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Meta-Analysis
. 2005 Oct 19;2005(4):CD004649.
doi: 10.1002/14651858.CD004649.pub2.

Laxatives for the treatment of hemorrhoids

P Alonso-Coello  1 , G Guyatt, D Heels-Ansdell, J F Johanson, M Lopez-Yarto, E Mills, Q Zhou
Affiliations
Meta-Analysis

Laxatives for the treatment of hemorrhoids

P Alonso-Coello et al. Cochrane Database Syst Rev. .

Abstract

Background: Symptomatic hemorrhoids are a common medical condition, which increase in prevalence in women during pregnancy and postpartum. Although the evidence appears to be inconclusive, narrative reviews and clinical practice guidelines recommend the use of laxatives (and fiber) for the treatment of hemorrhoids and relief of symptoms. This is due to their safety and low cost.

Objectives: To evaluate the impact of laxatives on a wide range of symptoms in people with symptomatic hemorrhoids.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CINAHL (1982 to 2005), BIOSIS, and AMED (Allied and Alternative Medicine Database), for eligible trials (including conference proceedings). We sought missing and additional information from authors, industry, and experts in the field.

Selection criteria: We selected all published and unpublished randomised controlled trials that compared any type of laxative to placebo or no therapy in any patient population.

Data collection and analysis: Two authors independently screened studies for inclusion and retrieved all potentially relevant studies. Data were extracted from studies that met our selection criteria on study population, intervention used, pre-specified outcomes, and methodology. We extracted methodological information for the assessment of internal validity: existence and method of generation of the randomization schedule, and method of allocation concealment; blinding of caregivers and outcomes assessors; numbers of and reasons for participants lost to follow up; and use of validated outcome measures.

Main results: Seven randomised trials enrolling a total of 378 participants to fiber or a non-fiber control were identified. Meta-analyses using random-effects models showed that laxatives in the form of fiber had a beneficial effect in the treatment of symptomatic hemorrhoids. The risk of not improving hemorrhoids and having persisting symptoms decreased by 53% in the fiber group (risk reduction (RR) 0.47, 95% CI 0.32 to 0.68). These results are compatible with large treatment effects regarding prolapse, pain, itching, although the pooled analyses showed a tendency toward no-effect for these parametres. The effect on bleeding showed a significant difference in favour of the fiber (RR 0.50, 95% CI 0.28 to 0.89). Studies including data on multiple follow ups (usually after six weeks and three months) showed consistent results over time. However, we have to stress two possible limitations of this review: the risk of publication bias, and only moderate study quality.

Authors' conclusions: The use of fiber shows a consistent beneficial effect for relieving overall symptoms and bleeding in the treatment of symptomatic hemorrhoids.

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Conflict of interest statement

None known.

Figures

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Trialflow.
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Update of

  • doi: 10.1002/14651858.CD004649

References

References to studies included in this review

Broader 1974 {published data only}
    1. Broader JH, Gunn IF, Alexander‐Williams J. Evaluation of a bulk‐forming evacuant in the management of haemorrhoids. British Journal of Surgery 1974;61(2):142‐44. - PubMed
Foster 1979 {published data only}
    1. Foster GE, Bolwel JS, Wright J, Hardcastle JD. Controlled trial of bulk forming evacuants in the treatment of patients with haemorrhoids. GUT 1979;20(Suppl 2):A452.
Hunt 1981 {published data only}
    1. Hunt PS, Korman MG. Fybogel in haemorrhoid treatment. The Medical journal of Australia 1981;2(5):256‐58. - PubMed
Jensen 1988 {published data only}
    1. Jensen SL, Harling H, Tange G, Shokouh‐Amiri MH, Nielsen OV. Maintenance bran therapy for prevention of symptoms after rubber band ligation of third‐degree haemorrhoids. Acta chirurgica Scandinavica 1988;154(5‐6):395‐98. - PubMed
Moesgaard 1982 {published data only}
    1. Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. High‐fiber diet reduces bleeding and pain in patients with haemorrhoids: a double‐blind trial of Vi‐Siblin. Diseases of the Colon & Rectum 1982;25(5):454‐6. - PubMed
Perez‐Miranda 1996 {published data only}
    1. Perez‐Miranda M, Gomez‐Cedenilla A, Leon‐Colombo T, Pajares J, Mate‐Jimenez J. Effect of fiber supplements on internal bleeding haemorrhoids. Hepatogastroenterology 1996;43(12):1504‐507.. - PubMed
Webster 1978 {published data only}
    1. Webster DJ, Gough DC, Craven JL. The use of bulk evacuant in patients with haemorrhoids. British Journal of Surgery 1978;65(4):291‐92. - PubMed

References to studies excluded from this review

Craven 1976 {published data only}
    1. Craven JL. A controlled, double blind study of dietary fiber in patients with hemorrhoids. Symposium on dietary fiber. St James Hospital, Leeds 1976.
Gorgul 1999 {published data only}
    1. Gorgul A. Mentes BB. Tascilar O. Ates Y. Kandilci U. Tatlicioglu E. The results and comparison of rubber band ligation and injection sclerotherapy supplemented by high‐fibre diet in the treatment of second‐degree internal hemorrihoids. Turkish Journal of Gastroenterology 1999;10(1):66‐71.
Hunt 1981a {published data only}
    1. Hunt P, Stewardson A, Korman M. Double‐blind trial of fybogel (isphaghula husk) in the treatment of haemorrhoids. Australian & New Zealand Journal of Medicine 1981;11:221‐22.
Maté 1996 {published data only}
    1. Maté J, Gómez A, Correa JA, León T, Pérez M, Pajares JM. Therapeutic Fiber and Bleeding Haemorrhoids. GUT 1996;39(3):A140.

