42 (95% CI 0.28–0.61). Acute dose: 6 tablets per day for 4 days, then 4 tablets per day for 3 days. Foundation therapy is stool optimization (fiber, hydration), topical care, and minimally invasive procedures for severe symptoms.
- DSea buckthornAdd-on therapy · Herbal preparation, sea buckthorn berries and seeds (Hippophae rhamnoides); in Russia sea buckthorn oil is a registered medicinal product for topical useIn Russia sea buckthorn rectal suppositories are registered for haemorrhoids, anal fissures and proctitis in the healing phase. Suppositories are inserted once or twice daily after defecation for 10–14 days. The evidence base consists of Soviet-era clinical studies and case series; Western-style RCTs are absent. International haemorrhoid guidelines (ASCRS 2018, ESCP 2020) do not include sea buckthorn; first-line therapy in stage 1–2 disease is bowel-habit normalisation, flavonoids (micronised purified flavonoid fraction – Daflon, diosmin), topical steroids or anaesthetics. If conservative therapy fails, rubber-band ligation or haemorrhoidectomy follow. If sea buckthorn suppositories were prescribed by a Russian doctor for a superficial anal fissure without active bleeding, the use follows the national pharmacopoeia. For overt bleeding, haemorrhoidal thrombosis or suspected colorectal cancer, sea buckthorn does not replace proctology assessment and colonoscopy.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DGlycerolNot recommended · Rectal laxative, osmotic and stimulantWith hemorrhoids constipation is doubly hard, and a glycerol suppository looks like the obvious answer. The AEMPS ficha técnica thinks otherwise: anorectal disorders, hemorrhagic proctocolitis and inflammatory hemorrhoidal processes are among the contraindications. The reason is simple: the suppository mechanically irritates the inflamed pile and the lining, and the flare worsens. The logic of hemorrhoid treatment is the reverse – soften the stool systemically rather than irritate the rectum. That means fibre, water, an oral osmotic laxative, sitz baths and topical products prescribed by a doctor. Rectal bleeding is also not always hemorrhoidal, and writing it off to piles without an examination is unsafe. If glycerol suppositories were advised during a hemorrhoid flare, consider seeking a second opinion.
- DSodium lauryl sulfoacetateNot recommended · Rectal laxative, wetting agentDuring a hemorrhoid flare a micro-enema looks like the gentle option, but the AEMPS ficha técnica lists acute hemorrhoidal crisis and hemorrhagic colitis among the contraindications. The cannula mechanically touches the inflamed pile, the lining is already fragile and bleeding increases. The logic of hemorrhoid treatment is different: soften the stool systemically – fibre, water, an oral osmotic laxative – so that defecation does not injure the piles, plus sitz baths and topical products prescribed by a doctor. Rectal bleeding deserves a separate conversation: in some patients the cause is not hemorrhoids, and writing it off to piles without an examination is unsafe. If a micro-enema was advised during a hemorrhoid flare, consider seeking a second opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit