Skip to main content
SpringerLink
Log in

Treatment of benign anal disease with topical nitroglycerin

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Fissure-in-ano and acutely thrombosed external hemorrhoids are common, benign anal conditions, usually characterized by severe anal pain. Internal anal sphincter hypertonia appears to play a role in the etiology of this pain. Nitric oxide has recently been identified as the “novel biologic messenger” that mediates the anorectal inhibitory reflex in humans. This report documents a therapeutic role for nitroglycerin, a nitric oxide donor, in the treatment of acutely thrombosed external hemorrhoids and anal fissure. METHODS: Five patients with thrombosed external hemorrhoids and fifteen patients with anal fissure or ulcer were identified. A treatment regimen that included 0.5 percent nitroglycerin ointment applied topically to the anus was instituted. After one week of therapy, all patients were re-examined and questioned regarding pain relief and side effects of treatment. Fissure patients were followed for eight weeks or until healing occurred. RESULTS: All patients reported dramatic relief of anal pain following application of nitroglycerin. Pain relief lasted from two to six hours. Complete healing of fissures occurred within two weeks in ten patients and within one month in two patients. One patient, whose fissure had not healed completely within two weeks requested surgical sphincterotomy. Two patients remained with persistent anal ulcers despite two months of therapy. Both, however, were pain-free. Side effects were limited to transient headache in 7 of 20 patients. CONCLUSION: Topically applied nitroglycerin ointment appears to have a therapeutic role in the treatment of thrombosed external hemorrhoids and anal fissure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thomson H. The real nature of “perianal haematoma.” Lancet 1982;2:467–8.

    Article  PubMed  Google Scholar 

  2. Oh C. Acute thrombosed external hemorrhoids. Mt Sinai J Med 1989;56:30–2.

    PubMed  Google Scholar 

  3. Corman ML. Colon and Rectal Surgery. 3rd ed. Philadelphia: JB Lippincott, 1993:77–8.

    Google Scholar 

  4. Lin JK. Anal manometric studies in hemorrhoids and anal fissures. Dis Colon Rectum 1989;32:839–42.

    PubMed  Google Scholar 

  5. Abcarian H, Lakshmanan S, Read DR, Roccaforte P. The role of the internal sphincter in chronic anal fissures. Dis Colon Rectum 1982;25:525–8.

    PubMed  Google Scholar 

  6. Farouk R, Duthie G, MacGregor A, Bartolo D. Sustained internal sphincter hypertonia in patients with chronic anal fissure. Dis Colon Rectum 1994;37:424–9.

    Article  PubMed  Google Scholar 

  7. Shafik A. Role of warm-water bath in anorectal conditions: the “thermosphincteric reflex”. J Clin Gastroenterol 1993;16:304–8.

    PubMed  Google Scholar 

  8. Schouten WR, Briel JW, Auwerda JJ. Relationship between anal pressure and anodermal blood flow: the vascular pathogenesis of anal fissures. Dis Colon Rectum 1994;37:664–9.

    Article  PubMed  Google Scholar 

  9. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum 1989;32:43–52.

    PubMed  Google Scholar 

  10. Gibbons CP, Read NW. Anal hypertonia in fissures: cause or effect? Br J Surg 1986;73:443–5.

    PubMed  Google Scholar 

  11. Rattan S, Sarkar A, Chakder S. Nitric oxide pathway in rectoanal inhibitory reflex of opossum internal anal sphincter. Gastroenterology 1992;103:43–50.

    PubMed  Google Scholar 

  12. Tottrup A, Glavind EB, Svane D. Involvement of the L-arginine-nitric oxide pathway in internal anal sphincter relaxation. Gastroenterology 1992;102:409–15.

    PubMed  Google Scholar 

  13. Chakder S, Rattan S. Release of nitric oxide by activation of nonadrenergic noncholinergic neurons of internal anal sphincter. Am J Physiol 1993;264:G7–12.

    PubMed  Google Scholar 

  14. Rattan S, Chakder S. Role of nitric oxide as a mediator of internal anal sphincter relaxation. Am J Physiol 1992;262:G107–12.

    Google Scholar 

  15. O'Kelly T, Brading A, Mortensen N. Nerve mediated relaxation of the human internal anal sphincter: the role of nitric oxide. Gut 1993;34:689–93.

    PubMed  Google Scholar 

  16. Fung H-L. Clinical pharmacology of organic nitrates. Am J Cardiol 1993;72:9C-15C.

    Article  PubMed  Google Scholar 

  17. Loder P, Kamm M, Nicholls R, Phillips R. Topical glyceryl trinitrate (GTN): reversible chemical sphincterotomy [meeting abstract]. Dis Colon Rectum 1994;36:P22.

    Google Scholar 

  18. Guillemot F, Leroi H, Lone, YC, Rousseau CG, Lamblin M-D, Cortot A. Action ofin situ nitroglycerin on upper anal canal pressure of patients with terminal constipation: a pilot study. Dis Colon Rectum 1993;36:372–6.

    Article  PubMed  Google Scholar 

  19. Jost WH, Schimrigk K. Use of botulinum toxin in anal fissure [letter]. Dis Colon Rectum 1993;36:974.

    Article  PubMed  Google Scholar 

  20. Gilman AG, Goodman LS, Rell TW, Murad F, eds. Goodman and Gilman's the pharmacologic basis of therapeutics. 7th ed. New York: MacMillan Publishing, 1985:806–26.

    Google Scholar 

  21. Smith LE. Hemorrhoids. In: Fazio VW, ed. Current therapy in colon and rectal surgery. Toronto: BC Decker, 1990:10–5.

    Google Scholar 

  22. Rosen L, Abel ME, Gordon PH,et al. The Standards Task Force American Society of Colon and Rectal Surgeons. Practice parameters for the management of anal fissure. Dis Colon Rectum 1992;35:206–8.

    Article  PubMed  Google Scholar 

  23. Jensen SL. Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointmentversus hydrocortisone ointment or warm sitz baths plus bran. BMJ 1986;292:1167–9.

    PubMed  Google Scholar 

  24. Shub HA, Salvati EP, Rubin RJ. Conservative treatment of anal fissure: an unselected, retrospective and continuous study. Dis Colon Rectum 1978;21:582–3.

    PubMed  Google Scholar 

References

  1. Farouk R, Duthie G, MacGregor A, Bartolo D. Sustained internal sphincter hypertonia in patients with chronic anal fissure. Dis Colon Rectum 1994;37:424–9.

    Article  PubMed  Google Scholar 

  2. Schouten WR, Briel JW, Auwerda JJ. Relationship between anal pressure and anodermal blood flow: the vascular pathogenesis of anal fissures. Dis Colon Rectum 1994;37:664–9.

    Article  PubMed  Google Scholar 

  3. Bogaert MG. Clinical pharmacokinetics of glyceryl trinitrate following the use of systemic and topical preparations. Clin Pharmacokinet 1987;12:1–11.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mount Sinai School of Medicine, New York, New York

    Stephen R. Gorfine M.D.

  2. Seattle, Washington

    Richard P. Billingham M.D.

Authors
  1. Stephen R. Gorfine M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard P. Billingham M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Gorfine, S.R., Billingham, R.P. Treatment of benign anal disease with topical nitroglycerin. Dis Colon Rectum 38, 453–457 (1995). https://doi.org/10.1007/BF02148842

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02148842

Key words

Search

Navigation