This World Piles Day, Let's Vouch to Strike the
CORE of Hemorrhoidal Disease.

Human beings have suffered from hemorrhoids since they have started to walk, and hemorrhoids are described in both Old Testament and Buddhist scriptures. Some known mentioning of this affliction are the existence of doctors treating hemorrhoids in Egyptian palaces in 2500 BC, treatment records of both Edwin Smith Papyrus (1700 BC) and Ebers Papyrus (1500 BC), and treatment records in India, China, Greece, and Rome

Hemorrhoidal Disease – History & Pathophysiology

Hemorrhoids, which are characterized by symptomatic expansion and distal displacement of the usual anal cushions, are commonly encountered forms of anorectal disease. They are a significant medical and socio-economic issue affecting millions worldwide.

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Piles / Hemorrhoids may come with Various Presentations

Acute

Chronic

Physicians need to be aware of the proper identification and classification of hemorrhoids to reach a correct diagnosis.


Hemorrhoids have a strong link to Chronic Venous Disease(CVD)

Overlay of Chronic Venous Disease and Hemorrhoidal Disease

Chronic venous disease (CVD) affects a large portion of the general population and is a persistent, progressive, and generally unnoticed condition with significant socio-economic,physical, and psychological consequences. A wide range of venous disorders that substantially impair blood return is included under CVD...

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Treatment modalities of the hemorrhoidal disease range from lifestyle management to surgical management based on the disease's intensity and the case's demands.

Treatment Modalities in Hemorrhoidal disease -A Review

Hemorrhoidal disease (HD) is a form of an anorectal disease characterized by symptomatic enlargement and/or distal displacement of the healthy anal cushions known....

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Simple lifestyle changes help in the management of hemorrhoids as well as preventing their recurrence.


Hemorrhoids management can be both Medical or Surgical

A Conservative Approach to the Management of Hemorrhoidal Disease

Hemorrhoids is a common, multifactorial anorectal disease affecting millions worldwide and one of the oldest proctological illnesses...

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Management of Hemorrhoidal Disease Surgical Approach

Hemorrhoidal disease (HD) is a common cause of anal pathology, but its exact prevalence is difficult to determine as patients are often reluctant to seek ..

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Micronized Purified Flavonoid Fraction (MPFF) has a major role in Management of Piles / Hemorrhoids

MPFF consists of micronized diosmin (90%) and other active flavonoids (hesperidin, diosmetin, linarin and isorhoifolin; 10%) and shows clinical efficacy in the treatment of chronic venous disease 3 and Hemorrhoidal Disease (HD) 4–6

  • MPFF improves venous tone and lymphatic drainage by modulating noradrenergic signaling and reducing nore-pinephrine metabolism 7,8
  • It also reduces capillary hyper-permeability and improves capillary resistance in patients with abnormal capillary fragility, leading to further improvement of
    microcirculation 9,10

A systematic review of the literature indicates that micronized purified flavonoid fraction (MPFF) can reduce bleeding, pain, anal discomfort, anal discharge and pruritus in patients with acute HD, and can reduce pain,bleeding duration and the requirement for analgesics in patients undergoing surgery for HD

Bleeding

Pain

Anal discomfort

Anal discharge

Pruritus

MPFF has been shown to be effective and well tolerated in all grades of HD, either as a first-line treatment in combination with dietary modifications, or as an adjunct in patients recovering from hemorrhoidectomy.

Guidelines Recommend Management of MPFF in HD Treatment

  • The Association of Colon & Rectal Surgeons of India (ACRSI) - Recommends In its clinical practice guidelines for the management of hemorrhoids, MPFF as a first-line treatment for grade I–II and selected/minor grade III hemorrhoids 11. MPFF treatment is strongly recommended (grade A), with an evidence level of 1 (indicating high-quality evidence from well-performed randomized trials).
  • The American Gastroenterological Association - Recognizes MPFF as the pharmacological treatment of reference, citing its efficacy in reducing the symptoms and signs of HD.
  • The Russian Association of Coloproctology - Gives MPFF a Grade B (Evidence level 1a) recommendation for the treatment of HD in its clinical guidelines for the diagnosis and treatment of hemorrhoids.

References:

* Kaidar-Person, O., Person, B., & Wexner, S. D. (2007). Hemorrhoidal disease: a comprehensive review. Journal of the American College of Surgeons, 204(1), 102-117. 1. https://pubmed.ncbi.nlm.nih.gov/28331268/ 2 Kaidar-Person, O., Person, B., & Wexner, S. D. (2007). Hemorrhoidal disease: a comprehensive review. Journal of the American College of Surgeons, 204(1), 102-117. 3. Rathore, Rajesh Kumar. "Comparative study of management of second and third degree Hemorrhoids with injection Sclerotherapy using Polidocanol." International Journal of Surgery 3.2 (2019): 145-147. 4. Kakkos SK, Nicolaides AN. Efficacy of micronized purified flavonoid fraction (DaflonR ) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int. Angiol. 37(2), 143– 5. Aziz Z, Huin WK, Badrul Hisham MD, Tang WL, Yaacob S. Efficacy and tolerability of micronized purified flavonoid fractions (MPFF) for haemorrhoids: a systematic review and meta-analysis. Complement. Ther. Med. 39, 49–55 (2018). 6. Cospite M. Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology 45(6 Pt 2), 566–573 (1994). 7. Cospite M. Double blind placebo controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute haemorrhoids. Phlebology 9(Suppl. 1), 40–43 (1994). 8. Cotonat A, Cotonat J. Lymphagogue and pulsatile activities of Daflon 500 mg on canine thoracic lymph duct. Int. Angiol. 8(Suppl. 4),15–18 (1989). 9. Mchale NG, Hollywood MA. Control of lymphatic pumping: interest of Daflon 500 mg. Phlebology 9, 23–25 (1994). 10. Behar A, Lagrue G, Cohen-Boulakia F, Baillet J. Study of capillary filtration by double labelling I131-albumin and Tc99m red cells.Application to the pharmacodynamic activity of Daflon 500 mg. Int. Angiol. 7(Suppl. 2), 35–38 (1988). 11.Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A. Executive summary - The Association of Colon & Rectal Surgeons of India (ACRSI) practice guidelines for the management of haemorrhoids-2016. Indian J. Surg. 79(1), 58–61 (2017). •• Updated practice guideline for managing hemorrhoids from the Association of Colon and Rectal Surgeons of India.