Objective: A systematic review of the literature on the efficacy and safety of flavonoids versus other available treatments in adults with hemorrhoidal disease with or without surgery.

Methods: We performed searches on the main published studies and study protocols databases to identify randomized clinical trials, systematic reviews or meta-analysis assessing the efficacy and safety of flavonoids versus currently available treatments in patients with hemorrhoidal disease with or without surgery. The selection, data extraction, bias risk and study quality evaluations was performed by at least 2 researchers based on Cochrane methodology and the PRISMA checklist.

Results: Seven studies were selected. Based on high quality evidence, reports of bleeding decreasing in 42/66 patients on the flavonoids group and in 29/68 of the placebo group was statistically significant (Chi-Square = 5.9; p = 0.015). Three meta-analyses of studies with placebo as a comparator were analyzed, flavonoids improved bleeding cessation with no significant difference on pain improvement or adverse events between groups.

Conclusions: The qualitative and quantitative analysis showed that flavonoids can improve the main symptoms in adults with hemorrhoidal disease with or without surgery. However, more studies are required to conclude on the efficacy and safety in comparison with other treatments.