Fissure-in-ano is characterized by pain, bleeding, and internal anal sphincter hypertonicity. Spasm of the internal sphincter also plays a role in hemorrhoid disease and may be a source of anal pain after hemorrhoid surgery.
Inducing sphincter relaxation with a nitroglycerin ointment has shown promise in healing anal fissures and relieving symptoms of pain.
A study reported in the journal Diseases of the Colon and Rectum has examined whether topical nitroglycerin applied to the perianal region might be beneficial in reducing pain after hemorrhoidectomy.
In order to test such a theory, members from the Department of Colon and Rectal Surgery at the William Beaumont Hospital in Royal Oak, Michigan, USA, randomly assigned 39 patients who had just undergone hemorrhoidectomy to receive 0.2% nitroglycerin ointment (n = 19) or placebo (n = 20).
Ointments were applied to the perianal region three times daily for seven days. Patients were prescribed hydrocodone bitartrate to take as needed.
Visual analog scales were used to measure postoperative pain intensity and ointment benefits. Patients completed questionnaires to record medication morbidity and number of prescribed or non-prescribed medications taken.
The researchers found that patients using nitroglycerin had less pain and greater benefit from ointment than did those in the placebo group, although these differences were not significant.
Narcotic use was higher in the placebo group when considered on a daily basis, but was statistically significant only on the second post-operative day.
Morbidity from ointment application was significantly higher in the nitroglycerin group, however, and included a headache in 8 of 19 patients.
|Nitroglycerin: side effect was headaches|
|Diseases of the Colon and Rectum|
Nonsteroidal anti-inflammatory drugs and acetaminophen were not prescribed, but were taken more frequently in nitroglycerin patients.
Dr Harry J. Wasvary, a co-author of the report said that "although perianal application of the nitroglycerin ointment significantly reduced narcotic requirements on the second postoperative day, the headaches and subsequent need for non-narcotic medications brought about by the treatment may limit the benefits of nitroglycerin."