What is the efficacy of Maylinglong for treating hemorrhoids?

Maylinglong for Hemorrhoids: Efficacy and Evidence

There is no specific evidence supporting the efficacy of Maylinglong for treating hemorrhoids in the provided medical literature and guidelines. Based on the American Gastroenterological Association guidelines, topical treatments for hemorrhoids have limited supporting data overall 1, 2.

Standard Hemorrhoid Classification and Symptoms

• Hemorrhoids are classified as internal (above the dentate line) or external (below the dentate line) 1
• Internal hemorrhoids are graded I-IV based on severity of prolapse, with grade I hemorrhoids bleeding but not protruding, and grade IV being irreducible prolapsed hemorrhoids 1, 2
• External hemorrhoids typically become symptomatic only when thrombosed, presenting with acute anal pain and a palpable perianal lump 1
• Common hemorrhoid symptoms include bleeding, pain, pressure, mucus discharge, and pruritus ani 1

Evidence-Based Treatments for Hemorrhoids

First-Line Conservative Management

• Increased dietary fiber and water intake to soften stool and reduce straining is the universal recommendation for all hemorrhoid grades 1, 2
• Avoiding straining during defecation is critical to prevent symptom exacerbation 2
• Controlling diarrhea with fiber and anti-motility agents can benefit hemorrhoid symptoms 1

Topical Treatments with Evidence

• Topical analgesics may provide symptomatic relief of local pain and itching 1, 2
• Corticosteroid creams can reduce local perianal inflammation but should be used short-term (≤7 days) as long-term use can cause tissue thinning 1, 2
• Topical 0.3% nifedipine with 1.5% lidocaine applied every 12 hours for two weeks has shown effectiveness for external hemorrhoids 2
• Nitroglycerin ointment has demonstrated relief for pain from thrombosed external hemorrhoids, though headaches may limit use 1, 2

Oral Medications with Evidence

• Micronized purified flavonoid fraction (MPFF) has shown efficacy in placebo-controlled trials, working by increasing venous tone and normalizing capillary permeability 1
• Phlebotonics (including flavonoids) can reduce bleeding, rectal pain, and swelling, though symptoms often recur within 3-6 months after stopping treatment 3

Procedural Interventions

• Rubber band ligation is the most effective office-based procedure for grades I-III hemorrhoids, with success rates up to 89% 2, 3
• Sclerotherapy is suitable for first and second-degree hemorrhoids, with 70-85% short-term efficacy 1, 3
• Surgical hemorrhoidectomy is indicated for failed conservative therapy or grades III-IV hemorrhoids 2, 3

Clinical Approach to Hemorrhoid Treatment

1. Begin with conservative measures: increased fiber, water intake, and avoiding straining 1, 2
2. For symptomatic relief, use evidence-based topical treatments like lidocaine for pain or short-term corticosteroids for inflammation 2
3. Consider oral phlebotonics like MPFF for symptom management 1, 3
4. For persistent symptoms, proceed to office-based procedures like rubber band ligation or sclerotherapy based on hemorrhoid grade 2, 3
5. Reserve surgical intervention for refractory cases or advanced hemorrhoids 2, 3

Caution and Pitfalls

• Long-term use of high-potency corticosteroid creams should be avoided due to potential tissue thinning 1, 2
• Anal pain is generally not associated with uncomplicated hemorrhoids and suggests other pathology requiring investigation 1
• Up to 20% of patients with hemorrhoids have concomitant anal fissures that require specific treatment 1
• Thrombosed external hemorrhoids presenting within 72 hours benefit from excision under local anesthesia, while those presenting later are better managed conservatively 2