How does diltiazem (Cardizem) treat a thrombosed hemorrhoid?

From the Guidelines

Diltiazem is not typically used to treat thrombosed hemorrhoids, and the standard treatments include surgical excision of the clot within 72 hours of onset, or conservative management with pain control using oral analgesics, sitz baths, and topical treatments. For thrombosed hemorrhoids, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference 1. However, topical diltiazem (2% ointment) may sometimes be prescribed for anal fissures or chronic anal pain due to its calcium channel blocking properties that relax the internal anal sphincter and improve blood flow to the area. This mechanism can indirectly help with hemorrhoid symptoms by reducing pressure and improving circulation, but it is not a primary treatment for thrombosed hemorrhoids specifically. Some key points to consider in the management of thrombosed hemorrhoids include:

• In patients with complicated hemorrhoids, non-operative management as first-line therapy, with dietary and lifestyle changes, is recommended 1
• The use of topical muscle relaxant, such as diltiazem, may be suggested for thrombosed or strangulated hemorrhoids, although the evidence is based on low-quality evidence 1
• Surgical excision of the clot within 72 hours of onset may provide rapid relief, but the decision should be based on local expertise and patient’s preference 1
• Self-care measures, such as ice packs, sitz baths, over-the-counter pain relievers, and stool softeners, can help alleviate symptoms and prevent constipation, which can worsen hemorrhoid pain. It is essential to seek medical attention promptly if you have a thrombosed hemorrhoid, as early intervention can provide the most rapid relief.

From the Research

Treatment of Thrombosed Hemorrhoids with Diltiazem

• Diltiazem, also known as Cardizem, is a calcium channel blocker that can be used to treat thrombosed hemorrhoids 2, 3, 4.
• The application of topical diltiazem ointment has been shown to reduce pain after hemorrhoidectomy, which is a surgical procedure to remove hemorrhoids 3, 4.
• In the context of thrombosed hemorrhoids, diltiazem can help to relax the anal sphincter muscle and reduce pain and discomfort 2, 3, 4.
• However, the exact mechanism of how diltiazem treats thrombosed hemorrhoids is not fully understood and may require further research.

Efficacy of Diltiazem in Reducing Pain

• Studies have shown that topical diltiazem ointment can significantly reduce pain after hemorrhoidectomy, with some studies reporting a reduction in pain scores of up to 45% 2, 3, 4.
• The efficacy of diltiazem in reducing pain has been demonstrated in several randomized controlled trials, including a meta-analysis of five trials that included 227 patients 4.
• The use of diltiazem has also been shown to reduce the need for rescue analgesia, which is a measure of the effectiveness of a pain relief treatment 3.

Comparison with Other Treatments

• Diltiazem has been compared to other treatments for thrombosed hemorrhoids, including lidocaine and placebo, and has been shown to be effective in reducing pain and discomfort 2, 3, 4.
• However, the choice of treatment for thrombosed hemorrhoids depends on several factors, including the severity of symptoms, patient preferences, and the presence of any underlying medical conditions 5, 6.