How nifedipine ointment works for thrombosed hemorrhoids

Introduction

Patients who have thrombosed external hemorrhoids experience acute severe pain. This pain will reduce by itself within a few days, and the patient will continue to get better as time goes by. Narcotic and NSAID analgesics are also prescribed for pain relief. These analgesics cannot be used for long periods of time. With prolonged use, narcotic analgesics are habit-forming and NSAIDs may cause gastric ulceration or worsen existing peptic ulcers. Topical therapy with nifedipine has been shown to be effective for analgesia for thrombosed external hemorrhoids, especially when combined with lidocaine.

How does it work?

The resting anal sphincter tone (the extent to which the smooth muscles of the anus are tightened when the patient is not passing faeces or gas) of patients with external thrombosed hemorrhoids has been found to be higher than that of the healthy population. Thus, in a situation in which there is already pain because the thrombosed hemorrhoids have caused tissue infarction and inflammation, the tightness of the anal sphincter stretches the tissues and worsens the pain.

Nifedipine is a calcium channel blocker. Calcium channels are like pores in the cells of the muscles that allow calcium to enter and start the process by which the muscle contracts. Nifedipine blocks those channels and prevents the entry of calcium. The contraction or tightening of the muscles is reduced. The resting anal sphincter tone is reduced and therefore the stretching of the inflammed tissue around the thrombosed hemorrhoids is reduced. The end result is that the patient feels less pain.

How is topical nifedipine used?

The application of topical nifedipine ointment for the treatment of pain in thrombosed external hemorrhoid is a conservative approach to management (avoids surgery).

Nifedipine as 0.2% topical ointment in a formulation that contains 2% lidocaine is used twice daily for 2 weeks. It is rubbed on the thrombosed external hemorrhoid.

Advantages of Topical nifedipine use

  • It is more effective when combined with lidocaine than lidocaine alone for treating the pain associated with thrombosed external hemorrhoids
  • It has no side effects than narcotic analgesics and NSAIDs
  • Topical nifedipine has also been found useful for patients who undergo surgery for internal hemorrhoids and anal fissures
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Powerful agent against hemorrhoids and rectal fissures




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https://www.aafp.org/afp/2011/0715/p204.html