Diseases of the Colon & Rectum

, Volume 44, Issue 5, pp 680–685 | Cite as

Nitroderm TTS® band application for pain after hemorrhoidectomy

  • A. Coskun
  • S. A. Duzgun
  • A. Uzunkoy
  • M. Bozer
  • O. Aslan
  • B. Canbeyli
Original Contributions


PURPOSE: Anal sphincter spasm is believed to play an important role in pain after hemorrhoidectomy. We tested a different form of nitroglycerin: the Nitroderm TTS® band. We investigated its efficacy on posthemorrhoidectomy pain and the relation between pain and anal resting pressure measured preoperatively and postoperatively. METHODS: Thirty-eight hemorrhoid patients were divided into two groups: those with high anal resting pressure were classified as group A (n=24) and those with low anal resting pressure were classified as group B (n=14). After hemorrhoidectomy, Nitroderm TTS® bands were placed into the anal canal in half of the patients in groups A and B (groups A-1 and B-1) and not in the remaining half (groups A-2 and B-2). Anal resting pressure measurement was repeated at the first day and third month postoperatively. Postoperative pain was assessed by linear analog scale, and analgesic consumption was recorded. RESULTS: Preoperative anal resting pressure was 112.0 (range, 95–140) cm H2O in group A-1 and 110.6 (range, 96–138) cm H2O in group A-2. The difference was insignificant. However, on the first postoperative day, anal resting pressures were 88.7 (range, 75–115) and 110.9 (range, 92–135) cm H2O (P=0.0001), and at the third month, they were 76.5 (range, 70–100) and 78.0 (range, 70–105) cm H2O, respectively (P=0.690). Postoperative pain scores were significantly lower in group A-1 than group A-2 (P=0.0001). In the low-pressure groups (B-1 and B-2), anal resting pressures before surgery, on the first postoperative day, and at the third month postoperatively were 70.4 (range, 56–76), 67.4 (range, 50–75), and 67.2 (range, 55–74) cm H2O in group B-1 and 69.8 (range, 58–76), 70.2 (range, 60–76), and 68.4 (range, 60–74) cm H2O in group B-2. The differences were insignificant (P≥0.660). The differences between pain scores in these groups were also insignificant (P≥0.160). CONCLUSION: Nitroderm TTS® bands effectively reduced anal resting pressure and relieved pain in patients with high preoperative anal resting pressure.

