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→2.3. Main Mechanisms of Natural Products’ Effects on Hemorrhoids

→Table 1. Goligher classification system: classification criteria and symptoms of internal hemorrhoids.

→Hemorrhoids can be classified into three types according to their location: internal, external, and mixed types. The statistics of different countries and regions are not the same; in China, internal types accounted for 52.23% of all hemorrhoids, which refer to pathological changes in the submucosal venous plexus that lead to the formation of hemorrhoidal cores, which can be graded into four degrees according to the Goligher classification system [20,21] (Table 1). The main clinical manifestations of internal types are bleeding, prolapse, and pruritus, and complications such as thrombosis, incarceration, strangulation, and defecation difficulty may also occur [22]. External types (14.04%) occur below the dentate line and are caused by damage to the anal venous plexus or persistent and recurrent inflammation, blood stasis, thrombosis, or anal tissue hyperplasia. The main symptoms of external hemorrhoids are pain and swelling due to inflammation and thrombosis, which can cause severe discomfort during defecation. Based on histopathological characteristics, external hemorrhoids can be further categorized into four types: connective tissue external hemorrhoids, varicose vein external hemorrhoids, thrombotic external hemorrhoids, and inflammatory external hemorrhoids [22]. Mixed types (21.05%) refer to the presence of both internal and external hemorrhoids, where the vascular plexuses of the internal and corresponding external hemorrhoids merge across the dentate line, forming a single entity. Mixed hemorrhoids can present with symptoms of both internal and external hemorrhoids and, in severe cases, may prolapse in the form of circumferential hemorrhoids [22,23].

→2.2. Classification and Symptoms

→Hemorrhoid disease represents a complex ailment for which the pathogenic mechanisms remain unclear [11]. The etiology of hemorrhoids is typically multifactorial. Predominant contributing factors include human physiological structure [12], dietary habits, lack of physical exercise, and defecatory behaviors [4]. These factors collectively increase intra-abdominal pressure during bowel movements, adversely affecting blood flow in the anal and rectal vessels, which may lead to swelling, bleeding, and the development of hemorrhoids [13]. Additionally, inflammatory responses [14], dysbiosis of the intestinal microbiota [15], and perianal infectious abscesses can also indirectly contribute to the onset of hemorrhoids [16]. Lastly, certain specific conditions such as sexual activity [17], pregnancy [18], and genetic factors [17] may also be associated with the development of hemorrhoids. Furthermore, in a sample of 4984 patients, it was shown that of these factors [17], defecation factors were present in 1455 patients (about 29.19%), exercise factors in 1231 patients (24.70%), sex factors in 1046 patients (20.99%), dietary factors in 923 patients (18.52%), and 329 cases (6.60%) had genetic factors. And a review reported a prevalence of between 25% and 35% in pregnant women [19].

→2.1. Etiology

→2. Etiology, Classification, and Mechanisms of Natural Products for Hemorrhoids

→Therefore, finding natural products that are cost-effective, efficacious, have clear pharmacological mechanisms, and are safe for hemorrhoid improvement is significant. This review aims to provide some reference bioactive components for the future development of hemorrhoid medications and prevention products. At the same time, it offers reference for improving the composition of existing hemorrhoid medications by integrating the etiology, classification, and natural product pharmacological mechanisms of hemorrhoids.

→According to the above facts, utilizing natural medicines or natural products for hemorrhoid improvement is a viable approach, yet the clinical application of natural medicines remains limited due to low evidential support, unclear active ingredients, and other factors, leading to their role primarily as complementary and alternative therapies. Furthermore, the number of approved chemical drugs with hemorrhoid improvement effects is very limited [3].

→Iranian traditional medicine, on the other hand, utilizes natural medicines like Allium ampeloprasum, Phyllanthus emblica, and Aloe vera in the improvement of hemorrhoids and their attendant symptoms [9]. In China, comprehension of hemorrhoid disease can be traced back approximately 2000 years to the Classic of Mountains and Rivers (Shan Hai Jing), where various natural medicines, including Sanguisorba officinalis L. (Di Yu) and dried flowers and buds of Sophora japonica L. (Huai Hua), are often employed as therapeutic medicines for hemorrhoids [10]. These instances collectively illustrate the potential of natural therapies in the improvement of hemorrhoids.

→Natural therapies, which are advocated by the guidelines of the European Society of Coloproctology on hemorrhoid disease management, include bran, psyllium, and senna, to alleviate symptoms and bleeding associated with hemorrhoids [7]. Meanwhile, in the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids [8], medical therapies are highlighted as a means to alleviate the condition with minimal harm and maximal dignity, specifically mentioning the use of phlebotonics, particularly flavonoids, in the improvement of both acute and chronic hemorrhoid disease.

→Hemorrhoid disease is defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The main symptoms of hemorrhoids include bleeding, inflammation, pain, infection, pruritus, ulceration, prolapse, and mucus exudation. Currently, the hemorrhoid medications with evidence of effectiveness include diosmin, troxerutin, hydroxyethylrutoside, and calcium dobesilate, which can significantly improve hemorrhoid bleeding, inflammation, and pruritus [4,5,6], etc.

→Figure 1. Current status of hemorrhoids.

→Hemorrhoids are a type of global disease that encompasses external, internal, and mixed hemorrhoids. The prevalence of hemorrhoids worldwide varies from 4% to 55% [1]. An epidemiological survey of common anorectal diseases among urban residents in China revealed that 51.14% of adults suffered from anorectal diseases, with hemorrhoids accounting for 50.28% of these cases [2]. The complications arising from hemorrhoids often cause significant distress to patients, severely impacting their quality of life. Hemorrhoids have evidently become a major health concern that threatens human well-being. Meanwhile, a study on the economic burden of hemorrhoids in the United States highlights the need to expand research on the etiology, prevention, and treatment of hemorrhoids, considering the escalating costs of treatment and the substantial economic burden [3] (Figure 1).

→1. Introduction

→Keywords: hemorrhoid improvement; hemorrhoids; natural products; pharmacological mechanisms.

→Building on this foundation, we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types.

→Therefore, we take the view that they are a class of potential hemorrhoid drugs, prevention products, and medication add-on ingredients. This article first reviews the factors contributing to the development of hemorrhoids, types, primary symptoms, and the mechanisms of natural products for hemorrhoids.

→In this context, searching for available natural products to improve hemorrhoids exhibits tremendous potential. These products are derived from nature, predominantly from plants, with a minor portion coming from animals, fungi, and algae. They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities.

→Hemorrhoid disease is a common anorectal disorder affecting populations worldwide, with high prevalence, treatment difficulties, and considerable treatment costs. Compared to other treatment options, medical therapy for hemorrhoids offers minimal harm, more dignity to patients, and is more economical. Unfortunately, there are few chemical hemorrhoid medications available clinically, which makes the search for efficacious, cost-effective, and environmentally friendly new medication classes a focal point of research.