Condition

Hemorrhoids

Swollen veins in the lower rectum and anus

352M

People Affected

Active Trials

52.8M

New Cases/Year

500

Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

Excisional Hemorrhoidectomy

92% Effectiveness• 90% Confidence• 55% Safety• 28 trials• 120K participants

HIGH EvidenceExcellent ValueDose: Surgical procedure

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

4-6 weeks for full recovery

Duration

Single procedure, recovery 4-6 weeks

Response Rate

93%

Remission Rate

88%

Common Side Effects:

Post-operative pain: 95%

Bleeding: 8%

Anal stenosis: 3%

Infection: 2%

Annual Cost of Care

Drug Cost

$150

Monitoring

$400

Side Effects

$750

Total Annual

$8,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.6

ICER

$13,333/QALY

Cost per Remission

$9,091

Cost per Responder

$8,602

Treatment Outcomes

Primary Outcomes

Hemorrhoid Symptom Score15/20 (higher score indicates worse symptoms)

-80% (-12 points)

Rectal Bleeding Severity3/4 (on a 0-4 scale, 4 = daily severe bleeding)

-90% (-2.7 points)

Hemorrhoid Prolapse Severity8/10 (on a 0-10 Visual Analogue Scale, 10 = constant irreducible prolapse)

-95% (-7.6 points)

Pain during Defecation (Numeric Rating Scale)7/10 (on a 0-10 NRS, 10 = worst pain imaginable)

-85% (-5.95 points)

Secondary Benefits

Disease-Specific Quality of Life40/100 (lower score indicates worse QoL)

+75% (+30 points)

Anal Itching Severity (Visual Analogue Scale)6/10 (on a 0-10 VAS, 10 = worst itching imaginable)

-70% (-4.2 points)

Anal Discharge/Soiling Severity5/10 (on a 0-10 VAS, 10 = severe, constant discharge)

-80% (-4 points)

Common Side Effects

Post-operative pain

+95%

Bleeding

+8%

Anal stenosis

+3%

Rubber Band Ligation

83% Effectiveness• 85% Confidence• 65% Safety• 14 trials• 55K participants

HIGH EvidenceExcellent ValueDose: 1-2 bands per session

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to 1 week

Duration

Multiple sessions (1-3) over several weeks

Response Rate

75%

Remission Rate

65%

Common Side Effects:

Pain/Discomfort: 40%

Bleeding: 7%

Vasovagal syncope: 1%

Annual Cost of Care

Drug Cost

$50

Monitoring

$450

Side Effects

$150

Total Annual

$2,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.3

ICER

$6,667/QALY

Cost per Remission

$3,077

Cost per Responder

$2,667

Treatment Outcomes

Primary Outcomes

Overall Hemorrhoid Symptom Score (HSS)HSS score: 15/20 (higher is worse)

-70% (-10.5 points)

Frequency of Bleeding Episodes3-4 episodes per week

-85% (Reduced by ~3 episodes per week)

Hemorrhoid Prolapse Grade ImprovementAverage Prolapse Grade: 2.5 (on a 0-4 scale)

-50% (-1.25 points)

Hemorrhoid-Related Pain (VAS)VAS score: 6/10

-65% (-3.9 points)

Secondary Benefits

Hemorrhoid-Specific Quality of Life (QoL)QoL score: 45/100 (higher is better)

+40% (+18 points)

Frequency of Analgesic/Topical Medication UseDaily use

-70% (Reduced to 2-3 times per week)

Itching/Pruritus Severity ScoreSeverity score: 7/10 (higher is worse)

-60% (-4.2 points)

Common Side Effects

Pain/Discomfort

+40%

Bleeding

+7%

Vasovagal syncope

+1%

Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL)

78% Effectiveness• 80% Confidence• 60% Safety• 1 trials• 15K participants

MODERATE EvidenceExcellent ValueDose: Surgical procedure

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Weeks to months for full symptom improvement

Duration

Single procedure, recovery days to a week

Response Rate

73%

Remission Rate

55%

Common Side Effects:

Post-operative pain: 30%

Tenesmus: 7%

Bleeding: 3%

Recurrence: 15%

Annual Cost of Care

Drug Cost

$100

Monitoring

$300

Side Effects

$200

Total Annual

$4,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.4

ICER

$10,000/QALY

Cost per Remission

$7,273

Cost per Responder

$5,479

Treatment Outcomes

Primary Outcomes

Hemorrhoid Bleeding Severity (VAS 0-10)6.5/10

-75% (-4.9 points)

Hemorrhoid Pain Severity (VAS 0-10)5.8/10

-65% (-3.8 points)

