The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Indrasena, Buddhike Sri Harsha; Ghahramani, Leila; Hosseini, Seyed Vahid; Rahimikazerooni, Salar; Bananzadeh, Alimohammad; Jahromi, Bahia Namavar; Samsam, Alamtaj; Zadeh, Abbas Rezaeian; Safarpour, Ali Reza; Jahromi, Ali Bagherpour; Banihashemi, Seyed Hesamaddin

doi:10.17795/acr-11488

Cited by 12 publications

(3 citation statements)

References 15 publications

(11 reference statements)

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“…We read with interest the article published by Ghahramani, et al (1). The research has been well-planned and blinded.…”

Section: Dear Editormentioning

confidence: 99%

Commentary on: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Indrasena¹

2013

Ann Colorectal Res

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We read with interest the article published by Ghahramani, et al. (1). The research has been well-planned and blinded. The results are impressive. However, there is a discrepancy between the outcome measures of the study and the outcome measured mentioned in the title. It would be better if constipation as an outcome is also included in the title because constipation alone without haemorrhoids and fissures is also a cause of concern in pregnancy. Further, I found that the results of the study are more reliable with respect of beneficial effects on constipation than haemorrhoids.I would like to make the following remarks in good faith regarding this study:A) It was not clear whether the subjects followed the same life style as usual during the study or they were free to change whenever necessary. Lack of activity and lowfiber and water diet can be considerd as the risk factors for constipation (2). Also it is not clear whether they were advised to refrain from using additional measures to soften stools when they felt constipated or they were free to follow additional measures to prevent constipation.B) It is also not clear how many of them actually sought medical attention for their disease during the follow up period; this is a better parameter than routine clinical examinations because only symptomatic patients need treatment. One study has reported 82% prevalence of haemorrhoids in asymptomatic population (3). It is also taught in medical schools that haemorrhoids are the normal vascular cushions in the anal canal and is a disease only when they give rise to problems like bleeding and prolapse. This aspect has not been addressed in this study.C) The article does not say clearly how haemorrhoids was diagnosed and excluded at the beginning and at the end of the study. The study had not tried to assess the severity of the disease. Further it can be understood from the article that the prevalence of haemorrhoids in the placebo group was 1%. This has to be equivalent to the prevalence of haemorrhoids in the general population in the third trimester of pregnancy. However this figure is much less than the reported prevalence of haemorrhoids in the third trimester of pregnancy, which is as high as 11%-38% (4). Therefore the results with respect to haemorrhoids are not reliable in this study. D) In this study the incidence of constipation in the placebo group was 18%. This can be taken as the prevalence of constipation in the population in the third trimester of pregnancy. The results here seem to be reliable because the figure is comparable with the other published studies (5). Looking at the results the incidence of constipation had come down from 18% to 5% after treating with Psyllium. This is a good achievement. But still 5% continue to carry the problem. This means constipation remains a significant problem among pregnant women even after using this medicine.Accordingly this article showed that Psyllium can be used effectively in pregnancy to prevent constipation but its efficacy in preventing haemorrhoids cannot ...

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“…We read with interest the article published by Ghahramani, et al (1). The research has been well-planned and blinded.…”

Section: Dear Editormentioning

confidence: 99%

Commentary on: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Indrasena¹

2013

Ann Colorectal Res

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“…Dear Editor, Ghahramani et al recently published a well-organized, double blind, placebo-controlled clinical trial concerning the efficacy of psyllium powder laxatives in preventing constipation, hemorrhoids, and anal fissure during pregnancy (1). The authors concluded that psyllium powder consumption used during the third trimester of pregnancy could significantly prevent constipation, hemorrhoid, and anal fissure.…”

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confidence: 99%

“…It was proven that in the non-pregnant population, the psyllium laxatives increased the frequency of defecation; however, data concerning the treatment of constipation in pregnancy are limited (5). The results of Ghahramani et al (1) suggest that psyllium powder supplementation can be a great resource for pregnant patients with constipation. Since some data suggest that psyllium use might significantly reduce the systolic and diastolic blood pressures in overweight individuals with hypertension, it would be represented as another important indication of its usage (6).…”

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confidence: 99%

Psyllium Powder Laxatives Are Effective Treatment of Constipation in Pregnancy, but What Is About Safety?

et al. 2014

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Interventions for treating constipation in pregnancy

Rungsiprakarn

Laopaiboon

Sangkomkamhang

et al. 2015

Cochrane Database of Systematic Reviews

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There is insufficient evidence to comprehensively assess the effectiveness and safety of interventions (pharmacological and non-pharmacological) for treating constipation in pregnancy, due to limited data (few studies with small sample size and no meta-analyses). Compared with bulk-forming laxatives, stimulant laxatives appear to be more effective in improvement of constipation (moderate quality evidence), but are accompanied by an increase in diarrhoea (moderate quality evidence) and abdominal discomfort (low quality evidence) and no difference in women's satisfaction (moderate quality evidence). Additionally, fibre supplementation may increase frequency of stools compared with no intervention (moderate quality evidence), although these results were of moderate risk of bias.There were no data for a comparison of other types of interventions, such as osmotic laxatives, stool softeners, lubricant laxatives and enemas and suppositories.More RCTs evaluating interventions for treating constipation in pregnancy are needed. These should cover different settings and evaluate the effectiveness of various interventions (including fibre, osmotic, and stimulant laxatives) on improvement in constipation, pain on defecation, frequency of stools and consistency of stools.

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The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Cited by 12 publications

References 15 publications

Commentary on: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Commentary on: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure during Pregnancy, a Randomized Double Blind Clinical Trial

Psyllium Powder Laxatives Are Effective Treatment of Constipation in Pregnancy, but What Is About Safety?

Interventions for treating constipation in pregnancy

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