Key words

Hemorrhoidectomy Anal resting pressure Pain Nitroderm TTS® 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Patel N, O'Connor T. Suture haemorrhoidectomy: a day-only alternative. Aust N Z J Surg 1996;66:830–1.Google Scholar
  2. 2.
    Goldstein ET, Williamson PR, Larach SW. Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management. Dis Colon Rectum 1993;36:439–46.Google Scholar
  3. 3.
    O'Hara DA, Fragen RJ, Kinzer M. Ketorolac tromethamine as compared with morphine sulphate for treatment of postoperative pain. Clin Pharmacol Ther 1987;41:556–61.Google Scholar
  4. 4.
    Weisbrodot NW, Sussman SE, Steawart JJ. Effect of morphine sulphate on intestinal transit and myoelectric activity of the small intestine of the rat. J Pharmacol Exp Ther 1980;214:333–8.Google Scholar
  5. 5.
    Hiltunen KM, Matikainen M. Anal manometric findings in symptomatic hemorrhoids. Dis Colon Rectum 1985;28:807–9.Google Scholar
  6. 6.
    Arabi Y, Alexander-Williams J, Keighley MR. Anal pressures in hemorrhoids and anal fissure. Am J Surg 1977;134:608–10.Google Scholar
  7. 7.
    Deutsch AA, Moshkovitz M, Nudelman I, Dinari G, Reiss R. Anal pressure measurements in the study of hemorrhoid etiology and their relation to treatment. Dis Colon Rectum 1987;30:855–7.Google Scholar
  8. 8.
    Ho YH, Seow-Choen F, Low JY, Tan M, Leong AP. Randomised controlled trial of trimebutine (anal sphincter relaxant) for pain after haemorrhoidectomy. Br J Surg 1997;84:377–9.Google Scholar
  9. 9.
    Loder PB, Kamm MA, Nicholls RJ, Phillips RK. “Reversible chemical sphincterotomy” by local application of glyceryl trinitrate. Br J Surg 1994;81:1386–9.Google Scholar
  10. 10.
    Asfar SK, Juma TH, Ala-Edeen T. Hemorrhoidectomy and sphincterotomy: a prospective study comparing the effectiveness of anal stretch and sphincterotomy in reducing pain after hemorrhoidectomy. Dis Colon Rectum 1988;31:181–5.Google Scholar
  11. 11.
    Roe AM, Bartolo DC, Vellacott KD, Locke-Edmunds J, Mortensen NJ. Submucosal versus ligation excision haemorrhoidectomy: a comparison of anal sensation, anal sphincter manometry and postoperative pain and function. Br J Surg 1987;74:948–51.Google Scholar
  12. 12.
    Clark WG, Brater DC, Johnson AR. Antianginal drugs. In: Goth's Medical Pharmacology. 13th ed. St Louis: Mosby-Year Book, 1992:440–8.Google Scholar
  13. 13.
    Fung HL, Chung SJ, Bauer JA, Chong S, Kowaluk EA. Biochemical mechanism of organic nitrate action. Am J Cardiol 1992;70:4B-10B.Google Scholar
  14. 14.
    Manookian CM, Fleshner P, Moore B, Teng F, Cooperman H, Sokol T. Topical nitroglycerin in the management of anal fissure: an explosive outcome! Am Surg 1998;64:962–4.Google Scholar
  15. 15.
    Bogaert MG. Clinical pharmacokinetics of glyceryl trinitrate following the use of systemic and topical preparations. Clin Pharmacokinet 1987;12:1–11.Google Scholar
  16. 16.
    Hiltunen KM, Matikainen M. Anal dilatation, lateral subcutaneous sphincterotomy and haemorrhoidectomy for the treatment of second and third degree haemorrhoids: a prospective randomized study. Int Surg 1992;77:261–3.Google Scholar
  17. 17.
    Murie JA, Sim AJ, Mackenzie I. Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: a long term prospective clinical trial. Br J Surg 1982;69:536–8.Google Scholar
  18. 18.
    MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities: a meta-analysis. Dis Colon Rectum 1995;38:687–94.Google Scholar
  19. 19.
    Lewis AA, Rogers HS, Leighton M. Trial of maximal anal dilatation, cryotherapy and elastic band ligation as alternatives to haemorrhoidectomy in the treatment of large prolapsing haemorrhoids. Br J Surg 1983;70:54–6.Google Scholar
  20. 20.
    Goligher JC, Graham NG, Clark CG, De Dombal FT, Giles G. The value of stretching the anal sphincters in the relief of post-haemorrhoidectomy pain. Br J Surg 1969;56:859–61.Google Scholar
  21. 21.
    Eisenhammer S. Internal anal sphincterotomy plus free dilatation versus anal stretch with special criticism of the anal stretch procedure for hemorrhoids: the recommended modern approach to hemorrhoid treatment. Dis Colon Rectum 1974;17:493–522.Google Scholar
  22. 22.
    Mathai V, Ong BC, Ho YH. Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy. Br J Surg 1996;83:380–2.Google Scholar
  23. 23.
    Sun WM, Read NW, Shorthouse AJ. Hypertensive anal cushions as a cause of the high anal canal pressures in patients with haemorrhoids. Br J Surg 1990;77:458–62.Google Scholar
  24. 24.
    Ho YH, Seow-Choen F, Goh HS. Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed haemorrhoids. Br J Surg 1995;82:596–8.Google Scholar
  25. 25.
    el-Gendi MA, Abdel-Baky N. Anorectal pressure in patients with symptomatic hemorrhoids. Dis Colon Rectum 1986;29:388–91.Google Scholar
  26. 26.
    Schouten WR, van Vroonhoven TJ. Lateral internal sphincterotomy in the treatment of hemorrhoids: a clinical and manometric study. Dis Colon Rectum 1986;29:869–72.Google Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2001

Authors and Affiliations

  • A. Coskun
    • 1
  • S. A. Duzgun
    • 1
  • A. Uzunkoy
    • 1
  • M. Bozer
    • 1
  • O. Aslan
    • 2
  • B. Canbeyli
    • 1
  1. 1.Department of General SurgeryFrom Harran University School of MedicineSanliurfaTurkey
  2. 2.Department of PharmacologyFrom Harran University School of MedicineSanliurfaTurkey

Personalised recommendations