From the Guidelines
Nitroglycerin ointment helps with hemorrhoids by relieving pain due to thrombosed external hemorrhoids, presumably by decreasing anal tone. When applied topically, nitroglycerin ointment causes vasodilation of the anal sphincter and surrounding blood vessels, which decreases pressure in the area and improves blood flow 1. This action helps relieve the intense pain associated with thrombosed external hemorrhoids.
- The ointment is typically applied with a finger or cotton swab to the affected area, usually 2-3 times daily for up to two weeks.
- Patients should use only a small pea-sized amount to avoid side effects like headaches, which occur when the medication is absorbed systemically.
- Improvement is often noticed within the first few days of treatment, as the ointment works through the release of nitric oxide, which triggers smooth muscle relaxation and reduces sphincter tone, creating an environment more conducive to healing while providing pain relief 1.
- It is essential to note that while nitroglycerin ointment provides relief for thrombosed external hemorrhoids, other treatments, such as adding dietary fiber and avoiding straining at stool, are also crucial in managing hemorrhoidal symptoms 1.
From the Research
Mechanism of Action
- Nitroglycerin ointment helps with hemorrhoids by donating nitric oxide, which mediates the anorectal inhibitory reflex in humans, leading to relaxation of the internal anal sphincter 2.
- This relaxation helps to reduce pain and discomfort associated with hemorrhoids, particularly thrombosed external hemorrhoids and anal fissure 2.
Efficacy in Hemorrhoid Treatment
- Topically applied nitroglycerin ointment has been shown to provide dramatic relief of anal pain in patients with thrombosed external hemorrhoids and anal fissure 2.
- The use of nitroglycerin ointment after hemorrhoidectomy has been found to reduce narcotic requirements and pain intensity, although it may cause side effects such as headaches 3.
- Nitroglycerin ointment is considered a medical management option for hemorrhoids, along with stool softeners, topical over-the-counter preparations, and dietary modifications 4.
Comparison with Other Treatments
- Nitroglycerin ointment has been compared to other treatments such as rubber band ligation, injection sclerotherapy, and infrared coagulation, which are also used to manage hemorrhoids 5, 6.
- These treatments have varying success rates and complication profiles, and the choice of treatment depends on the severity of the hemorrhoids and patient preferences 5, 6.