Condition

Hemorrhoids

Swollen veins in the lower rectum and anus

352M
People Affected
60
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.

1
Excisional Hemorrhoidectomy
92% Effectiveness• 90% Confidence• 55% Safety• 28 trials• 120K participants
HIGH EvidenceExcellent ValueDose: Surgical procedure
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Comparative Safety Scale(Higher is safer)

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55
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%
2
Rubber Band Ligation
83% Effectiveness• 85% Confidence• 65% Safety• 14 trials• 55K participants
HIGH EvidenceExcellent ValueDose: 1-2 bands per session
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Comparative Safety Scale(Higher is safer)

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Meth💀
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65
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%
3
Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL)
78% Effectiveness• 80% Confidence• 60% Safety• 1 trials• 15K participants
MODERATE EvidenceExcellent ValueDose: Surgical procedure
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Comparative Safety Scale(Higher is safer)

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Meth💀
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60
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%
4
Sclerotherapy
72% Effectiveness• 80% Confidence• 65% Safety• 14 trials• 40K participants
MODERATE EvidenceExcellent ValueDose: 3-5ml sclerosant per hemorrhoid
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Comparative Safety Scale(Higher is safer)

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Meth💀
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65
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

$0

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%
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.
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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85
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)

7

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
6
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
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
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)

5

Common Side Effects:

Bloating: 15%
Gas: 15%
Abdominal cramps: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$800

Side Effects

$0

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