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No assured evidence on traditional Chinese medicine herbs (TCMHs) stopping bleeding from haemorrhoids but limited evidence on TCMHs alleviating some symptoms caused by haemorrhoids.

Haemorrhoids, one of the common perianal diseases, may easily lead to haematochezia, perianal inflammation, perianal venous prolapse or incarceration once it progresses to a serious stage. Besides surgical operation or minimally invasive treatment, a variety of Traditional Chinese Medicine herbs (TCMHs) have been used for treating bleeding haemorrhoids in many patients in China. TCMHs might be effective for this illness and provide an alternative therapeutic measure. However, our primary research for this review showed that there was no strong evidence concerning the effectiveness of TCMHs in stopping bleeding from haemorrhoids. The included studies were few and of low quality. Limited, weak evidence showed that some formulae, when including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, etc., may alleviate some symptoms caused by haemorrhoids. These symptoms include hematochezia and congestive haemorrhoidal cushions, in the short term. Additional, standardised trials are needed for meta‐analysis to draw a final conclusion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Enlarged hemorrhoids: How can you relieve the symptoms yourself?

There is a lot of advice out there about how to relieve the symptoms of enlarged hemorrhoids yourself – including things like avoiding constipation, and using special ointments or warm baths. Some of these approaches can actually help, but many of them have not been tested in good scientific studies.If someone has enlarged hemorrhoids (also known as “piles”), trying to prevent constipation and changing their toilet habits can make an important difference. Various medications and other measures can also be tried out to relieve the symptoms. But this will not make enlarged hemorrhoids shrink again.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 29, 2014

The ligasure technique is superior in terms of patient tolerance, but long term risk of recurrence of hemorrhoids needs to be evaluated.

Hemorrhoidectomy is a frequently performed surgical procedure. The excisional technique is regarded to be the first choice for grade III and IV or recurrent hemorrhoids. As conventional hemorrhoidectomy is associated with postprocedural pain, modifications have been proposed to diminish this complication. An example is the use of the Ligasure as coagulation between the forceps only with high frequency currency and active feedback control over the power output has minimal thermal spread and limited tissue charring. This could result in a decreased incidence of postoperative pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Laxatives for the treatment of hemorrhoids

Symptomatic hemorrhoids are a common medical condition but what causes them is not completely understood. Minimizing constipation with its associated prolonged straining may affect both lifestyle measures and medicines used as treatments for symptomatic hemorrhoids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium

Not enough evidence on non‐surgical interventions for treating problematic piles (haemorrhoids) during pregnancy and in the early weeks after birth (puerperium).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This review compares the safety and effectiveness of two of the most popular treatments for haemorrhoids, rubber band ligation (RBL) and excisional haemorrhoidectomy (EH).

When conservative treatments like change of diet or ointments do not help, people usually see a doctor for haemorrhoid removal. RBL involves placing rubber bands around haemorrhoids until they eventually fall off. There are other nonsurgical treatments for haemorrhoids but RBL is often considered the best. For more severe haemorrhoids surgical removal of the haemorrhoids (EH) may be necessary. Although it is very effective, it is more painful and invasive.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Phlebotonics for haemorrhoids

Haemorrhoids are among the most common benign anorectal pathologies which usually manifest with the common symptoms and signs of bleeding, pain, pruritus, swelling and discharge. The prevalence can vary from 4.4% in the general population to 36.4% in general practice. However their true prevalence will inevitably be underestimated due to the under‐reporting of these symptoms. Medical and conservative management with high‐fibre diets, stool softeners and laxatives are the preferred treatments for grade I‐II haemorrhoids whereas surgical procedures such as haemorrhoidectomy are reserved for the more severe forms of haemorrhoids.  Phlebotonics are a heterogeneous class of drugs used to treat haemorrhoidal disease in the less severe stages of first and second‐degree haemorrhoids, and during the thrombosis episodes. Although their true mechanism of action has not been well established, they are associated with strengthening of blood vessel walls, increasing venous tone, lymphatic drainage and normalizing capillary permeability. We considered twenty four studies for inclusion in this review. This review identified twenty randomised controlled trials enrolling a total of (2334) participants which compared an intervention using phlebotonics with a control intervention. Of these twenty studies, one study compared phlebotonics with a medical intervention and another with rubber band ligation. Of the remaining four trials, we identified two trials which compared phlebotonics with each other, one trial which compared phlebotonics with herbal therapy and one trial which compared phlebotonics with infrared photocoagulation. The trials obtained did not show any significant adverse events or side‐effects from the use of phlebotonics. The studies demonstrated a beneficial effect of phlebotonics in treating the symptoms and signs of haemorrhoidal disease as well as symptom relief post‐haemorrhoidectomy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Enlarged hemorrhoids: What procedures can be done?

