Diosmin, an anti-inflammatory and vasoconstrictive compound derived from citrus fruits, is a safe and effective remedy for pregnancy-associated hemorrhoids.

Internal hemorrhoids affect roughly 25% of all women of childbearing age, the prevalence increasing with both age and parity. They can sometimes be quite severe, causing extreme discomfort. Conventional therapies for hemorrhoids are limited largely to surgical interventions like band ligation, infrared coagulation and other procedures that are generally contraindicated during pregnancy. Consequently, there is a major therapeutic gap in treating this problem.

Diosmin is a flavonoid compound derived from hesperidin, itself a flavonoid extracted from the nearly mature fruit of Rutaceae aurantiae, a small, sweet orange grown in the southern Mediterranean and North African regions, as well as parts of China.

Products containing micronized diosmin have been widely used in Europe and Asia for decades, as a treatment for hemorrhoids, varicose veins and other peripheral vascular problems. In France and several other European countries, it is available only as a prescription drug. A dietary supplement ingredient known as DiosVein, which is manufactured in Europe according to standards set by the European Pharmacopeia, is now available in the US.

A number of well-controlled European clinical studies have shown diosmin to be highly effective in both prevention and treatment of hemorrhoids and varicose veins of the leg in men and non-pregnant women (Cospite M. Phlebology. 1992; 2: 53–56; Delmont J, et al. Int J Clin Pract. 1992; 8: 14–18). The compound appears to prolong the vasoconstrictive effect of noradrenalin on venous walls, thus increasing vessel tone and reducing capacitance. It also increases lymphatic drainage, while reducing a number of key inflammatory mediators, including thromboxane B2 and prostaglandins E2 and F2α (Labrid C, Duhault J. Int J Med. 1987; Suppl. 85: 30–35).

After preliminary toxicological studies showed that neither diosmin nor hesperidin cross the placenta in significant amounts, and would likely be very safe for pregnant women, a research team at the All India Institute of Medical Science tested a formulation containing 90% diosmin and 10% hesperidin in 50 pregnant women with acute internal hemorrhoids.

For the first 4 days of the trial, the patients took 6 tablets per day (each tablet containing 450 mg diosmin and 50 mg hesperidin), in two divided doses. The dose was lowered to 4 tablets daily for another 7 days, and then lowered again to 2 tablets daily for the next 30 days. Hemorrhoidal severity was evaluated through patient self-assessment and direct clinical observation at baseline, and again at Day 8, Day 30 and Day 60.

After the initial 4-day dose-loading phase, 66% of the patients had marked improvements in overall symptom scores. Bleeding, pain, and rectal exudation were all markedly reduced. Twenty-four patients showed visibly reduced rectal inflammation. At baseline 42 of 50 patients (84%) had severe inflammation, and this was reduced to 18 of 47 (38%). There was, however, no significant difference in venous prolapse or thrombosis in the women showing these at baseline (Buckshee K, et al. Int J Gyn Obstet. 1997; 57: 145–151).

Generally, the patients who responded were able to maintain their improved status while taking diosmin. Compared with their antenatal histories prior to beginning treatment, 54% of the women completing the trial had fewer episodes of hemorrhoidal symptoms during the month-long maintenance phase.

The investigators looked at hemodynamic measures, including heart rate, blood pressure and biochemical variables, and found no changes as a result of diosmin therapy. Likewise, ultrasonography revealed no fetal abnormalities. Given that diosmin crosses the placenta at levels of 0.003% or less, no such fetal effects were expected. Six of the women showed some degree of placental insufficiency, but it is not clear if this was related to the treatment.

Adverse effects were rare and relatively minor. Several patients experienced nausea or diarrhea, and in only two cases, were these bothersome enough to discontinue therapy. Another two patients dropped out of the trial for reasons unrelated to treatment.

The authors concluded that, “Symptoms of acute hemorrhoids and occurrence of relapse improved to a clinically important degree.” They added that diosmin, “is safe to use in the last trimester of pregnancy,” and that it, “may fill the therapeutic gap that exists in the management of hemorrhoids of pregnancy.”

The DiosVein brand of diosmin was recently introduced into the US supplement and nutraceutical market by Berg Imports, and is available as a finished product from Nutraceutics, a practitioner level supplement company based in St. Louis. (www.nutraceutics.com, Tel. 877-664-6684).