Haemorrhoids (hemorrhoids in American spelling) are vascular structures of arteries, veins and connective tissue in the anal canal. The 2024 guideline of the American Society of Colon and Rectal Surgeons (ASCRS) describes haemorrhoidal disease as one of the most common conditions seen in American clinics, with more than 2.2m outpatient visits a year, and treats it with fibre and bowel habits first, then office procedures such as banding, then surgery for the larger, prolapsing grades. Most trials of acupuncture for haemorrhoids sit at the last step: they test needling, electroacupuncture or stimulation of acupoints through the skin for the pain after an operation, and for the difficulty passing urine that follows it.
The reviews of those trials report lower pain scores than usual care or analgesics, from trials mostly run in China and mostly unblinded. The PROSPECT group of anaesthetists and surgeons added acupuncture to its recommendations for pain after haemorrhoid surgery in 2023; the surgical guidelines on haemorrhoidal disease do not mention it.
No Cochrane review
The Cochrane Library holds no review of acupuncture for haemorrhoids, for pain after haemorrhoidectomy or for urinary retention after it, as of October 2026. No systematic review found here covers acupuncture for the symptoms of haemorrhoidal disease without surgery.
Pain after haemorrhoidectomy
Haemorrhoidectomy, the cutting away of the haemorrhoids, brings moderate to severe pain, in the words of the PROSPECT recommendations below. Five systematic reviews have pooled trials of acupuncture and related methods for that pain. They differ in what they count as acupuncture and what they compare it with, so the table keeps them apart. Usual care here means the hospital’s standard care after surgery, painkillers included, without any acupoint treatment.
| Review | Trials and people | Comparison | Finding | Certainty |
|---|---|---|---|---|
| Qin and colleagues, 2020, network meta-analysis of 40 acupoint treatments | 107 trials, 10,972 people | Usual care, and the treatments against each other | Auricular acupressure (seeds taped to ear points) combined with acupuncture, acupuncture alone and auricular acupressure alone each raised the share of people responding over usual care; eight treatments lowered pain intensity | Assessed with GRADE; the authors say the findings were limited by the quality of the evidence |
| Chen and colleagues, 2022, needle acupuncture only | 4 trials, 275 people, all in China | Sham (1 trial); analgesics or local anaesthetic (3 trials) | Electroacupuncture lowered pain against sham at some time points and at first defecation; the two trials of manual acupuncture against drugs disagreed | Not graded; the authors call the evidence not conclusive |
| Du and colleagues, 2022, electroacupuncture only | 5 trials, 465 people, all in China | Controls without acupuncture; no trial blinded | Lower pain scores at 6 hours (standardised mean difference −0.89) and at later time points | Not graded; PubMed and the Cochrane Library were the only databases searched |
| Ye and colleagues, 2022, three acupoint methods without needling | 47 trials, 5,121 people | Analgesics | Auricular plaster, acupoint catgut embedding and acupoint application, a medicinal paste held on points, each lowered pain scores more than analgesics | Not graded; 3 of the 47 trials were blinded |
| Huang and colleagues, 2024, snap needles | 11 trials, 1,188 people | Control groups without snap needles | Pain 1.1 points lower on a visual analogue scale | Very low to moderate |
Snap needles are tiny press needles left taped in the skin. Chen’s review found BL57 (Chengshan) on the calf used in three of its four trials, followed by Erbai on the forearm (EX-UE2 in the WHO notation), GV01 (Changqiang) between the coccyx and the anus, and LI04 (Hegu).
Trials against sham
Three trials of pain after haemorrhoidectomy compared acupuncture with a sham, a procedure built to feel like acupuncture without stimulating the chosen points, which is the comparison that allows for patients’ expectations.
- Stapled haemorrhoidopexy, 2012. A trial by Langenbach and colleagues, described by its authors as the first Western trial of acupuncture after this operation, randomised 50 people after stapled haemorrhoidopexy to standard painkillers alone, painkillers plus acupuncture, or painkillers plus sham acupuncture. Pain was lower with acupuncture than with sham, but the difference from painkillers alone, the trial’s main comparison, fell short of significance (p = 0.057). The acupuncture group needed fewer rescue painkillers.
- Electroacupuncture around the wound, 2018. A single-centre trial by Wu and colleagues gave 72 people one 30-minute session of electroacupuncture with needles around the lesion, or sham acupuncture, within 15 minutes of a Milligan–Morgan haemorrhoidectomy. Patients and assessors were blinded. Pain was lower with electroacupuncture at 6 and 24 hours and at the first bowel movement, and not at the other eight time points measured.
- Pestle needles, 2020. A single-centre trial by Wang and colleagues gave 154 people three 15-minute sessions of pestle needle therapy, which the authors describe as manual stimulation of acupoints, at
GV01,GV02(Yaoshu),GV04(Mingmen),BL57, Erbai and points around the anus, or a sham with very light pressure. Pain at 12 hours, the main outcome, averaged 3.1 against 4.8 on a visual analogue scale.