Hemorrhoid Prolapse Severity (Clinical Score 0-3)2.5/3

-60% (-1.5 points)

Global Hemorrhoid Symptom Score (0-20 scale)14/20

-70% (-9.8 points)

Secondary Benefits

Hemorrhoid Disease-Specific Quality of Life (0-100 scale)45/100

+50% (+22.5 points)

Pruritus Ani Severity (VAS 0-10)4.0/10

-55% (-2.2 points)

Frequency of Analgesic Use for Hemorrhoid Symptoms (doses/week)4 doses/week

-80% (-3.2 doses/week)

Common Side Effects

Post-operative pain

+30%

Tenesmus

+7%

Bleeding

+3%

Sclerotherapy

72% Effectiveness• 80% Confidence• 65% Safety• 14 trials• 40K participants

MODERATE EvidenceExcellent ValueDose: 3-5ml sclerosant per hemorrhoid

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to 1 week

Duration

Multiple sessions (1-4) over several weeks

Response Rate

65%

Remission Rate

45%

Common Side Effects:

Mild discomfort/pain: 15%

Bleeding: 3%

Rectal ulceration: 0.5%

Annual Cost of Care

Drug Cost

Monitoring

$350

Side Effects

$75

Total Annual

$1,500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$7,500/QALY

Cost per Remission

$3,333

Cost per Responder

$2,308

Treatment Outcomes

Primary Outcomes

Hemorrhoid Bleeding Severity (0-5 scale)4/5 (frequent, significant bleeding)

-75% (-3 points)

Hemorrhoid Prolapse Severity (1-4 scale for Grade I-IV)2/4 (Grade II internal hemorrhoid)

-50% (-1 point (e.g., from Grade II to Grade I))

Overall Hemorrhoid Symptom Score (0-20 points)12/20 (moderate-severe symptoms)

-66.7% (-8 points)

Secondary Benefits

Hemorrhoid-Specific Quality of Life Score (0-100, higher is better)50/100

+30% (+15 points)

Anal Discomfort Score (VAS 0-10)4/10

-50% (-2 points)

Weekly OTC Hemorrhoid Medication Use (frequency per week)5 times/week

-80% (-4 times/week)

Common Side Effects

Mild discomfort/pain

+15%

Bleeding

+3%

Rectal ulceration

+0.5%

Micronized Purified Flavonoid Fraction (MPFF)

68% Effectiveness• 85% Confidence• 85% Safety• 2 trials• 7.5K participants

HIGH EvidenceExcellent ValueDose: Acute: 1000mg TID for 4 days, then 1000mg BID for 3 days. Chronic: 500-1000mg daily.

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to 1 week

Duration

Acute episodes (7 days), chronic management (weeks to months)

Response Rate

65%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Gastrointestinal disturbances (diarrhea, nausea): 3%

Headache: 1%

Annual Cost of Care

Drug Cost

$400

Monitoring

$50

Side Effects

$25

Total Annual

$475

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

ICER

$4,750/QALY

Cost per Responder

$731

Treatment Outcomes

Primary Outcomes

Frequency of Bleeding Episodes3 episodes/week

-70% (-2.1 episodes/week)

Hemorrhoidal Pain Severity (VAS)7/10

-50% (-3.5 points)

Hemorrhoidal Pruritus Severity (VAS)6/10

-45% (-2.7 points)

Hemorrhoidal Swelling Score3/5

-40% (-1.2 points)

Secondary Benefits

Overall Hemorrhoid Symptom Score15/25

-40% (-6 points)

Hemorrhoid-Specific Quality of Life50/100

+20% (+10 points)

Weekly Analgesic Doses7 doses/week

-70% (-4.9 doses/week)

Common Side Effects

Gastrointestinal disturbances (diarrhea, nausea)

+3%

Headache

+1%

Clinical Trial Phases:

Phase 4

Fiber Supplements (e.g., Psyllium)

62% Effectiveness• 90% Confidence• 90% Safety• 120 trials• 12K participants

HIGH EvidenceExcellent ValueDose: 5-10g 1-3 times daily with water

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days for stool consistency, weeks for symptom reduction

Duration

Chronic/lifetime for prevention and management

Response Rate

55%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Bloating: 15%

Gas: 15%

Abdominal cramps: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$800

Side Effects

Total Annual

$900

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$1,250/QALY

Cost per Responder

$182

Treatment Outcomes

Efficacy Outcomes

Overall Effectiveness

+62%

Response Rate

+55%

Common Side Effects

Bloating

+15%

Gas

+15%

Abdominal cramps

+7%

Clinical Trial Phases:

Phase 4