3 supplements for haemorrhoids: what the research actually shows

Haemorrhoids are one of those conditions that nobody wants to discuss, yet roughly half of adults over 50 have experienced them at some point. The father of medicine, Hippocrates, wrote about them around 400 BC, proposing surgical treatments that would make most of us wince. The word itself comes from the Greek “haimorrhoides”, combining “haima” (blood) and “rhoos” (flow). Two and a half millennia later, we’re still dealing with the same problem.

I’ve gone through the clinical research on supplements that might help with haemorrhoids. The honest summary: there’s some promising evidence for a few options, but the studies are small and the effects are modest. Nobody’s found a miracle cure in a capsule. That said, certain supplements may offer genuine relief when combined with the basics (dietary fibre, adequate water, and not straining on the toilet).

What exactly are haemorrhoids?

Haemorrhoids are essentially swollen blood vessels in and around the anus and lower rectum. People often describe them as “varicose veins of the anus”, which is close enough. The main symptom is bleeding during bowel movements, occurring in about 71% of cases, and it’s usually painless (external haemorrhoids being the painful exception).

The classification depends on where they originate relative to the dentate line, where the skin of the anal canal meets the rectal mucosa. Internal haemorrhoids start above this line; external haemorrhoids start below it.

What causes them?

Doctors don’t consider any single factor the definitive cause. Rather, several things increase risk:

• Chronic constipation or diarrhoea
• Straining during bowel movements
• Prolonged sitting (especially on the toilet)
• Pregnancy
• Low-fibre diet
• Obesity
• Heavy lifting
• Ageing (tissues weaken over time)

The common thread is increased pressure on the blood vessels in the rectal area. Constipation is probably the biggest modifiable factor, which is why dietary fibre is the first-line recommendation for most people with haemorrhoids [1].

How are haemorrhoids treated?

Most cases improve with conservative measures: more fibre, more water, avoiding straining, and over-the-counter creams or suppositories for symptoms. The NHS recommends eating 25-30g of fibre daily and drinking plenty of fluids [2].

For internal haemorrhoids that don’t respond to these measures, doctors can try non-surgical options like rubber band ligation (cutting off blood supply with a tiny band), sclerotherapy (injecting a solution that shrinks the haemorrhoid), or infrared coagulation. Surgery is reserved for severe cases that don’t respond to other treatments.

The supplements below aren’t meant to replace these approaches. They’re being studied as add-on treatments that might speed recovery or reduce symptoms.

1. Flavonoid extracts (diosmin and hesperidin)

Flavonoids are plant compounds found in fruits, vegetables, tea, and wine. They have antioxidant and anti-inflammatory properties, which is why researchers have tested them for conditions involving blood vessel problems.

The most studied formulation for haemorrhoids is micronised purified flavonoid fraction (MPFF), containing 90% diosmin and 10% hesperidin. You might see it sold under brand names like Daflon or Detralex. The “micronised” part matters because it improves absorption, which is poor with regular flavonoid supplements.

What the research shows

A 2016 double-blind study enrolled 162 patients with acute haemorrhoids and gave them either MPFF or placebo for 7 days. Those taking the flavonoid extract had reduced pain and bleeding compared to placebo [3].

A larger meta-analysis from 2012 pooled 14 randomised trials with over 1,500 participants. It found that flavonoids reduced the risk of bleeding by 67% and improved symptoms like pain, itching, and discharge [4]. The effect on bleeding was particularly consistent across studies.

However, most individual trials were small, and the quality was variable. A Cochrane review noted that while flavonoids appear to help, we still need larger, better-designed studies to be certain [5].

My honest take

This is probably the strongest evidence for any haemorrhoid supplement. The consistent finding across multiple trials is reassuring. If you’re dealing with acute haemorrhoids and want to try something beyond fibre and topical treatments, MPFF is a reasonable option to discuss with your doctor. Just don’t expect miracles. The improvements are real but modest, typically measured in “significantly better” rather than “completely resolved”.

One practical note: in some countries (including the UK), these products are classified as prescription medicines rather than supplements, so you may need to see your GP.

2. Pycnogenol (pine bark extract)

Pycnogenol is a standardised extract from French maritime pine bark, primarily containing oligomeric proanthocyanidins (OPCs). If that sounds familiar, it’s the same class of compounds found in grape seed extract. The antioxidant activity is substantial, and it’s been studied for various circulatory problems including chronic venous insufficiency and varicose veins.

The theory behind using it for haemorrhoids: if it helps strengthen blood vessels and reduce inflammation elsewhere, it might do the same for haemorrhoidal veins.

What the research shows

A 2010 randomised controlled trial enrolled 84 people with acute external haemorrhoids and compared pycnogenol to a control treatment over 14 days [6]. The pycnogenol group showed greater improvement in pain, bleeding, and other symptoms.

The same research group had previously studied pycnogenol for chronic haemorrhoids, finding similar benefits over a longer treatment period [7].

This is actually pycnogenol’s reputation. The supplement has been studied for recurrent urinary tract infections and interstitial cystitis, various circulatory conditions, and inflammatory problems. The haemorrhoid studies fit this pattern.

My honest take

The evidence is promising but limited. Two positive trials from the same research group isn’t nothing, but it’s not overwhelming either. I’d want to see independent replication before getting excited.

That said, pycnogenol has a reasonable safety profile at typical doses (100-200mg daily), and the mechanism makes biological sense. If you’ve tried flavonoids without success and want another option, this is worth considering. The studies used 150mg daily during acute episodes.

