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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(02): 124-130
DOI: 10.1055/s-0041-1730012
Original Article

Clinical Efficacy of Medicinal Leech Therapy in Treating Third- and Fourth-Degree Hemorrhoids

Eficácia clínica da hirudoterapia no tratamento de hemorroidas de terceiro e quarto graus
Abdul Mobeen 
1   Department of Moalajat (Medicine), National Institute of Unani Medicine, Bangalore, India
,
Ashfaque Ahmad 
2   Department of Moalajat, Saifia Hamidia Unani Tibbiya College, Burhanpur, MP, India
,
Mohd Aleemuddin Quamri 
3   Department of Moalajat (Medicine), National Institute of Unani Medicine, Bangalore, India
,
Abdul Nasir Ansari
4   Department of Ilaj Bit Tadbeer, National Institute of Unani Medicine, Bangalore, India
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Abstract

Objectives Hemorrhoids are characterized by bleeding, mucous discharge, itching, pain, and prolapse. This condition is known as bawaseer in Unani medicine, and Hirudinaria granulosa has been used for its treatment in Irsal-e Alaq, or medicinal leech therapy (MLT), for centuries. Hirudinaria granulosa with antithrombotic and antiinflammatory action is used in the treatment of chronic venous disease and hemorrhoids. The present study was aimed to investigate the efficacy of MLT in third and fourth-degree hemorrhoids.

Methods A single-centre prospective, clinical trial with a pre and postanalysis design was conducted at the hospital of the National Institute of Unani Medicine. Twenty male and female patients, with a mean age of 38 years, presenting moderate symptoms assessed with the colorectal evaluation of clinical therapeutics scale (CORECTS) questionnaire were included in the study. Hirudinaria granulosa were applied around the pile mass for 15 minutes weekly, for 4 weeks. The efficacy of the treatment was measured by an objective and subjective assessment using the CORECTS.

Results When analyzed by the clinician, MLT reduced the symptoms' severity score in the following domains: pain (55% improvement; p < 0.001); anorectal itching (30% improvement; p < 0.10); and bleeding (10% improvement; p < 0.7963). Significant improvement (p < 0.001) was reported in the CORECTS score in relation to pain (44.09% improvement; p < 0.001), itching (38.55% improvement; p < 0.001), swelling (44% improvement; p < 0.001), bleeding (17.28% improvement; p < 0.007), discomfort (34.01% improvement; p < 0.001), and wellbeing (32.35 %improvement; p < 0.001), giving an average overall opinion on the therapy of 4/10.

Conclusion The results of the study albeit smaller in sample size show that MLT is an effective and safe therapeutic option in reducing the symptoms of 3rd and 4th degree haemorrhoids.

Resumo

Objetivos As hemorroidas são caracterizadas por sangramento, secreção mucosa, prurido, dor e prolapso. Esta condição é conhecida como bawaseer na medicina Unani, e a Hirudinaria granulosa tem sido usada para seu tratamento na Irsal-e Alaq, ou hirudoterapia, há séculos. A H. granulosa, devido à sua ação antitrombótica e anti-inflamatória, é utilizada no tratamento de doenças venosas crônicas e hemorroidas. O presente estudo teve como objetivo investigar a eficácia da hirudoterapia em hemorroidas de terceiro e quarto graus.

Métodos Este ensaio clínico prospectivo e unicêntrico com delineamento pré e pós-análise foi conduzido no hospital do National Institute of Unani Medicine. Foram incluídos no estudo 20 pacientes de ambos os sexos, com média de idade de 38 anos, que apresentavam sintomas moderados avaliados pelo questionário colorectal evaluation of clinical therapeutics scale (CORECTS). Espécimes de H. granulosa foram aplicadas em volta da área afetada por um período de 15 minutos semanais, durante 4 semanas. A eficácia do tratamento foi medida por uma avaliação objetiva e subjetiva usando o questionário CORECTS.

Resultados Quando analisada pelo clínico, a hirudoterapia reduziu o escore de gravidade dos sintomas nos seguintes domínios: dor (55% de melhora; p < 0,001); prurido anorretal (melhora de 30%; p < 0,10); e sangramento (melhora de 10%; p < 0,7963). Melhora significativa (p < 0,001) foi relatada no escore CORECTS em relação à dor (44,09% de melhora; p < 0,001), prurido (38,55% de melhora; p < 0,001), inchaço (44% de melhora; p < 0,001), sangramento (17,28 % de melhora; p < 0,007), desconforto (34,01% de melhora; p < 0,001) e bem-estar (32,35% de melhora; p < 0,001), o que resultou em uma opinião geral média sobre a terapia de 4/10.

Conclusão Os resultados do estudo, embora com tamanho de amostra pequeno, mostram que a hirudoterapia é uma opção terapêutica eficaz e segura na redução dos sintomas de hemorroidas de terceiro e quarto graus.

Keywords

hemorrhoids - medicinal leach therapy - Unani medicine - bawaseer - irsal-e-alaq

Palavras-chave

hemorroidas - hirudoterapia - medicina Unani - bawaseer - irsal-e-alaq

Disclaimer

The present paper presents the findings of the postgraduate research dissertation submitted to Rajiv Gandhi University of Health Sciences, Karnataka




Publication History

Received: 15 August 2020

Accepted: 15 January 2021

Article published online:
03 June 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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