The rare flavonoids diosmin and hesperidin can stop the show . . .

Hemorrhoids result when the veins around the anus, or in the anal canal, swell when stretched under pressure. In pregnancy and in some other cases, they can be caused by obstruction to the flow of blood in the veins of the rectum. Among other causes, hemorrhoids can result from constipation, straining to have a bowel movement, too little dietary fiber, heavy lifting, obesity, sports-related exertion, or simply aging.

The first symptom of hemorrhoids, whatever the cause, is often bleeding from the anus, particularly during a bowel movement. Only a slight trace of blood may be seen on the toilet paper, or bleeding may be profuse. At the same time, there may be irritation, itching, or pain. The American Medical Association reports that hemorrhoids are very common. Although they are not dangerous in themselves, they can be very annoying and painful. Although bleeding is a common symptom of hemorrhoids, it can also be a sign of cancer of the rectum or colon. You should therefore see a physician at the first sign of anal bleeding. Even if there is no bleeding, hemorrhoids should still be taken seriously, because they are a reflection of damaged veins. If the damage goes on, it can lead to varicose veins, venous insufficiency, and even venous thrombosis (a blood clot).

Believe it or not, diseases of the venous system (veins) can be very serious. Following heart attack and stroke, venous thromboembolism (vein blockage by a clot) is the third most common vascular disease in the United States, responsible for between 300,000 and 600,000 hospitalizations and up to 100,000 deaths annually.1

In Singapore, a study was done to assess the role of the flavonoids diosmin and hesperidin in the management of bleeding, nonprolapsed (nonprotruding, internal) hemorrhoids.2 A total of 162 subjects were randomly assigned to receive a dietary fiber supplement (ispaghula husk), a rubber-band ligation plus fiber, or a 9-to-1 mixture of the flavonoids diosmin and hesperidin plus fiber. There were 66 subjects in the fiber group, 57 in the rubber-band/fiber group, and 39 in the flavonoids/fiber group. The observers were blinded as to which subjects got what treatment.

When the results were in, it was seen that hemorrhoidal bleeding was relieved most rapidly in the flavonoids/fiber group, with a mean time for bleeding cessation of just 4 days. In the rubber-band/fiber group, the mean time was 6 days, and in the fiber group, it was 11 days. No complications or side effects were noted.

Interestingly, three of the subjects in the fiber group gave up after 7 days because they presumed the treatment would not work. The recurrence rates at 6 months of follow-up found that only 5% in the flavonoids/fiber group had relapsed, versus 12% for the fiber group and 21% for the rubber-band/fiber group. Hemorrhoidectomies (surgical removal of hemorrhoids) were eventually performed on two of the subjects in the fiber group and on five in the rubber-band/fiber group. No surgery was performed on anyone in the flavonoids/fiber group.

The flavonoids diosmin and hesperidin have been found to inhibit the inflammatory response3 and to maintain the integrity of the capillary endothelium (lining).4 They also alter the way that noradrenaline operates to improve venous tone.5 Moreover, diosmin and hesperidin reduce edema, thus improving drainage.6

The diosmin/hesperidin mixture used with fiber supplements rapidly and safely relieved bleeding from nonprolapsed hemorrhoids. Subjects were far less likely to relapse, and, unlike the other groups, surgery was avoided, presumably because the flavonoids improved their venous health.


  1. Centers for Disease Control. Vital and Health Statistics, Series 10, No. 199 (10/98);p.83.
  2. Ho YH, Tan M, Seow-Choen F. Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum 2000 Jan;43(1):66-9.
  3. Lonchampt M, Guardiola B, Sicot N, Bertrand M, Perdrix L, Duhault J. Protective effect of a purified flavonoid fraction against reactive oxygen radicals. In vivo and in vitro study. Arzneimittelforschung 1989 Aug;39(8):882-5.
  4. Friesenecker B, Tsai AG, Allegra C, Intaglietta M. Oral administration of purified micronized flavonoid fraction suppresses leukocyte adhesion in ischemia-reperfusion injury: in vivo observations in the hamster skin fold. Int J Microcirc Clin Exp 1994 Jan-Apr;14(1-2):50-5.
  5. Juteau N, Bakri F, Pomies JP, Foulon C, Rigaudy P, Pillion G, Lange G, Genre O, Cron JP. The human saphenous vein in pharmacology: effect of a new micronized flavonoidic fraction (Daflon 500 mg) on norepinephrine induced contraction. Int Angiol 1995 Sep;14(3 Suppl 1):8-13.
  6. Cotonat A, Cotonat J. Lymphagogue and pulsatile activities of Daflon 500 mg on canine thoracic lymph duct. Int Angiol 1989 Oct-Dec;8(4 Suppl):15-8.