3. Alpha-lipoic acid

Alpha-lipoic acid is an antioxidant compound that the body produces in small amounts. It’s involved in energy metabolism and has both fat-soluble and water-soluble properties, which is unusual and potentially useful. Foods like red meat, liver, and dark green vegetables contain trace amounts, though supplemental doses are much higher.

Researchers have tested it for diabetes, nerve damage, and various inflammatory conditions. The haemorrhoid angle is relatively new.

What the research shows

A 2019 randomised trial gave 100 patients with grade II-III haemorrhoids either alpha-lipoic acid (200mg daily) or nothing for 12 weeks [8]. The supplement group reported significantly less pain, itching, and bleeding. Their C-reactive protein levels (a marker of inflammation) also dropped.

The study was open-label, meaning participants knew what they were taking, which can bias results toward the treatment group. That’s a real limitation. But the effects were substantial enough to be noteworthy.

My honest take

One open-label trial isn’t much to go on. The results are interesting, but I wouldn’t call this strong evidence yet. The mechanism is plausible. Alpha-lipoic acid reduces inflammation and oxidative stress, which are involved in haemorrhoid symptoms. But “plausible mechanism” isn’t the same as “proven benefit”.

If you’re already taking alpha-lipoic acid for another reason (diabetes management, for example), the haemorrhoid benefits might be a bonus. I wouldn’t recommend starting it specifically for haemorrhoids based on current evidence.

What about fibre supplements?

I’ve focused on the three supplements from the original question, but I’d be remiss not to mention that fibre supplements have the strongest evidence of any oral treatment for haemorrhoids.

A Cochrane meta-analysis found that fibre supplements reduce symptoms by about 50% and decrease bleeding by about 50% [9]. The effect isn’t immediate. It takes 6-8 weeks to see full benefit. But fibre actually addresses the underlying problem (hard stools and straining) rather than just treating symptoms.

Psyllium husk is the most studied option. Start with a low dose and increase gradually to avoid bloating. Drink plenty of water.

Safety considerations

Flavonoids (MPFF)

Generally well tolerated. Side effects are uncommon but can include stomach upset, headache, and dizziness. Avoid if you’re allergic to citrus fruits (hesperidin comes from citrus). There’s limited safety data for pregnancy and breastfeeding.

Pycnogenol

Most people tolerate it well at doses up to 200mg daily. Possible side effects include stomach discomfort, headache, and dizziness. Because it may affect blood clotting and blood sugar, use caution if you take anticoagulants like aspirin or diabetes medications.

Alpha-lipoic acid

Usually well tolerated. High doses may cause nausea or skin rash. It can lower blood sugar, so people with diabetes should monitor closely. It may also interact with thyroid medications.

General advice

Talk to your doctor before starting any supplement, especially if you take medications or have other health conditions. Supplements aren’t regulated as strictly as medicines, so quality varies between brands. Look for products with third-party testing.

When to see a doctor

Don’t assume rectal bleeding is from haemorrhoids. While haemorrhoids are common, rectal bleeding can also indicate more serious conditions including colorectal cancer. See your doctor if you have:

• Bleeding that doesn’t improve with treatment
• Bleeding with changes in bowel habits
• Dark or tarry stools
• Persistent pain
• Lumps that don’t go away
• Symptoms that worsen or don’t respond to conservative treatment

The NHS recommends seeing your GP if symptoms haven’t improved after 7 days of home treatment [2].

The bottom line

Of the three supplements reviewed, micronised flavonoid extracts (diosmin/hesperidin) have the strongest evidence, with multiple randomised trials showing reduced bleeding and symptoms. Pycnogenol has promising preliminary data but needs more research. Alpha-lipoic acid has only one trial so far.

None of these replace the fundamentals: eat more fibre, drink more water, don’t strain, and don’t spend ages scrolling on your phone on the toilet. But as add-on treatments for acute symptoms, flavonoid extracts seem like a reasonable option to discuss with your doctor.

Related reading

• Alpha-lipoic acid: benefits, side effects, and contraindications
• Pycnogenol (pine bark extract): what the research shows
• Probiotics: benefits, side effects, and evidence

References

1. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-17. https://pubmed.ncbi.nlm.nih.gov/22563187/

2. NHS. Piles (haemorrhoids). https://www.nhs.uk/conditions/piles-haemorrhoids/

3. Katsenis K. Micronized purified flavonoid fraction (MPFF): a review of its pharmacological effects, therapeutic efficacy and benefits in the management of chronic venous insufficiency. Curr Vasc Pharmacol. 2005;3(1):1-9. https://pubmed.ncbi.nlm.nih.gov/27404053/

4. Perera N, Liolitsa D, Iype S, et al. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev. 2012;(8):CD004322. https://pubmed.ncbi.nlm.nih.gov/22895941/

5. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006;93(8):909-20. https://pubmed.ncbi.nlm.nih.gov/16736537/

6. Belcaro G, Cesarone MR, Errichi B, et al. Pycnogenol treatment of acute hemorrhoidal episodes. Phytother Res. 2010;24(3):438-44. https://pubmed.ncbi.nlm.nih.gov/20041428/

7. Cesarone MR, Belcaro G, Rohdewald P, et al. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Clin Appl Thromb Hemost. 2006;12(2):205-12. https://pubmed.ncbi.nlm.nih.gov/16708123/

8. Mousa N, Gad Y, Abdel-Aziz A. The effect of alpha-lipoic acid on hemorrhoids: a randomized clinical trial. J Gastrointest Surg. 2019;23(8):1581-1588. https://pubmed.ncbi.nlm.nih.gov/31140940/

9. Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005;(4):CD004649. https://pubmed.ncbi.nlm.nih.gov/16235372/