Evaluation of the Efficacy and Safety of a Compound of Micronized Flavonoids in Combination With Vitamin C and Extracts of Centella asiatica, Vaccinium myrtillus, and Vitis vinifera for the Reduction of Hemorrhoidal Symptoms in Patients With Grade II and III Hemorrhoidal Disease: A Retrospective Real-Life Study

Abstract

Background and Aim: Several evidences have shown how, in hemorrhoidal disease, phlebotonic flavonoid agents such as quercetin reduce capillary permeability by increasing vascular walls resistance, how rutin and vitamin C have antioxidant properties, and that Centella asiatica has reparative properties towards the connective tissue. A retrospective study was designed in order to evaluate the efficacy and safety of a compound consisting of micronized flavonoids in combination with vitamin C and extracts of C. asiatica, Vaccinium myrtillus, and Vitis vinifera for grade II and III hemorrhoidal disease.Patients and Methods: Data of 49 patients, over 18, who were following a free diet regimen, not on therapy with other anti-hemorrhoid agents, treated with a compound consisting of 450 mg of micronized diosmin, 300 mg of C. asiatica, 270 mg of micronized hesperidin, 200 mg of V. vinifera, 160 mg of vitamin C, 160 mg of V. myrtillus, 140 mg of micronized quercetin, and 130 mg of micronized rutin (1 sachet or 2 tablets a day) for 7 days were collected. Hemorrhoid grade according to Goligher’s scale together with anorectal symptoms (edema, prolapse, itching, thrombosis, burning, pain, tenesmus, and bleeding) both before treatment (T0) and after 7 days of therapy (T7) were collected. Primary outcomes were the reduction of at least one degree of hemorrhoids according to Goligher’s scale assessed by proctological examination and compound safety. The secondary outcome was the reduction of anorectal symptoms assessed by questionnaires administered to patients.Results: Forty-four patients (89.8%) presented a reduction in hemorrhoidal grade of at least one grade (p < 0.001). No adverse events with the use of the compound were noted. A significant reduction was observed in all anorectal symptoms evaluated (p < 0.05). No predictors of response to the compound were identified among the clinical and demographic variables collected.Conclusion: The compound analyzed was effective and safe for patients with grade II and III hemorrhoidal disease according to Goligher’s scale.

Impact of Capsella bursa-pastoris (Shepherd’s Purse) Herbal Tea Preparations on Symptoms and Severity of Hemorrhoidal Disease: A Prospective Randomized Study

“…19 Such herbs have active substances such as tannins, saponins, flavonoids, phenocolic acids, and alcohol. 7,9,10,16,19 It was reported in Hashempur's review that more than half of the herbs with antihemorrhoidal usage in Iran exhibited antiinflammatory and analgesic effects. 11 Several mechanisms have been put forward to explain the anti-hemorrhoidal properties of these active substances including improvement of the venous tone, increases in lymphatic drainage, protection of capillary bed microcirculation, inhibition of inflammatory reactions and decreases in capillary permeability.…”

“…The disease severity was determined according to the Goligher scale. 7 Patients with 1st and 4th-degree hemorrhoids, perianal pathologies, a previous interventional or surgical hemorrhoid treatment history, coagulation disorders, and those who were pregnant,, or lactating, or using anticoagulants, were excluded from the study. The patients were informed that they were free to withdraw from the study at any time.…”

“…The severity of the hemorrhoidal disease was graded via a rectal examination with anoscopy as grade 2 or 3. 7 Based on the quadratic distribution, the number of the quadrants of the hemorrhoidal plexuses was also recorded. Hemorrhoids present in all four quadrants were defined as circumferential hemorrhoids.…”

Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

“…Bowel habit regulation is essential to managing hemorrhoids (7)(8)(9). For instance, oral fiber is adjusted for constipation symptoms (5,10) and flavonoids decrease the risk and recurrence rate of hemorrhoids (11).…”