title: Rectogesic (glyceryl trinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures.
abstract: OBJECTIVE
  Some haemorrhoids are associated with high resting anal canal pressures. The aim of this study was to assess if Rectogesic, a topical glyceryl trinitrate 0.2% ointment was effective in relieving symptoms of early grade haemorrhoids associated with high resting anal canal pressures.
  
  
  METHODS
  This was a prospective, two-centre, open label study of 58 patients with persistent haemorrhoidal symptoms. Patients with first or second degree haemorrhoids and a maximum resting anal canal pressure > 70 mmHg were included. Rectogesic was applied three times a day for 14 days. Anorectal manometry was performed 30 min after the first application of Rectogesic. A 28-day diary was completed during 14 days of therapy and for 14 days after cessation of treatment. This recorded the incidence of rectal bleeding, and visual analogue scales for anal pain, throbbing, pruritus, irritation and difficulty in bowel movement.
  
  
  RESULTS
  Maximum resting anal canal pressures were reduced after application of Rectogesic (115.0 +/- 40.4 mmHg vs 94.7 +/- 34.1 mmHg, P < 0.001). In the study period and at 14 days after cessation of Rectogesic, there was significant reduction in rectal bleeding (P = 0.0002), and significant improvement of anal pain (P = 0.0024), throbbing (P = 0.0355), pruritus (P = 0.0043), irritation (P = 0.0000) and difficulty in bowel movement (P = 0.001). The main adverse event was headache in 43.1% of patients.
  
  
  CONCLUSIONS
  Rectogesic is a safe and feasible treatment for patients with early grade haemorrhoids associated with high resting anal canal pressures.
authors.affiliation: Department of Colorectal Surgery, Epworth Colorectal Center and The Royal Melbourne Hospital, Melbourne, Australia. tjandra@connexus.net.au
authors.forename: J J
authors.initials: JJ
authors.lastname: Tjandra
authors.forename: J J Y
authors.initials: JJ
authors.lastname: Tan
authors.forename: J F
authors.initials: JF
authors.lastname: Lim
authors.forename: C
authors.initials: C
authors.lastname: Murray-Green
authors.forename: M L
authors.initials: ML
authors.lastname: Kennedy
authors.forename: D Z
authors.initials: DZ
authors.lastname: Lubowski
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006484:Hemorrhoids / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D009824:Ointments; D011446:Prospective Studies; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin