Hemorrhoids
Hemorrhoids are one of the most common medical problems, characterized by swollen, inflamed veins in the buttocks. They result most commonly from constipation, but other factors include pregnancy and aging (1). Although more than half of the population develops hemorrhoids (2), only 20% visit a medical doctor (3). Of the 20% of the population that seeks treatment, nearly 1 in 5 will require surgery (4).
The medical approach for treating hemorrhoid attacks is very basic yet “very effective in improving signs and symptoms”. It includes dietary changes to lessen constipation, reducing sugar and alcohol, increasing intake of fluids and the use of fibers and stool softeners, and even exercise. Both oral and topical anti-inflammatory medications have been used for acute attacks off hemorrhoids (5).
Pycnogenol is Effective in Reducing Severe Symptoms of Hemorrhoids, Including Bleeding
Pycnogenol® has been found to have numerous other health benefits that include helping deal with lower leg swelling (6), helping with venous ulcers (7) and venous leg circulation (8), benefiting both mental health (9) and healthy levels of inflammation (10) and even helping with pain (11).
A randomized, controlled study conducted by G D'Annunzio University in Italy and published in 2010 in Phytotherapy Research reveals Pycnogenol® has important anti-inflammatory and anti-thrombotic properties that may be beneficial in patients with hemorrhoids, both for acute and chronic treatment, and in preventing new attacks.(12)
The study investigated 84 patients suffering from an acute episode of external hemorrhoids, lasting 24 to 48 hours prior to inclusion (in the study). The most frequently observed signs and symptoms, including hemorrhoidal bleedings, severe perineal pain and intravascular thrombus, were evaluated during the study period of two weeks. Patients were randomly allocated to one of four groups, as follows :
- Group 1: Pycnogenol 300 mg (six 50 mg tablets) per day for four days, then 150 mg (three tablets) per day for three days.
- Group 2: Placebo tablets.
- Group 3: Same supplementation as Group 1 but an addition of topical 0.5 % Pycnogenol cream
- Group 4: Pycnogenol tablets and placebo topical cream.
Patients were then released from the hospital and followed on one of these protocols for seven days and then were observed for an additional seven days after the treatments were stopped.
Results were measured by monitoring the following: variation in signs and symptoms (bleeding severity, acute intravascular thrombus, severe perineal pain, tenderness); quality of life parameters (impairment in walking, standing, sitting, embarrassment or social withdrawal); duration of peak pain time, and the costs associated with lost working days. The patients provided feedback on their hemorrhoid pain through the use of a 100-point survey called the Karnofsky scale. They also kept a diary to keep track of social life and lost working days. They were permitted to ask for extra inflammatory medications to help with their pain.
| Symptom | Group | Inclusion | Day 7 | Day 14 |
|---|---|---|---|---|
| Acute intravascular thrombus |
PYC tabl. | 2,1 |
0,6 |
0,2 |
| PLA | 2,3 |
1,9 |
1,7 |
|
| PYC tabl. + cr.. | 2,3 |
0,3 |
0,2 |
|
| PYC tabl.+PLA cr. | 2,1 |
0,5 |
0,2 |
|
| Acute, severe perianal pain |
PYC tabl. | 3,2 |
0,8 |
0,3 |
| PLA | 3,4 |
2,2 |
1,9 |
|
| PYC tabl. + cr. | 3,3 |
0,3 |
0,2 |
|
| PYC tabl.+PLA cr. | 3,2 |
0,7 |
0,2 |
|
| Purple/black, edematous, tense subcutaneous perianal mass |
PYC tabl. | 3,6 |
1,1 |
1,1 |
| PLA | 3,6 |
2,8 |
2,4 |
|
| PYC tabl. + cr. | 3,5 |
0,5 |
0,4 |
|
| PYC tabl.+PLA cr. | 3,5 |
1,2 |
1,0 |
|
| Tenderness |
PYC tabl. | 3,8 |
1,4 |
1,4 |
| PLA | 3,7 |
2,8 |
2,1 |
|
| PYC tabl. + cr. | 3,7 |
1,1 |
1,0 |
|
| PYC tabl.+PLA cr. | 3,7 |
1,3 |
1,3 |
|
| Ischemia-necrosis of the overlying skin |
PYC tabl. | 2,2 |
1,0 |
0,5 |
| PLA | 2,4 |
2,6 |
2,0 |
|
| PYC tabl. + cr. | 2,2 |
0,5 |
0,3 |
|
| PYC tabl.+PLA cr. | 2,3 |
1,0 |
0,5 |
|
| Bleeding |
PYC tabl. | 2,6 |
0,0 |
0,0 |
| PLA | 2,8 |
1,3 |
1,0 |
|
| PYC tabl. + cr. | 2,7 |
0,0 |
0,0 |
|
| PYC tabl.+ PLA cr. | 2,6 |
0,0 |
0,0 |
PYC = Pycnogenol, PLA = placebo, tabl. = tablet, cr. = cream
Results showed that Pycnogenol® significantly lowered acute peri-anal pain. The decrease in symptoms was significantly higher in the Pycnogenol® groups as compared to the control group showing the efficacy of Pycnogenol® in relieving the signs and symptoms of acute external hemorrhoids.The complication of hemorrhoidal bleedings was completely absent in the Pycnogenol® groups after seven days and thereafter, while it was still observed in the placebo group during two weeks of follow up. Results for quality of life parameters confirmed a significant improvement in social functions by using Pycnogenol® orally, with the important added benefit of a topical application of Pycnogenol®. Results also confirmed the duration of peak pain was significantly lower in the combined oral plus topical Pycnogenol® group. Finally, there was a decrease in the number of lost working days, as well as a decrease in the recurrence of complications and overall treatment costs the month following in both Pycnogenol® groups.
Summary
The uinvestigators concluded “This study indicates that Pycnogenol®, both in oral and in topical form, is effective for controlling this common, disabling health problem... The application of Pycnogenol® eases the management of acute hemorrhoidal attacks and helps avoid bleedings... Our study suggests that Pycnogenol® may help with all major symptoms.”
References
- 1. “Hemorrhoids” posted on http://www.nlm.nih.gov/medlineplus/hemorrhoids.html
- 2. Chand M, Nash GF, Dabbas N. 2008. The management of haemorrhoids. 1: Br J Hosp Med (Lond) 69: 35–40.
- 3. Pigot F. 2008. Haemorrhoidal disease. Rev Prat 58: 1763–1768.
- 4. Loder PB. 1994. Hemorrhoids: pathology, pathophysiology anbaetiology. Br J Surg 81: 946–954.
- 5. Misra MC. 2005. Drug treatment of haemorrhoids. Drugs 65: 1481–1491.
- 6. Belcaro G. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clin Appl Thromb Hemost. 2004 Oct;10(4):373-7
- 7. Belcaro, G., M. R. Cesarone, et al. (2005). "Venous ulcers: microcirculatory improvement and faster healing with local use of pycnogenol((r))." Angiology 56(6): 699-705
- 8. Cesarone MR. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Clin Appl Thromb Hemost 2006; 12(2): 205-12
- 9. Trebaticka J. Treatment of ADHD with French maritime pine bark extract, Pycnogenol®). Eur Child Adolesc Psychiatry. 2006 May 13; [Epub ahead of print]
- 10. Grimm T. Inhibition of NF-êB activation and MMP-9 secretion by plasma of human volunteers after ingestion of maritime pine bark extract (Pycnogenol) Journal of Inflammation 2006, 3:1 (27 January 2006)
- 11. Canali R. The anti-inflammatory pharmacology of Pycnogenol® in humans involves COX-2 and 5-LOX mRNA expression in leukocytes. Inter Immunopharmacol 2009.
- 12. Belcaro G. Pycnogenol® Treatment of Acute Hemorrhoidal Episodes. Phytother. Res. 24: 438–444 (2010)