Association of Topical Glyceryl Trinitrate (0.2%) Use With Resting Anal Canal Pressure and Symptom Severity in Patients With Symptomatic Haemorrhoids: A Cross-Sectional Observational Study
Keywords:
Pharmaceutical Preparations, Glycol Trinitrate reductase, Hemorrhoids, Anal Fissure, Drugs, PharmacologyAbstract
Background:
Elevated resting anal canal pressure has been implicated in the pathophysiology of symptomatic haemorrhoids, contributing to pain, discomfort, and impaired venous drainage. Topical glyceryl trinitrate (GTN) 0.2% ointment induces smooth muscle relaxation via nitric oxide–mediated pathways and is known to reduce anal sphincter tone. While widely used in anal fissure management, evidence regarding its association with symptom relief in haemorrhoid patients with high resting anal pressure remains limited in real-world clinical settings.
Methodology:
This cross-sectional observational study was conducted in outpatient clinics in Karachi, Pakistan. Adults aged 18–65 years with clinically diagnosed internal haemorrhoids were enrolled. Participants were categorized into GTN-exposed (≥7 days of topical GTN 0.2% use) and non-exposed groups. Resting anal canal pressure was measured using anorectal manometry. Symptom severity was assessed using a structured composite score evaluating pain, bleeding, pruritus, and defecatory discomfort. Between-group comparisons and multivariable analyses were performed to assess associations between GTN use, anal pressure, and symptom burden.
Results:
Patients using topical GTN demonstrated lower resting anal canal pressures and reduced symptom severity compared with non-exposed patients. Lower anal pressures were significantly associated with reduced pain and overall symptom scores. These associations remained significant after adjustment for age, haemorrhoid grade, constipation severity, and stool consistency.
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References
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