Hemorrhoids are swollen, inflamed veins in the rectum that can ache and bleed. They are very common and are usually caused by constipation, a low-fiber diet, a sedentary lifestyle, pregnancy, or liver cirrhosis.
The most important interventions for hemorrhoids aim at reversing their causes. Adopting a high-fiber diet, sitting down less, getting plenty of exercise, and maintaining regular bowel habits can make a significant difference.
Medical treatment consists mainly of stool softeners and moist heat. In more severe cases, surgical procedures may be used.
Contrary to popular belief, it does not appear that consumption of foods spiced with hot chili peppers causes any discomfort or harm to people with hemorrhoids; a double-blind study found no difference in symptoms following consumption of hot peppers or placebo.11
Bioflavonoids are colorful substances that occur widely in the plant kingdom. Reasonably good, though not indisputable, evidence suggests that the citrus bioflavonoids diosmin and hesperidin (in a special micronized combination preparation) may be helpful for hemorrhoids.12
For example, a 2-month, double-blind, placebo-controlled trial of 120 individuals with recurrent hemorrhoid flare-ups found that treatment with combined diosmin and hesperidin significantly reduced the frequency and severity of hemorrhoid attacks.1 Another double-blind, placebo-controlled trial of 100 individuals had positive results with the same bioflavonoids in relieving symptoms once a flare-up of hemorrhoid pain had begun.2 A 90-day, double-blind trial of 100 individuals with bleeding hemorrhoids also found significant benefits for both treatment of acute attacks and prevention of new ones.3 Finally, this bioflavonoid combination was found to compare favorably with surgical treatment of hemorrhoids.4 However, less impressive results were seen in a double-blind, placebo-controlled study, in which all participants were given a fiber laxative with either combined diosmin and hesperidin or placebo.5
Other sources of bioflavonoids have been studied, as well. For example, in a 4-week, double-blind, placebo-controlled trial of 40 people with hemorrhoids, use of an extract made from the bioflavonoid-rich herb bilberry significantly reduced hemorrhoid symptoms as compared to placebo.10 In addition, according to some but not all double-blind studies, the semi-synthetic bioflavonoids known as oxerutins may also be helpful for hemorrhoids, including the hemorrhoids that occur during pregnancy.6,7
Although it is not known precisely how flavonoids work, it is thought that they stabilize the walls of blood vessels, making them less susceptible to injury.
One study reported benefit for hemorrhoids by using a combination of olive oil, honey, and beeswax.13 However, because this trial lacked a placebo group, its results mean little to nothing. (For information on the necessity of placebos, see Why Does This Database Depend On Double-Blind Studies?)
The natural treatments used for varicose veins are also often recommended for hemorrhoids, because a hemorrhoid is actually a special kind of varicose vein. Some of the most commonly mentioned include horse chestnut, oligomeric proanthocyanidins (OPCs), gotu kola, and butcher's broom.
Traditional herbal remedies for hemorrhoids include calendula (applied topically), Collinsonia root (oral or topical), oak bark (topical), slippery elm (oral or topical), and witch hazel (topical). However, there has been little to no scientific evaluation of these treatments.
For a discussion of homeopathic approaches to hemorrhoids, see the article of that name in the Homeopathy database.
1. Godeberge P. Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Angiology. 1994;45:574-578.
2. Cospite M. Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology. 1994;45:566-573.
3. Misra MC, Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg. 2000;87:868-872.
4. Ho YH, Tan M, Seow-Choen F. Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum. 2000;43:66-69.
5. Thanapongsathorn W, Vajrabukka T. Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum. 1992;35:1085-1088.
6. Wijayanegara H, Mose JC, Achmad L, et al. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res. 1992;20:54-60.
7. Wadworth AN, Faulds D. Hydroxyethylrutosides. A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs. 1992;44:1013-1032.
8. Saggioro A, Chiozzini G, Pallini P, et al. Treatment of hemorrhoidal crisis with mesoglycan sulfate [in Italian; English abstract]. Minerva Dietol Gastroenterol. 1985;31:311-315.
9. Saggioro A, Chiozzini G. Mesoglycan sulfate in acute hemorrhoidal pathology [in Italian; English abstract]. Minerva Med. 1986;77:1909.
10. Villalba G. Anthocyanosides as a new vasculotrophic agent in patients with hemorrhoids. Medicina (Mex). 1974;54:73-76.
11. Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized placebo-controlled crossover trial. Dis Colon Rectum. 2006 May 19. [Epub ahead of print]
12. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006 May 31. [Epub ahead of print]
13. Al-Waili NS, Saloom KS, Al-Waili TN, et al. The safety and efficacy of a mixture of honey, olive oil, and beeswax for the management of hemorrhoids and anal fissure: a pilot study. Sci World J. 2006;6:1998-2005.
Last reviewed September 2014 by EBSCO CAM Review Board
Last Updated: 9/18/2014
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