Prospective, Randomised, Double-Blinded, Placebo-Controlled Trial of Glyceryl Trinitrate Ointment in the Treatment of Early Symptomatic Haemorrhoids

Haemorrhoids are dilated vascular cushions of the anal canal. Although they are common, their precise aetiology remains unknown and there is no optimum method for treating symptomatic haemorrhoids.

To provide an alternative treatment for early symptomatic haemorrhoids by reduction of the resting anal canal pressure by using glyceryl trinitrate (GTN) topical ointment, twenty patients were randomised to have either GTN ointment 0.2% (Group A, 10 patients) or placebo preparation ointment (Group B, 10 patients).

Topical GTN treatment in patients with first and second-degree symptomatic haemorrhoids significantly decreased mean resting pressure (MRP) after four weeks of treatment (p=0.04). However, the decrease in mean squeeze pressure (MSP) failed to reach a statistical significance (p=0.16). Overall, all patients receiving GTN reported improvement at the end of the treatment in at least one haemorrhoid symptom.

This lowering of anal sphincter pressure by a pharmacological agent is reversible and represents an alternative to the previous practice of achieving anal sphincter relaxation by manual dilatation under a general anaesthetic (Lord's procedure). The latter technique is a recognised method of treating haemorrhoids but has now been largely abandoned due to the high incidence of internal anal sphincter injury resulting in incontinence of flatus and liquid stools.