TREATMENT OF BENIGN ANAL DISEASE WITH TOPICAL NITROGLYCERIN

PURPOSE: Fissure-in-ano and acutely thrombosed external hemorrhoids ar e common, benign anal conditions, usually characterized by severe anal pain. Internal anal sphincter hypertonia appears to play a role in th e etiology of this pain. Nitric oxide has recently been identified as the ''novel biologic messenger'' that mediates the anorectal inhibitor y reflex in humans. This report documents a therapeutic role for nitro glycerin, a nitric oxide donor, in the treatment of acutely thrombosed external hemorrhoids and anal fissure. METHODS: Five patients with th rombosed external hemorrhoids and fifteen patients with anal fissure o r 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 questione d regarding pain relief and side effects of treatment. Fissure patient s were followed for eight weeks or until healing occurred. RESULTS: Al l 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 with in one month in two patients. One patient, whose fissure had not heale d completely within two weeks requested surgical sphincterotomy. Two p atients remained with persistent anal ulcers despite two months of the rapy. Both, however, were pain-free. Side effects were limited to tran sient headache in 7 of 20 patients. CONCLUSION: Topically applied nitr oglycerin ointment appears to have a therapeutic role in the treatment of thrombosed external hemorrhoids and anal fissure.