Hemorrhoidal disease is characterized by distal displacement and deterioration of structural integrity of vascular cushions in the anal canal, which physiologically help defecation and continence. Unlike advanced stage (stage IV) hemorrhoids, which require surgical intervention, various topical agents (gels, ointments, creams), oral venoactive drugs, homeopathic and phytotherapeutic products and nutritional supplements are widely used in stage II and III hemorrhoidal disease. The genus Ruscus (family Asparagaceae) is a group of plants native to the Mediterranean basin, Southern and Western Europe, and Iran, represented by perennial, rhizome-based, and evergreen shrubs. Among the species belonging to this genus, Ruscus aculeatus L. has the widest distribution area. The subsoil parts of the Ruscus plant are rich in steroidal saponins and show vasoconstrictor, diuretic, anti-inflammatory and venotonic effects, especially with ruscogenin and neoruscogenin compounds. Due to these properties, R. aculeatus stands out as a traditional phytotherapy agent that has been used for a long time in chronic venous insufficiency. However, there are no controlled clinical studies in the literature evaluating the efficacy and safety of Ruscus aculeatus L. in hemorrhoidal disease. Therefore, this study was aimed to systematically evaluate the contribution of a phytotherapeutic product containing R. aculeatus to the treatment of stage II-III hemorrhoidal patients and to provide scientific evidence of a new and potentially safe herbal treatment option that can be used in the treatment of hemorrhoids.
Patients between the ages of 18-45 with complaints (symptomatic) consistent with hemorrhoidal disease
Patients with Stage II and III hemorrhoids according to the Goligher Hemorrhoid Rating system using physical examination (digital rectal examination, anoscopy/rectoscopy performed within a maximum of four weeks before the examination)
Patients who have signed the Informed Consent Form
Patients aged <18 and >45 years
Stage I and IV hemorrhoids according to the Goligher Hemorrhoid Rating system
Surgery for hemorrhoids at any time
Injection treatment for multiple hemorrhoids in the last 3 years
Parallel
Neoven 225 mg capsules
DrugPatients in this group will only use Neoven 225 mg capsules orally. There will be no signs or inscriptions on the capsules regarding their contents. The duration of the study is determined as 42 days. A total of 378 mg of total ruscogenin (ruscogenin/neoruscogenin mixture obtained by extraction method) will be taken orally using one Neoven capsule orally with meals twice a day. A total of 84 capsules will be given to the patients, and their use will be questioned by phone on the 7th and 14th days of the treatment and the number of uses will be checked at the end of the treatment. Failure to use all of the capsules will be considered as a criterion for exclusion from the study.
Placebo
DrugPatients in this group will only receive an oral placebo capsule designed for this study. There will be no signs or inscriptions on the capsules regarding their contents. The duration of the study is determined as 42 days. During this period, one placebo capsule will be taken orally twice a day with meals. A total of 84 capsules will be given to the patients, and their use will be questioned by phone on the 7th and 14th days of the treatment and the number of uses will be checked at the end of the treatment. Failure to use all of the capsules will be considered as a criterion for exclusion from the study.
Quality of Life for HSS (Hemorrhoid Severity Score)
Hemorrhoid Severity Score (HSS) is the total score obtained by the sum of the numerical grades of pruritis, pain, prolapse, bleeding and soiling. All the five components in this classification system are graded into four grades ranging from 0 to 3.
Hemorrhoidal Disease Symptom Score (HHSS)
The HHSS is a scale that is scored based on five main symptoms: pain, bleeding, itching, fecal incontinence, and prolapse. For the frequency rating of these symptoms, the total score is calculated according to the five-point Liekert classification \[Never (score=0), Less than once a month (score=1), Less than once a week (score=2), 1-6 days a week (score=3), Every day/always (score=4)\]. The total score ranges from 0 to 20.
Visual Analog Scale (VAS)
A visual scale with a value range between 0 and 10 will be shown to patients for the VAS pain score, and the they will be asked to rate their current pain as "0"; for no pain and "10"; for unbearable severe pain
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Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
Lead sponsor
Atabay Kimya Sanayi Ticaret A.S.
Collaborator
