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Laxatives for the treatment of hemorrhoids.

  • Review
  • Intervention

Authors


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 methods

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We selected all published and unpublished randomised controlled trials that compared any type of laxative to placebo or no therapy in any patient population.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

摘要

背景

痔瘡的瀉藥治療

有症狀的痔瘡是一種常見的醫療狀況, 其中婦女在懷孕和產後,患病率增加。儘管證據似乎仍無結果,敘事審查和臨床實踐指南建議使用瀉藥(和纖維)治療痔瘡及減緩症狀.這是基於安全性和低成本。

目標

評估廣泛症狀及有症狀的痔瘡患者使用瀉藥的影響.

搜尋策略

搜索方式:我們搜詢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),合法試驗者.我們從這方面的作者、機構及專家尋找額外的信息。

選擇標準

我們選擇所有發表和未發表的隨機對照試驗,比較任何類型的瀉藥,安慰劑或沒有治療的患者群.

資料收集與分析

兩位作者獨立研究列入篩選和回收所有可能有關的研究。研究中提取數據,符合我們選擇標準的研究人口,預先規定的成果和方法.我們的信息提取方法為內部有效性的評估:存在和方法生成的隨機時間表和方法分配隱藏;照顧者和成果的評審; 參與者失去追蹤的數目和理由,和使用驗證結果的措施.

主要結論

7個隨機試驗共招收學員378例,纖維控制還是非纖維控制被定義。分析方法利用隨機效應模型顯示:纖維形式的瀉藥在治療痔瘡的症狀有好的效果.在纖維控制組痔瘡風險沒有得到改善,並具有痔瘡症狀持續減少53%,(減少風險(RR)的0.47,95%CI為0.32至0.68) 這些結果都符合有關脫垂治療效果,疼痛,瘙癢,雖然合併分析顯示傾向不影響這些規範,偏好纖維這組,出血的影響顯著差異(居民代表0.50,95%CI為0.28至0.89)研究包括多次追蹤的數據(通常在6個星期和3個月),隨著時間的推移顯示一致的結果.但是,本次審查,我們必須強調兩個可能的限制,出版偏見的風險,只有中度的研究量。

作者結論

在症狀性痔瘡的治療上,使用纖維一致顯示有利的影響,可解除整體症狀和流血.

翻譯人

本摘要由國泰綜合醫院張世昌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

瀉藥治療痔瘡及症狀性痔瘡是一種常見的醫療狀況,但由什麼原因導致我們不完全理解。最小便秘及其長期緊張可能會影響到生活方式和用於治療痔瘡的症狀藥物。 這個系統的審查表明使成纖維的瀉藥有利於改善症狀性痔瘡,尤其是出血.症狀改善長達三個月,但有一半的風險會有全面的症狀.包括試驗的結果其他症狀,如脫垂,疼痛或發癢並不明顯.相對少數患者參加試驗,至今可以說我們需要額外的更大規模的試驗。

Plain language summary

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.
This systematic review suggests a beneficial effect of laxatives in the form of fiber for improving symptoms of hemorrhoids, especially bleeding. The improvement, halving the risk of having overall symptoms, was consistent over up to three months follow up. The results for other symptoms such as prolapse, pain or itching were not clear from the included trials.
The relatively small number of patients enrolled in trials to date could argue for the need for additional larger trials.

Ringkasan bahasa mudah

Laksatif untuk rawatan buasir.

Gejala buasir adalah masalah perubatanyang biasadialami tetapi faktor yang menyebabkan terjadinya buasir ini masih tidak difahami sepenuhnya. Mengurangkan masalah sembelit dan peneranan berpanjangan mungkin memberi kesan terhadap gaya hidup dan ubat-ubatan yang digunakan sebagai rawatan untuk gejala buasir.
Ulasan sistematik ini menunjukkan laksatif dalam bentuk serat memberikan kesan yang baik dalam mengurangkan gejala-gejala buasir, terutamanya pendarahan. Pengurangan separuh daripada gejala buasir ini konsisten sehingga tiga bulan. Keputusan bagi gejala-gejala lain seperti buasir terkeluar daripada anus, sakit atau gatal-gatal tidak mendapat keputusan yang jelas daripada ujian yang terbabit.
Bilangan pesakit yang mendaftar dalam ujian agak kurang dan ini menunjukkan keperluan untuk ujian tambahan yang lebih besar.

Catatan terjemahan

Diterjemahkan oleh Ng Chia Shyn (International Medical University). Disunting oleh Rosnani Zakaria (Universiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi Ng.ChiaShyn@student.imu.edu.my.

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