5, 9 Various invasive and noninvasive methods, including sphincterotomy, 10 anal dilation, 11 application of topical preparations, such as trimebutine, 12 nitrates, 5 botulinum toxin, 13 metronidazole, 4, 14 topical administration and infiltration of local anesthetics such as lidocaine and prilocaine 15 – 17 and flavonoids, 18 have been suggested to relieve internal sphincter spasm and solve posthemorrhoidectomy pain. 6 – 8 Posthemorrhoidectomy pain seems to be significantly associated with a spasm of the internal anal sphincter.
4, 5 Anorectal manometry has shown that anal pressure is greater in patients with hemorrhoids than in the healthy population. When pain is adequately controlled, hemorrhoidectomy may be conducted in an outpatient setting, saving a lot of money. 3 Consequently, the introduction of novel methods for the control of pain after hemorrhoidectomy is required. Nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates have often been used to control pain, but their use is confined to a short period of time and is associated with frequent side effects. 2 However, surgery is associated with severe postoperative pain that is a source of such anxiety that some patients decide not to undergo the operation. 1 Surgical hemorrhoidectomy is indicated for the treatment of third- and fourth-degree symptomatic hemorrhoids. Treatment of hemorrhoidal disease depends on the stage of the disorder and the symptoms.
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