Sometimes the symptoms of enlarged hemorrhoids are so bad that treating the symptoms alone is no longer enough. Then there are various procedures that can be done to remove the tissue that is causing problems.Hemorrhoids are normal “cushions” of tissue filled with blood vessels, found at the end of the rectum, just inside the anus. If they become enlarged, they can cause unpleasant symptoms. This is what most people mean when they talk about having hemorrhoids or “piles.” The most suitable type of treatment will depend on the size of the hemorrhoids and the severity of symptoms. Every approach has its own advantages and disadvantages. Depending on the procedure, side effects can occur – some more severe than others.Sclerotherapy and “rubber band ligation” (“banding”) are generally carried out as day procedures, without an anesthetic. If someone has grade 3 or grade 4 hemorrhoids, doctors often recommend surgery. A general or local anesthetic is usually needed for this. You then have to stay in the hospital for a few days, and stay off work for some time too.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 29, 2014

Enlarged hemorrhoids: Overview

Did you know that we all have hemorrhoids? Hemorrhoids are normal “cushions” of tissue filled with blood vessels, found at the end of the rectum. They are only a problem if they become enlarged. A lot of people have enlarged hemorrhoids: It is estimated that about half of all adults over the age of 30 are affected.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 29, 2014

Aloe vera for treating acute and chronic wounds

Aloe vera is a cactus‐like, succulent plant which grows in tropical climates. Aloe vera is widely used in a variety of cosmetics including creams and toiletries. Some studies conducted in animals have suggested that Aloe vera may help wound healing. Aloe vera can be applied topically as a cream or gel, or can be impregnated into a dressing and applied to the wound.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

How do bowel movements work?

During a bowel movement, the indigestible parts of our food leave our body. It is usually possible to control bowel movements with the help of several parts of the end of the gastrointestinal tract: the rectum and anal canal, the sphincters (circular muscles), and hemorrhoids.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 29, 2014

Conventional surgical hemorrhoidectomy results in fewer recurrences than stapled hemorrhoidopexy.

Hemorrhoids are one of the most common anorectal disorders. The Milligan‐Morgan open hemorrhoidectomy is the most widely practiced surgical technique used for the management of hemorrhoids and is considered the current "gold standard". Circular stapled hemorrhoidopexy was first described in 1998 as alternative to conventional excisional hemorrhoidectomy.  A review of randomized control trials comparing stapled hemorrhoidopexy and conventional excisional surgery was conducted. The results show that the stapled technique is associated with a higher risk of recurrent hemorrhoids and some symptoms in long term follow‐up. Patients should be informed of these risks when being offered the stapled homorrhoidopexy as surgical therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Bowel cancer: Testing for hidden blood in stool

Fecal occult blood (FOB) tests can detect hidden traces of blood that may be caused by tumors or polyps in the bowel. If such traces are found, an endoscopy is performed to determine whether they're caused by a tumor or pre-cancerous tissue changes. It has been proven that, when combined with an endoscopy, the FOB test can lower the risk of dying of bowel cancer.Bowel cancer and advanced-stage bowel polyps can cause slight bleeding in the bowel. FOB tests can find traces of blood that can't be seen with the naked eye (occult blood). But not every tumor or polyp can be detected this way because not all of them bleed. Blood in the stool can also be caused by many benign (non-cancerous) conditions, such as hemorrhoids. This is why stool blood tests are meant to be done as preliminary tests. If blood is found, a colonoscopy is then performed to find the cause. So doing a FOB test makes the most sense if you're also prepared to have an endoscopy of the bowel if the test results are abnormal.There are two different ways to test for blood in the stool. Stool guaiac tests detect parts of the blood pigment hemoglobin using a chemical reaction. Immunochemical tests look for antibodies to hemoglobin, a component of blood, in order to find traces of blood.For screening purposes, German statutory health insurers only have to cover the costs of the stool guaiac tests “Hämoccult,” “HemoFec” and “HemoCare.” For people who have statutory health insurance in Germany, bowel cancer screening using these tests is free from the age of 50. Some insurers will also cover the costs of an immunochemical test.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 28, 2016