Trials against usual care
- Stimulation through the skin, 2018. A trial by Yeh and colleagues gave 39 people four 20-minute sessions of electrical stimulation through skin pads at
BL57and Erbai after haemorrhoidectomy, and 41 people none. The stimulated group reported less pain and anxiety. - Electroacupuncture at the sacral points, 2023. A trial by Shen and colleagues randomised 124 people having stapled haemorrhoidopexy to surgery alone or surgery plus electroacupuncture at
BL32(Ciliao) andBL33(Zhongliao), two of the eight sacral points known together as Baliao. Pain and the feeling of anal swelling were lower over the first 3 days, and fewer painkiller doses were given, as were cases of urinary retention. Only the investigators were blinded. - Wrist-ankle acupuncture, 2026. A single-centre trial in Nanjing by He and colleagues randomised 275 people after haemorrhoidectomy into three groups: usual care, or wrist-ankle acupuncture at lower zone 6 given either within an hour of surgery or once pain began, with the needle left in for 6 hours. Needling within the hour lowered pain from 6 to 24 hours after surgery, and both needled groups needed fewer extra painkillers. A letter by Hu and Huang points out that the trial had no sham arm, so patients knew they were being treated, and that it enrolled more than twice the number its sample-size calculation required.
Urinary retention after haemorrhoidectomy
Difficulty passing urine is a common complication of anal surgery. The ASCRS guideline reports it in 1% to 15% of haemorrhoidectomies and names it the most common reason for delayed discharge after day surgery. Two reviews cover acupoint methods for it, one for treating it and one for preventing it:
- Moxibustion to treat it. A 2023 review by Liu and Chien included 34 trials of moxibustion, the burning of mugwort over points, for urinary retention after haemorrhoidectomy and other anal surgery, all against usual care. People given moxibustion were 2.5 times as likely to pass urine within an hour with full relief, and passed urine sooner. The authors ask for further trials to confirm the finding.
- Stimulation through the skin to prevent it. A 2024 review by Huang and colleagues pooled 14 trials with 2,865 people having several kinds of surgery. In the 6 trials of anal surgery, 1 against sham and 5 against no stimulation, transcutaneous electrical acupoint stimulation lowered the rate of urinary retention (risk ratio 0.34). The authors could not rule out publication bias.
Shen’s trial above counted 1 case of urinary retention with electroacupuncture against 5 with surgery alone, and He’s found 14% against 29% with early wrist-ankle acupuncture. Urinary retention reports the trials after other operations and in other settings.
Haemorrhoids without surgery
Trials of acupuncture for the bleeding, prolapse and pain of haemorrhoidal disease itself are scarce. A 2008 trial by Li and colleagues, published in Chinese, randomised 120 people with painful haemorrhoids to 5 days of electroacupuncture at BL57 and GV01 or to tramadol with a Chinese medicine suppository, and reported that pain at defecation fell with electroacupuncture. A comparison with drugs cannot be blinded.
A 2011 historical study by Huang and Huang traced the textbook claim that LU06 (Kongzui) treats haemorrhoids and found it derives from incorrect dissemination, with no support in either the literature or clinical practice.
What guidelines say
The PROSPECT recommendations for haemorrhoid surgery, by Bikfalvi and colleagues, were published in 2023 and update the editions of 2010 and 2017; PROSPECT is a working group of anaesthetists and surgeons that writes pain recommendations for one operation at a time. The 2023 update lists acupuncture under other modalities and says perioperative acupuncture can be recommended as an analgesic adjunct. It cites the Qin review and three later trials, and adds that differing techniques, a reduction in pain of less than one point, and the specific training needed preclude wide use in clinical practice. Its table comparing editions marks acupuncture only in 2023.
The surgical guidelines on haemorrhoidal disease do not mention acupuncture: not the ASCRS guideline, published in May 2024 to replace its 2018 edition; not the European Society of Coloproctology (ESCP) guideline of 2020; and not the Italian Society of Colorectal Surgery (SICCR) consensus statement of 2020. The ESCP guideline says non-steroidal anti-inflammatory drugs and other non-opioid painkillers could be prescribed for pain. A 2025 evidence summary by Zou and colleagues in China, written to inform future guidelines, includes statements that acupuncture and electroacupuncture reduce pain after haemorrhoid surgery, drawn from the Ye and Du reviews, and notes that the trials behind them are of limited quality and mostly from Asian health systems.
What the reviews could not settle
Most of the trials in these reviews ran in China, and most compared acupuncture with usual care or drugs rather than sham, so patients knew which group they were in while rating their own pain. Where the trials come from discusses what a trial’s country tells a reader. The sham-controlled trials described here enrolled 50 to 154 people, and Langenbach’s found no clear difference from painkillers alone. PROSPECT judged the reduction in pain to be less than one point. The reviews pool many different methods, from needles to ear seeds to herbal pastes, and Qin’s network analysis ranked them on evidence its own authors call limited. The authors of the stimulation review say the limited quality of the trials and possible publication bias undermine their certainty, and the moxibustion review asks for further trials. No review covers acupuncture for haemorrhoidal disease without surgery. Pain after surgery reports the trials after other operations.
AcuiQ’s haemorrhoids, pain after surgery for mixed haemorrhoids and urinary retention after haemorrhoidectomy pages list the protocols individual studies prescribed, each with its citation.