From the Guidelines
Flavonoid medications are a recommended treatment option for patients with complicated hemorrhoids to relieve symptoms. According to the most recent guidelines, in patients with complicated hemorrhoids, non-operative management is recommended as first-line therapy, including dietary and lifestyle changes, and flavonoids can be administered to relieve symptoms 1. The use of flavonoids, such as micronized purified flavonoid fraction (MPFF), has been shown to be effective in reducing symptoms of hemorrhoids, including bleeding, pain, and itching, by strengthening vein walls, reducing inflammation, and improving microcirculation in the anal region 1.
Some key points to consider when using flavonoid medications for hemorrhoids include:
- The standard dosage of MPFF is 1000 mg daily for acute hemorrhoid episodes, which can be taken for 4-6 weeks
- For maintenance therapy, 500 mg daily may be sufficient
- Other flavonoid products, such as Venoruton (oxerutin) and Cyclo 3 Fort (combination of flavonoids), are also available
- Flavonoids are generally well-tolerated with minimal side effects, mainly mild gastrointestinal discomfort in some patients
- Lifestyle modifications, such as increased fiber intake, adequate hydration, and proper bathroom habits, should be used alongside flavonoid medications for optimal symptom management.
It is essential to note that while flavonoids can be effective for symptom management, they should not replace medical evaluation and treatment for severe or persistent hemorrhoids. Consult a healthcare provider for additional treatments that may be necessary 1.
From the FDA Drug Label
Multiple studies involving several hundred patients have been reported These have routinely shown that diosmin reduces symptoms of discomfort, swelling, inflammation and time to resolution when compared to standard of care. In general, resolution time of acute flares is shortened from 8 days to 4-5 days. A double-blind, placebo-controlled study (n=120) showed statistically better management of pain, pruritis, discharge, edema, erythema, and bleeding on examination One study (n=351) compared the effacacy of combining infrared photocoagulation (IRP) and diosmin vs each therapy used alone on bleeding cessation in patients with grades I, II, and III acute internal hemorrhoids. Patients experiencing an acute hemorrhoidal episodes for less then 48 h were enrolled in a randomized, double-blind, placebo-controlled study. One group received diosmin (n=49) and the other a placebo (n=41) During the 7 day administration, there was a significant difference in favor of diosmin in the dietary management of discomfort, edema and bleeding. A study has compared the results of the conservative management of hemorrhoids between diosmin and sclerotherapy (SCL), in terms of the subjective and objective outcome of patients after a follow-up period of 2 years In another study of 100 patients with endoscopically confirmed hemorrhoids, patients receiving diosmin showed an improvement in discomfort, anal discharge, proctitis and time to resolution compared to placebo (p<0. 001).
Diosmin is effective in the management of hemorrhoids, with studies showing a reduction in symptoms such as:
- Discomfort
- Swelling
- Inflammation
- Time to resolution
- Pain
- Pruritis
- Discharge
- Edema
- Erythema
- Bleeding The use of diosmin has been compared to other treatments, including infrared photocoagulation and sclerotherapy, and has been shown to be effective in the management of acute internal hemorrhoids 2.
From the Research
Flavonoid Medications for Hemorrhoids
- Flavonoids are herbal medicines widely used for chronic venous diseases and hemorrhoids, with the ability to reduce venous stasis, suppress local inflammation, improve venous tone, and lymphatic outflow 3.
- Diosmin, a type of flavonoid, has been shown to be effective in decreasing pain and bleeding in patients with hemorrhoids, with reduction rates of 79% and 67% respectively, in the first treatment week 4.
- A flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) has been found to be safe and effective in managing bleeding from hemorrhoidal disease, with minimal adverse events reported 5.
Efficacy of Flavonoids in Hemorrhoid Treatment
- Studies have demonstrated the efficacy of flavonoids in reducing symptoms of hemorrhoids, including pain, bleeding, and edema 4, 5, 6.
- A prospective, randomized, triple-blind, controlled trial found that a mixture of diosmin, troxerutin, and hesperidin significantly decreased pain, bleeding, and the proportion of patients with edema and thrombosis after 12 days of treatment 6.
- Another study found that semisynthetic diosmin improved clinical signs, quality of life, and CEAP stage of chronic venous insufficiency in patients with HVI 7.
Safety and Tolerability of Flavonoids
- Flavonoids have been found to be well-tolerated, with excellent tolerability and minimal adverse events reported 4, 5, 6.
- A study found that diosmin had excellent tolerability, making it easy to handle by general practitioners and useful for proctologists in preparing patients for further treatments 4.