From the Guidelines
Nitroglycerin ointment is effective in relieving pain due to thrombosed external hemorrhoids by decreasing anal tone. This is based on a study published in the journal Gastroenterology in 2004 1. The use of nitroglycerin ointment for hemorrhoids is supported by its ability to relax the smooth muscles in blood vessels, which reduces pain and improves blood flow in the anal area.
Mechanism of Action
When applied topically to hemorrhoids, nitroglycerin causes vasodilation of the anal sphincter and rectal blood vessels. This relaxation of the anal sphincter decreases pressure and pain, particularly in patients with anal fissures that often accompany hemorrhoids. The improved blood flow also promotes healing of the inflamed hemorrhoidal tissue.
Application and Side Effects
To use nitroglycerin ointment for hemorrhoids, apply a small amount (usually pea-sized) to the affected area 2-3 times daily for up to two weeks. It's essential to wear gloves when applying the medication and to wash hands thoroughly afterward to prevent absorption through the fingers, which could cause headaches. The most common side effect of nitroglycerin ointment is headaches due to its vasodilating properties, and patients should be aware that this might occur, especially during initial use.
Current Recommendations
Recent guidelines published in the World Journal of Emergency Surgery in 2021 recommend non-operative management as the first-line therapy for complicated hemorrhoids, including dietary and lifestyle changes 2. However, the use of nitroglycerin ointment is specifically supported by earlier evidence 1, which suggests its effectiveness in relieving pain associated with thrombosed external hemorrhoids.
Key Points
- Nitroglycerin ointment relieves pain due to thrombosed external hemorrhoids by decreasing anal tone.
- Apply a small amount to the affected area 2-3 times daily for up to two weeks.
- Wear gloves when applying and wash hands thoroughly to prevent side effects like headaches.
- Non-operative management, including dietary and lifestyle changes, is recommended as the first-line therapy for complicated hemorrhoids.
From the Research
Mechanism of Action
- Nitroglycerin ointment helps with hemorrhoids by releasing nitric oxide, which mediates the anorectal inhibitory reflex in humans, leading to relaxation of the internal anal sphincter 3.
- This relaxation helps to reduce pain and promote healing in conditions such as thrombosed external hemorrhoids and anal fissure 3.
Clinical Evidence
- A study published in 1995 found that topical application of 0.5 percent nitroglycerin ointment provided dramatic relief of anal pain in patients with thrombosed external hemorrhoids and anal fissure 3.
- Another study published in 2018 discussed the use of topical nitroglycerine as a medical management option for hemorrhoids, highlighting its potential benefits in reducing pain and discomfort 4.
- A randomized, prospective, double-blind, placebo-controlled trial published in 2001 found that topical nitroglycerin ointment reduced pain after hemorrhoidectomy, although the difference was not significant 5.
- A prospective randomized study published in 2013 found that 0.4% glyceryl trinitrate ointment significantly reduced post-operative pain, ameliorated wound healing, and improved recovery after conventional hemorrhoidectomy 6.
- A meta-analysis published in 2010 found that glyceryl trinitrate ointment used post-haemorrhoidectomy had a significant analgesic effect in the intermediate time period and significantly improved wound healing at 3 weeks 7.