Additional references

Abcarian 1994
    1. Abcarian H, Alexander‐Williams J, Christiansen J, Johanson J, Killingback M, Nelson RL, Ries‐Neto J. Benign anorectal disease: definition, characterization and analysis of treatment. American Journal of Gastroenterology 1994;89(Suppl 8):S182‐93. - PubMed
Abramowitz 2001
    1. Abramowitz L, Godeberge P, Staumont G, Soudan D. Clinical practice guidelines for the treatment of hemorrhoid disease. Gastroenterologie clinique et biologique 2001;25(6‐7):674‐702. - PubMed
Alderson 2004
    1. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers' Handbook 4.2.2 [updated March 2004].. Cochrane Database of Systematic Reviews 2004, Issue 1.
Alonso 2002
    1. Alonso P, Marzo M, Mascort JJ, Hervas A, Vinas L, Ferrus J, et al. Clinical practice guidelines for the management of patients with rectal bleeding Gastroenterol Hepatol. 2002 Dec;25(10):605‐32.. Gastroenterologia y hepatologia 2002;25(10):605‐32. - PubMed
Alonso‐Coello 2003
    1. Alonso‐Coello P, Marzo M. Office evaluation and treatment of hemorrhoids. Office evaluation and treatment of hemorrhoids. The Journal of family practice 2003;52:366‐74. - PubMed
Beck 1998
    1. Beck DE. Hemorrhoidal disease. In: Beck DE, Wexner SD editor(s). Fundamentals of anorectal surgery. 2nd Edition. London: WB saunders edition, 1998:237‐53.
Bennett 1996
    1. Bennett WG, Cerda JJ. Dietary fiber: fact and fiction. Digestive Disease 1996;14:43‐58. - PubMed
Bleday 1992
    1. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Diseases of the Colon & Rectum 1992;35:477‐481. - PubMed
Brisinda 2000
    1. Brisinda G. How to treat hemorrhoids. British Medical Journal 2000;321:582‐83. - PMC - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7:177‐88. - PubMed
Devereaux 2004
    1. Devereaux PJ, Choi PT, El‐Dika S, Bhandari M, Montori VM, Schunemann HJ, Garg AX, et al. An observational study found that authors of randomized controlled trials frequently use concealment of randomization and blinding, despite the failure to report these methods. Journal of Clinical Epidemiology 2004;57(12):1232‐36. - PubMed
Dickersin 2002
    1. Dickersin K, Manheimer E, Wieland S, Robinson KA, Lefebvre C, McDonald S. Development of the Cochrane Collaboration's CENTRAL Register of controlled clinical trials. Evaluation & the health professions 2002;25(1):38‐64. - PubMed
Fleiss 1973
    1. Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement 1973;33:613‐19.
Fleiss 1993
    1. Fleiss JL. The statistical basis of meta‐analysis. Statistical methods in medical research 1993;2:121‐45. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. British Medical Journal 2003;327:557‐60. - PMC - PubMed
Johanson 1990
    1. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990;98(2):380‐86. - PubMed
Johanson 1992
    1. Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhhoids: a comparative analysis of infrared coagulation, rubber band ligation,and injection sclerotherapy. American Journal of Gastroenterology 1992;87:1600‐606. - PubMed
Johanson 2002
    1. Johanson JF. Evidence‐based approach to the treatment of hemorrhoidal disease. Evidence‐Based Gastroenterology 2002;3(1):26‐31.
Johanson 2002a
    1. Johanson JF. Nonsurgical treatment of hemorrhoids. Journal of Gastrointestinal Surgery 2002;6(3):290‐94. - PubMed
Jones 2002
    1. Jones MP, Talley NJ, Nuyts G, Dubois D. Lack of objective evidence of efficacy of laxatives in chronic constipation. Digestive diseases and sciences 2002;47:2222‐230. - PubMed
Juni 2001
    1. Juni P, Altman DG, Egger M. Systematic reviews in health care: assesing the quality of controlled clinical trials. British Medical Journal 2001;323:42‐46. - PMC - PubMed
Kenny 2001
    1. Kenny KA, Dkelly JM. Dietary fiber for constipation in older adults: a systematic review. Clinical Effectiveness in Nursing 2001;5:120‐28.
Madoff 2004
    1. Madoff RD, Fleshman JW, Clinical Practice Committee, American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004;126(5):1463‐473. - PubMed
Perez‐Miranda 1996
    1. Perez‐Miranda M, Gomez‐Cedenilla A, Leon‐Colombo T, Pajares J, Mate‐Jimenez J. Effect of fiber supplements on internal bleeding hemorrhoids. Hepatogastroenterology 1996;43:1504‐507. - PubMed
Petticrew 2001
    1. Petticrew M, Rodgers M, Booth A. Effectivenes of laxatives in adults. Quality in Health care 2001;10:268‐73. - PMC - PubMed
Spiller 1994
    1. Spiller RC. Pharmacology of dietary fiber. Pharmacology & therapeutics 1994;62:407‐27. - PubMed
Tramonte 1997
    1. Tramonte SM, Brand MB, Mulrow CD, Amato MG, O'Keefe ME, Ramirez G. The treatment of chronic constipation in adults: a systematic review. Journal of General Internal Medicine 1997;12:15‐24. - PMC - PubMed