What is the use of diltiazem (Calcium Channel Blocker) 2% topical ointment for the treatment of hemorrhoids?

From the Guidelines

Diltiazem 2% ointment is not a recommended first-line treatment for hemorrhoids, and its use should be considered only under medical supervision for specific cases, such as thrombosed or strangulated hemorrhoids, where a topical muscle relaxant may be suggested, as indicated by the guidelines from the World Journal of Emergency Surgery 1. When considering treatment options for hemorrhoids, it's essential to prioritize established and evidence-based treatments. The guidelines suggest non-operative management as the first line of therapy, including dietary and lifestyle changes, and the use of flavonoids to relieve symptoms 1. For hemorrhoid treatment, over-the-counter options like hydrocortisone creams, witch hazel pads, or preparation H are more appropriate initial treatments, as they work by reducing inflammation, pain, and swelling. If considering diltiazem for hemorrhoids, it should only be used under medical supervision, typically applied a pea-sized amount to the affected area 2-3 times daily for no more than 2 weeks unless directed otherwise by a healthcare provider. Potential side effects include local irritation, headache, or dizziness. The mechanism behind diltiazem's potential benefit involves calcium channel blocking properties that relax blood vessels and potentially reduce pain and swelling. However, patients should first consult with a healthcare provider for proper diagnosis and treatment recommendations for hemorrhoids, as more established treatments may be more appropriate, and the use of diltiazem should be based on the most recent and highest quality evidence available, such as the guidelines from the World Journal of Emergency Surgery 1. Some key points to consider when treating hemorrhoids include:

• Non-operative management as the first line of therapy
• Use of flavonoids to relieve symptoms
• Topical treatments like hydrocortisone creams or witch hazel pads for reducing inflammation and pain
• Medical supervision for the use of any medication, including diltiazem
• Potential side effects and interactions of any treatment option. It's also important to note that the American Gastroenterological Association medical position statement on the diagnosis and treatment of hemorrhoids suggests that medical therapy is most appropriate for first-degree hemorrhoids, and that topical corticosteroids and analgesics are useful for managing perianal skin irritation 1. However, the most recent and highest quality evidence should always be prioritized, and in this case, the guidelines from the World Journal of Emergency Surgery 1 provide the most relevant and up-to-date recommendations for the treatment of hemorrhoids.

From the Research

Diltiazem 2% Ointment for Hemorrhoids

• Diltiazem 2% ointment has been studied as a potential treatment for post-hemorrhoidectomy pain and hemorrhoid symptoms 2, 3, 4, 5.
• The studies suggest that topical diltiazem ointment can reduce pain and improve patient satisfaction after hemorrhoidectomy 2, 3, 4, 5.
• A meta-analysis of randomized controlled trials found that topical diltiazem ointment was effective in reducing pain after hemorrhoidectomy, with minimal side effects 4.
• A prospective randomized double-blind study found that topical diltiazem 2% ointment significantly reduced postoperative pain and analgesic consumption compared to placebo 5.
• Another study found that patients who used diltiazem ointment had improved satisfaction and were more likely to recommend the procedure to others 2.

Mechanism of Action

• Diltiazem is a calcium channel blocker that can cause relaxation of gastrointestinal smooth muscle, which may help to reduce pain and discomfort associated with hemorrhoids 3, 4.
• The exact mechanism of action of diltiazem in reducing post-hemorrhoidectomy pain is not fully understood, but it is thought to be related to its ability to relax the internal anal sphincter and reduce anal pressure 5.

Clinical Use

• Diltiazem 2% ointment may be used as an adjunct to other treatments for hemorrhoids, such as rubber band ligation or hemorrhoidectomy 2, 6.
• The ointment is typically applied topically to the perianal area, three times a day for several days after the procedure 3, 5.
• Further studies are needed to fully establish the efficacy and safety of diltiazem 2% ointment for the treatment of hemorrhoids and post-hemorrhoidectomy pain 4, 6.