Fiber for the Treatment of Hemorrhoids Complications: A Systematic Review and Meta-Analysis

Alonso‐Coello, Pablo; Mills, Ed; Heels‐Ansdell, Diane; López-Yarto, Maite; Zhou, Qi; Johanson, John F.; Guyatt, Gordon

doi:10.1111/j.1572-0241.2005.00359.x

Cited by 165 publications

(68 citation statements)

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“…This is probably as fibre reduced constipation, which is one of the risk factors of hemorrhoids. 23 In the present study, author also found constipation to be one of the risk factors which was in accordance to other studies. 16,19,24 Straining during defecation was also found to be one of the risk factors which eventually resulted in complications such as bleeding through rectum, mass emerging through rectum as well as prolapse, which was also observed inpresent study.…”

Section: Discussionsupporting

confidence: 93%

Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre

Ravindranath

Rahul

2018

Int Surg J

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Background: Hemorrhoids, also called piles are masses or clumps of tissues which consist of muscle and elastic fibers with enlarged, bulging blood vessels and surrounding supporting tissues present in the anal canal of an individual. This condition is a common ailment among the adults. The actual burden of the disease remains unknown. Hence author had undertaken this study to assess the incidence and the risk factors of this disease among the patients in the area.Methods: 63 patients between the ages 20 and 80 who had come to the outpatient ward with hemorrhoids were included into the study. The demographic details from all the patients were noted. Their dietary habits, bowel habits, amount of physical activity, smoking and alcohol use as well as over the counter medication use were noted in detail.Results: Out of the 63 patients under study, 66.67% were males and 33.33% were females, with the most common age group affected was below 40 years of age. Less than 40% of the patients were vegetarians, with more than half of the patients having a mixed diet. More number of women history of hemorrhoids in their family (47.6%), while the history in the males was only 26.2%. Straining and constipation was seen in majority of the patients while many of them also had chronic cough. Bleeding and mass through the rectum was seen in majority of the patients (96.8% and 93.7% respectively) while 76.2% of them had pain during defecation. Few of the patients (33.3%) soiled their clothes.Conclusions: Hemerrhoids are one of the common diseases observed in patients below 40 years of age, especially if they are under stress. Proper diet, which is inclusive of adequate quantities of fibre as well as with less spice is essential to prevent this disease.

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Section: Discussionsupporting

confidence: 93%

Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre

Ravindranath

Rahul

2018

Int Surg J

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“…A consensus is emerging that a tailored approach is required for treatment of haemorrhoids based on grade. [92][93][94] Early-grade haemorrhoids can be effectively treated conservatively with diet, 95,96 alteration in lifestyle 94 and, perhaps, medical therapy, 38,97,98 whereas at the other end of the spectrum, grade IV circumferentially prolapsed piles may respond only to haemorrhoidectomy or SH. The eTHoS trial 99 hopes to provide data concerning the optimal procedure for the more advanced haemorrhoids.…”

Section: Justification Of Eligibility Criteriamentioning

confidence: 99%

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

Brown

Tiernan

Biggs

et al. 2016

Health Technol Assess

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BackgroundOptimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious.ObjectiveThe comparison of HAL with RBL for the treatment of grade II/III haemorrhoids.DesignA multicentre, parallel-group randomised controlled trial.PerspectiveUK NHS and Personal Social Services.Setting17 NHS Trusts.ParticipantsPatients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL.InterventionsHAL with Doppler probe compared with RBL.OutcomesPrimary outcome – recurrence at 1 year post procedure; secondary outcomes – recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness.ResultsA total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51;p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15;p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base-case analysis, the difference in mean total costs was £1027 higher for HAL. Quality-adjusted life-years (QALYs) were higher for HAL; however, the difference was very small (0.01) resulting in an incremental cost-effectiveness ratio of £104,427 per additional QALY.ConclusionsAt 1 year, although HAL resulted in fewer recurrences, recurrence was similar to repeat RBL. Symptom scores, complications, EQ-5D-5L and continence score were no different, and patients had more pain in the early postoperative period after HAL. HAL is more expensive and unlikely to be cost-effective in terms of incremental cost per QALY.LimitationsBlinding of participants and site staff was not possible.Future workThe incidence of recurrence may continue to increase with time. Further follow-up would add to the evidence regarding long-term clinical effectiveness and cost-effectiveness. The polysymptomatic nature of haemorrhoidal disease requires a validated scoring system, and the data from this trial will allow further assessment of validity of such a system. These data add to the literature regarding treatment of grade II/III haemorrhoids. The results dovetail with results from the eTHoS study [Watson AJM, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A,et al.Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial.Lancet2016, in press.] comparing stapled haemorrhoidectomy with excisional haemorrhoidectomy. Combined results will allow expansion of analysis, allowing surgeons to tailor their treatment options to individual patients.Trial registrationCurrent Controlled Trials ISRCTN41394716.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 88. See the NIHR Journals Library website for further project information.

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“…Чем продолжительнее период родовой деятельно-сти, тем более выражены эти процессы. После родов проис-ходит постепенное сокращение сфинктера заднего прохо-да, внутренние узлы уменьшаются и самостоятельно вправ-ляются, но при быстром сокращении сфинктера возможно ущемление узлов и развитие острого геморроя [5,7,9].…”

Section: ключевые слова: геморрой лечение местная терапия постеризанunclassified

Hemorrhoids in pregnant and postpartum women: principles of therapy

Lomova¹,

Dubrovina²,

Драгун³

et al. 2016

Med. sov.

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Fiber for the Treatment of Hemorrhoids Complications: A Systematic Review and Meta-Analysis

Abstract: Trials of fiber show a consistent beneficial effect for symptoms and bleeding in the treatment of symptomatic hemorrhoids.

Cited by 165 publications

References 25 publications

Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre

Prevalence and risk factors of hemorrhoids: a study in a semi-urban centre

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

Hemorrhoids in pregnant and postpartum women: principles of therapy

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