Recognizing warning signs of bowel cancer

Because bowel cancer does not cause obvious problems for a long time, it is only rarely detected at an early stage. But recognizing warning signs and taking them seriously as soon as possible can save precious time for people who are especially at risk. The earlier the cancer is discovered, the more successful treatment is likely to be.Noticing the following warning signs does not necessarily mean you have cancer though. On the contrary, in most cases they are caused by something harmless or another illness, such as enlarged hemorrhoids or an intestinal inflammation.The warning signs of bowel cancer areBlood in the stool or anal bleedingAnal mucus secretionChange in bowel habits over several weeks (for example constipation or diarrhea)The feeling of not being able to empty your bowels properlyPains or cramps in the abdomen (belly) or around the anusUnintentional weight lossAnemia due to low iron levels in the blood, leading to tiredness and weaknessHowever, bowel cancer is only rarely the cause of these problems, especially in people under 40 years old.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 4, 2011

Interventions for treating postpartum constipation

Women may experience constipation during the postpartum period. Consipation is defined as a functional bowel disorder that is characterised by pain and discomfort, straining, hard lumpy stools and a sense of incomplete bowel evacuation. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones and iron supplementation can increase the risk of postpartum constipation; as can damage to the anal sphincter or pelvic floor muscles during childbirth. It is a source of concern to the new mother who is recovering from the stress of delivery. The discomfort does not only affect the mother's health, but also impacts on the new baby's well‐being, since it needs most of the mother's attention at this time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for treating constipation in pregnancy

The term 'constipation' is defined as difficulty in passing stool and reduced frequency of bowel movements. It is characterised by discomfort, excessive straining, hard or lumpy stools, a sensation of incomplete evacuation, and infrequent bowel movements. Constipation is a common symptom experienced during pregnancy. This can result from a combination of factors, including changes in hormones during pregnancy affecting the digestive system, reduced physical activity and changes in dietary habits during pregnancy. In addition, as the baby grows it can press on the mother's intestines and cause digestive delays/obstructions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for preventing constipation after giving birth

Constipation is a bowel disorder that is characterised by symptoms such as pain or discomfort, straining, hard lumpy stool and a sense of incomplete bowel evacuation. Pain and discomfort during defecation can be a source of concern to the new mother who is recuperating from the stress of delivery, particularly if she has had perineal tears repaired or has developed haemorrhoids. Postpartum constipation can be stressful for women because of undue pressure on the rectal wall, leading to restlessness and painful bowel movements which may affect the quality of life of the mother. The administration of enemas before labour, the ability of women to eat during active labour, and irregular and altered eating habits during the first few days after delivery can each have an influence on bowel movements in the days after giving birth. We aimed to find all the trials assessing interventions that could prevent postpartum constipation. We examined the available evidence up to 30 April 2015. We included five randomised controlled trials (involving a total of 1208 women from the first day of giving birth) in this review. Overall, the trials were poorly conducted and reported.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Surgery for complete rectal prolapse in adults

Complete, or full‐thickness rectal prolapse is when the lower part of the intestine (the rectum) becomes loose and telescopes out of the anus when straining. It should not be confused with haemorrhoids (or piles), which is when the veins around the anus swell up. Rectal prolapse is most common in older people, especially women, although its cause is unclear. Rectal prolapse can cause complications, such as pain, ulcers, bleeding and faecal incontinence (inability to control bowel movements). Surgery is a common treatment for repairing the prolapse.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Injection of bulking material around the anus (back passage) for the treatment of faecal incontinence in adults

Loss of bowel control, also known as faecal incontinence, can be a devastating problem. It affects men and women of all ages in up to 15% of the adult population. Faecal incontinence can radically affect everyday life as many people become almost house bound, being unable to undertake simple tasks, such as shopping, because they are worried about faecal leakage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

What are immunological tests?

There are immunological tests for many different medical conditions and purposes – for instance, to test for an allergy, to screen for bowel cancer or to find out if a woman is pregnant.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 30, 2016

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