title: Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the impact of laxatives on a wide range of symptoms in patients with symptomatic hemorrhoids.
  
  
  METHODS
  We searched using the following sources: MEDLINE, EMBASE, CINAHL and CENTRAL, BIOSIS, AMED, Papers First and Proceedings; study authors, industry, and experts in the field. We included all published and unpublished parallel group randomized controlled trials comparing any type of laxative to placebo or no therapy in patients with symptomatic hemorrhoids. Two reviewers independently screened studies for inclusion, retrieved all potentially relevant studies, and extracted data on study population, intervention, prespecified outcomes, and methodology.
  
  
  RESULTS
  Seven trials randomized 378 patients to fiber or a nonfiber control. Studies were of moderate quality for most outcomes. Meta-analyses using random effects models suggested that fiber has an apparent beneficial effect. The risk of not improving/persisting symptoms decreased by 47% in the fiber group (RR = 0.53, 95% CI 0.38-0.73) and the risk of bleeding by 50% (RR = 0.50, 95% CI 0.28-0.89). Studies with multiple follow-ups, usually at 6 wk and at 3 months, showed consistent results over time. Results are also compatible with large treatment effects in prolapse, pain, and itching, but even in the pooled analyses confidence intervals were wide and compatible with no effect (RR = 0.79, 95% CI 0.37-1.67; RR = 0.33, 95% CI 0.07-1.65; and RR = 0.71, 95% CI 0.24-2.10, respectively). One study suggested a decrease in recurrence. Results showed a nonsignificant trend toward increases in mild adverse events in the fiber group (RR = 6.0, 95% CI 0.57-64.8).
  
  
  CONCLUSIONS
  Trials of fiber show a consistent beneficial effect for symptoms and bleeding in the treatment of symptomatic hemorrhoids.
authors.affiliation: Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: Ed
authors.initials: E
authors.lastname: Mills
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Maite
authors.initials: M
authors.lastname: López-Yarto
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: John F
authors.initials: JF
authors.lastname: Johanson
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D003248:Constipation / Q000150:complications*; D004043:Dietary Fiber / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D005769:Gastrointestinal Motility / Q000502:physiology; D006484:Hemorrhoids / Q000150:complications*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012005:Rectal Prolapse / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome