HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

PAIN MANAGEMENT IN HEMORRHOIDAL DISEASE

Gülçin Türkmen Sarıyıldız

Atılım University, Faculty of Medicine, Department of General Surgery, Ankara, Türkiye

Türkmen Sarıyıldız G. Pain Management in Hemorrhoidal Disease. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.139-145.

ABSTRACT

Hemorrhoidal disease (HD) is a common benign anal disorder that primarily manifests as painless, bright red rectal bleeding during or after defecation. Other associated symptoms include swelling, prolapse, fecal soiling, pruritus ani, and anal discomfort. While pain is generally rare in uncomplicated HD, its presence may indicate underlying conditions such as anal thrombosis, fissures, abscesses, or anorectal neoplasm. Diagnosis relies on a thorough history and physical examination, with colonoscopy recommended for patients at risk of colorectal cancer. various factors, including aging, obesity, pregnancy, and a low-fiber diet, contribute to the development and exacerbation of HD symptoms. Treatment approaches vary based on disease severity and patient condition. Conservative treatments, office procedures, and surgical interventions offer different benefits, with conservative options often providing relief in early stages and surgery being more effective in advanced disease. local anesthesia plays a pivotal role in post-surgical pain management, with methods like pudendal nerve blocks and ischiorectal blocks being commonly used. Comparative studies suggest that closed hemorrhoidectomy (Ferguson method) results in less postoperative pain than open methods (Milligan-Morgan). Furthermore, newer technologies like vascular sealing devices and ultrasonic scissors are associated with reduced pain, shorter operation times, and decreased blood loss. Postoperative pain can be exacerbated by internal anal sphincter (IAS) spasms, and techniques such as lateral internal sphincterotomy (lIS) or botulinum toxin injections have shown promise in managing this. Topical treatments, including calcium channel blockers, glyceryl trinitrate (GTN), and botulinum toxin, are also effective in alleviating IAS spasm and postoperative pain. Additionally, agents like 10% sucralfate, baclofen, and methylene blue have been utilized to manage pain and promote healing, although more research is needed to confirm their efficacy. Other supportive treatments, such as metronidazole and phlebotonics, aid in reducing inflammation and improving vascular health, further contributing to symptom relief. Alternative therapies, including sitz baths, transcutaneous electrical nerve stimulation (TENS), and dietary modifications (e.g., high-fiber diet, laxatives), have been found to enhance pain management and improve overall outcomes after hemorrhoidectomy. This comprehensive review highlights the diverse approaches to pain management in hemorrhoidal disease and underscores the importance of tailored treatments based on the individual patient’s condition and disease stage.

Keywords: Hemorrhoids; Conservative treatment; Analgesics; Botulinum toxins; local anesthesia

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