History of treatment of hemorrhoids is a history of unnecessary and invasive treatment.

                                                                     History of research of hemorrhoids is a history of great mistakes.

Treatment of hemorrhoids (medical or conservative)

When internal hemorrhoids begin to develop, the disease is progressive in its course. When untreated, hemorrhoids in the first stage of development soon reach the second and third stages. A great deal can be done to retard this progressive development by judicious palliative treatment. The medical measures have usually consisted of aperients or advice diet and laxatives to overcome constipation. Local medical treatment for hemorrhoids comprises the use the use of ointments and suppositories of various kinds. The value of these preparations is doubtful, but in the eyes of the patients they have the great psychological advantage of being applied directly to the site of origin of their symptoms. Pain caused by a thrombosed hemorrhoid can be treated with reassurance, warm size baths, anesthetic ointments and compresses. Ulcerated edematous strangulated hemorrhoids can be managed conservatively with analgesics, sitz baths, topical compresses and other conservative measures. If the patient is anemic an iron preparation should be prescribed to correct the anemia. A group of British physicians working in Africa in 60-70 years of previous century were surprised of near absence of hemorrhoids in local rural population of Nigeria. The physicians related this phenomenon to high fiber diet typical for rural African population. Accordingly with this hypothesis the last years the most fashionable prescription for this purpose has been unprocessed bran or other preparation, such as Fybogel, designed to increase the bulk of the stools.

Webster D.J. et.all (1) evaluated the influence of ispargula husk on the symptoms of hemorrhoids such as bleeding and prolapse. The patients were randomly allocated into two groups: group A received a 6-week course of isparghula husk 3-5 gr. twice daily followed by a 6-weeks course of a placebo. In group B the order was reversed. The assessing surgeon did not know the composition of groups A and B. The placebo was based on Weetabix, suitably formulated to match the ispargula husk. The sachets of ispargula husk provided approximately 3-6 gr. additional dietary fibre while the placebo sachets contributed approximately 1gr of cereal dietary fibre. The authors further noted that patients were reassessed at 6 and 12 weeks and changes in symptoms, general bowel habit, ease of defecation and palatability was obtained. The authors noted that proctoscopic assessment was made at each attendance and that each patient kept a daily record of his bowel action and the ease of defecation. The authors found slight improvement in bleeding in trial group comparatively to control group (P< 0.025). There was no difference between the groups in regard of prolapse.

Additional study was done to evaluate the role of diet fiber in the treatment of hemorrhoids. Broader et.al. (2) reported a double blind clinical trial designed to assess the value of the bulk-forming aperient (stercula) in the management of patients with hemorrhoids. Observations were confined to the first 3 months of treatment. Forty unselected outpatients with anal bleeding, prolapse or discomfort who had internal hemorrhoids were randomly allocated to trial (stercula) or placebo (starch) treatment groups. The authors concluded that bulk – forming evacuants appeared to affect the signs and symptoms of hemorrhoids more favorably than did a starch placebo but this difference was small and not statistically significant.                                                                        

     The findings in both studies on the role of high fiber diet are not surprising. High fibre diet as is shown in numerous studies is do no more than relaxations of anal sphincters due to high rectal volumes while rectal emptying of solid rectal volumes dependent mostly on straightening of recto-anal angle.

Read more on this topic on this site: fiber diet hypothesis isn’t relevant           

   References:

1 D.J.T. Webster et all The use of bulk evacuant in patients with hemorrhoids. Br.J. Surg. Vol. 65(1978) 291-292

2 J.H. Broader et all Evaluation of a bulk-forming evacuant in the management of hemorrhoids Br.J. Surg. Vol.61 (1974) 142-144