Herbal supplements for hemorrhoids: what the trials found

Herbal supplements for hemorrhoids are sold mostly as vein support: horse chestnut, pine bark, butcher’s broom, gotu kola, and blends from Chinese and Ayurvedic medicine. Some have small trials behind them. A few have real safety problems. None has the research base of flavonoids such as diosmin, which have their own page in diosmin for hemorrhoids, or of fiber.

Doctors group most of these plant extracts under the name phlebotonics, drugs thought to firm up vein walls and reduce leaky blood vessels ¹. This page goes herb by herb: what the trials found, how much weight each result can bear, and what to watch for. The quick comparison of every natural option is in natural remedies for hemorrhoids.

Herbal supplements at a glance

Horse chestnut extract

Horse chestnut seed extract is standardized to aescin (also spelled escin), the compound thought to do the work. A review of aescin describes anti-swelling and vein-toning effects in lab models and reports clinical use for leg vein problems, hemorrhoids and swelling after surgery ³.

The direct hemorrhoid evidence is one trial. In a 2024 randomized trial of aescin added to a flavonoid pill, people with grade 1 and 2 internal hemorrhoids took the purified flavonoid formula alone or with aescin ². Bleeding stopped after 2 days with the combination and after 4 days with flavonoids alone, and the feeling of a lump eased after 4 days against 5 ². Treatment failed less often in the combination group ². The authors asked for larger trials to confirm it ².

Most horse chestnut research is on chronic venous insufficiency, the condition behind aching, swollen legs. The Cochrane review of horse chestnut seed extract for leg veins found less leg pain and swelling than placebo, with side effects that were usually mild and infrequent ⁴. That supports the idea that aescin acts on veins. It is not a hemorrhoid result. Dosing, the bleeding concern and who should skip it are in horse chestnut for hemorrhoids.

Pine bark extract (Pycnogenol)

Pycnogenol is a branded extract of French maritime pine bark. In a randomized trial of pine bark extract for acute hemorrhoid flares, 84 people started treatment within 48 hours of a flare ⁶. Symptom scores fell more with the extract than with placebo after a week, and faster still when people used a pine bark gel as well as the pills ⁶. Bleeding was absent in everyone on the extract by day 7 and at day 14, while some in the placebo group were still bleeding ⁶.

Two later studies were registries, where people chose their own treatment rather than being randomly assigned. In women with hemorrhoids after their second pregnancy, 75 percent of those with grade 3 hemorrhoids who took the extract for 6 months were symptom-free, against 56 percent with standard care ⁷. After hemorrhoid surgery, 18 people taking the extract had lower pain and discomfort scores at 10 and 30 days than 20 people on standard care ⁸.

These results are encouraging. They also come from the same research group, and the registries name the manufacturer in their methods ^7,8. Independent trials have not repeated them.

Gotu kola (Centella asiatica)

Gotu kola is the common name for Centella asiatica. In a 2020 randomized trial, people with hemorrhoids were treated with flavonoids, with Centella, or with routine care alone ⁹. Bleeding stopped after a median of 2 weeks with either plant extract, against 3 weeks with routine care ⁹. Irritation scores were better with both extracts than with routine care ⁹. The authors judged flavonoids the more effective of the two, although the extracts did not differ significantly on irritation ⁹.

That is one trial. If you want a plant pill for bleeding, flavonoids have far more behind them.

Chinese herbal formulas

Traditional Chinese medicine uses many formulas for bleeding hemorrhoids. The Cochrane review of Chinese herbs for bleeding hemorrhoids found 9 trials with 1,822 people ¹⁰. The trials were generally of low quality and compared different formulas with each other or with Western drugs, so they could not be pooled ¹⁰. Some formulas seemed to ease bleeding and swelling in the short term, and side effects were rare and not serious ¹⁰. The authors said there was no strong evidence and that practice should not change on these results ¹⁰.

One formula, based on Sophora japonica flowers, has been tested against placebo ¹¹. After 14 days, 78 percent of the herb group had no symptoms, and the difference from placebo was not statistically significant ¹¹. Symptoms improved sharply in both groups as bowel habits improved and people took sitz baths ¹¹. That last point is worth noticing: the basics did much of the work.

Ayurvedic remedies

Ayurveda is a traditional medical system from India. In a trial of 90 people, a 7-day Ayurvedic kit of tablets, powder and cream was compared with standard care of psyllium powder and a lidocaine gel for 14 days ¹². More people on the kit had a symptom score of zero at day 14, 15 against 6, and the kit did better on straining, sphincter spasm and hemorrhoid grade ¹². Side effects were similar in both groups ¹².

The bigger issue with Ayurvedic products is what else may be in them. A JAMA study of Ayurvedic medicines sold online tested 193 products and found lead, mercury or arsenic in 20.7 percent ¹³. US-made products were as likely to contain metals as Indian-made ones ¹³. If you choose an Ayurvedic product, buy from a maker that publishes independent testing for heavy metals, and tell your doctor.

Butcher’s broom

Butcher’s broom (Ruscus aculeatus) is sold for vein health and shows up in many combination products. We searched PubMed in October 2026 and found reviews of its chemistry and old studies of combination products, and no modern randomized trial of butcher’s broom alone for hemorrhoids. Until it has been tested on its own, there is no way to say what it adds to a blend.

Herbal creams and ointments

Plant extracts are also tested as ointments. In a triple-blind trial of 134 women with grade 1 or 2 internal hemorrhoids after childbirth, a myrtle ointment worked about as well as a standard hemorrhoid ointment over 4 weeks, with less itching at 4 and 8 weeks ¹⁴. Aloe, tea tree oil, honey and propolis creams are covered in aloe vera for hemorrhoids, tea tree oil for hemorrhoids and the hub.

How to use a herbal supplement safely

1. Start with fiber, water and short toilet sits. In seven trials, fiber cut the risk of bleeding by half ¹⁵.
2. If you add a supplement, pick one herb, not a blend of six, so you can tell whether it helps.
3. Use standardized extracts only, never raw horse chestnut or homemade preparations ⁵.
4. Give it a week. Keep a note of bleeding and pain each day.
5. Stop if you get a rash, stomach upset, dizziness or headaches.
6. Ask a pharmacist before combining herbs with prescription medicines, and ask your obstetric provider if you are pregnant or breastfeeding.

Flavonoid pills and fiber capsules are compared on the best hemorrhoid pills. Creams, suppositories and pads with their own trial records are in over-the-counter hemorrhoid treatment.

When herbs are the wrong tool

A hemorrhoid that keeps prolapsing, or bleeding that keeps coming back after months of home care, usually needs an office treatment such as banding. Those options are laid out in hemorrhoid treatment and hemorrhoid procedures.

MedlinePlus advises a check when home care has not helped after a week, and says rectal bleeding has causes other than hemorrhoids ¹⁶. Colon cancer screening starts at age 45 for adults at average risk ¹⁷.