Hemorrhoids and Varicose Veins: A Review of Treatment Options

Alternative Medicine Review, April, 2001 by Douglas MacKay

Bioflavonoids: Diosmin, OPCs, and Hesperidin

Bioflavonoids, particulary diosmin (Figure 2), oligomeric proanthocyanidin complexes (OPCs), and hesperidin, have demonstrated efficacy in the treatment of hemorrhoids and varicose veins. These bioflavonoids exhibit phlebotonic activity, vasculoprotective effects, and antagonism of the biochemical mediators of inflammation.[40] OPCs, diosmin, and hesperidin have been the subject of numerous clinical trials on efficacy and safety in the treatment of varicose veins and hemorrhoids.

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There has been extensive research on the flavonoid mixture containing 90-percent diosmin and 10-percent hesperidin (Daflon 500, Les Laboratories, Servier, France). Several randomized controlled studies have established its efficacy in the treatment of varicose veins and hemorrhoids. The safety of these flavonoids has been established through animal studies, and confirmed clinically in long-term trials. Data collected on more than 2,850 patients treated with 450 mg diosmin and 50 mg hesperidin twice daily for up to one year confirms it is well tolerated and has no contraindications to its use.[41,42] Side effects are rare and mild with an incidence and nature similar to that found with placebo in double-blind, controlled trials.[41]

A double-blind, placebo-controlled trial of 120 patients reported the efficacy of Daflon in the treatment of acute and chronic symptoms of hemorrhoids.[43] The group was divided in half and matched at entry for general characteristics, clinical features, length of history, and acute episodes. Patients received the flavonoid mixture at a dose of two 500 mg tablets daily or placebo for two months. Subjects were evaluated on pain, pruritis, discharge, bleeding, edema, erythema, and bleeding on examination. Mean parameter scores and overall symptom scores fell significantly in the treated group. A similar double-blind, placebo-controlled study examined 100 patients suffering an acute hemorrhoid attack. These patients received Daflon in a loading dose of three 500 mg tablets twice daily for the first four days and two tablets twice daily the following three days. The clinical severity of proctorrhagia, anal discomfort, pain, and anal discharge diminished to a greater extent in the treatment group.[40]

During pregnancy many of the treatment options for hemorrhoids, such as injection, rubber band ligation, and surgery are contraindicated.[44] A study of pregnant women suffering from acute hemorrhoids who were treated with Daflon showed remarkable results. Fifty women were treated for eight weeks before delivery and four weeks after delivery using a seven-day loading dose of six tablets for four days, and four tablets for three days, followed by a maintenance dose of two tablets per day. Over half of the women reported relief from symptoms by the fourth day of treatment and fewer relapses occurred during the antenatal period. Treatment did not affect pregnancy, fetal development, birth weight, infant growth, or feeding.[42]