Is fiber beneficial for the treatment of hemorrhoids?

Gearhart, Susan

S Gearhart is an Assistant Professor of Surgery and Oncology at Johns Hopkins Medical Institution, Baltimore, MD, USA.

Correspondence: The Johns Hopkins Hospital 600 North Wolfe Street Blalock 656 Baltimore MD 21287 USA [email protected]

Received 13 December 2005

Accepted 22 February 2006

www.nature.com/clinicalpractice doi:10.1038/ncpgasthep0466

Nature Clinical Practice Gastroenterology & Hepatology 3(4):p 192-193, April 2006.

SYNOPSIS

BACKGROUND

Laxatives (including fiber) are recommended for the treatment of symptomatic hemorrhoids, a common medical condition. Evidence of the clinical efficacy of this type of therapy is, however, lacking.

OBJECTIVE

To evaluate the efficacy of laxatives for the treatment of patients with symptomatic hemorrhoids.

DESIGN AND INTERVENTION

This systematic review evaluated published and unpublished randomized, controlled studies that compared therapy with laxatives (including fiber, stimulant laxatives, fecal softeners and osmotic agents) to placebo or no therapy in patients with symptomatic hemorrhoids (grades I-III). Exclusion criteria included duplication and retrospective analysis. A comprehensive search of all major available databases, including EMBASE, CENTRAL, MEDLINE, BIOSIS, and AMED, was performed to identify studies for inclusion in the meta-analysis. Two investigators independently reviewed all selected studies. Any discrepancy between the authors regarding the inclusion of a study in the meta-analysis was resolved by consensus agreement or by obtaining further information from the original authors of the study. Agreement between the investigators was statistically analyzed. The investigators extracted relevant data from the studies for the meta-analysis including information on population, intervention, outcomes, number of patients free from symptoms, number with improved symptoms and methodology. Extracted data were analyzed in an intention-to-treat manner, and statistical analysis was performed to assess the relative risk of a treatment for not improving patient symptoms.

OUTCOME MEASURES

Outcome measures included overall assessment of treatment, bleeding, prolapse, pain, adverse effects, recurrence, itching and requirement for further treatment.

RESULTS

A total of seven studies including 378 patients were identified by the screening process and included in the meta-analysis. Pooled analysis for overall improvement revealed that the risk of patients' hemorrhoids not improving or patients still being symptomatic was reduced by 53% in those on fiber therapy (risk reduction [RR] 0.47, 95% CI 0.32-0.68, P = 0.40, NS). Four studies examined bleeding as an individual outcome and compared fiber therapy with placebo. The risk of bleeding was found to be reduced by 50% in patients on fiber therapy (RR 0.50, 95% CI 0.28-0.89). There was excellent agreement between the two investigators for the inclusion of studies (k = 0.1). There was no statistical reduction in the risk of prolapse, pain or itching in patients on fiber therapy. One study examined recurrence and requirement for further treatment in patients on fiber therapy compared with placebo. A reduction in the incidence of recurrence at 18 months was shown in patients on fiber therapy compared with placebo (15% versus 45%, RR 0.37, 95% CI 0.15-0.77). Results were consistent over the study follow-up periods, which ranged 6-12 weeks. Adverse events were minimal and usually consisted of gastrointestinal symptoms.

CONCLUSIONS

Laxatives (in the form of fiber) are an effective treatment for the relief of symptoms in patients with symptomatic hemorrhoids.