{ "slug": "ice-hemorrhoid", "question": "Does putting ice on hemorrhoids help?", "shortTitle": "Ice for Hemorrhoids", "clinicalQuestion": "In adults with symptomatic internal or external hemorrhoids, does topical application of ice or cold packs to the anorectal area reduce pain, swelling, or time to symptom resolution compared with no ice or other conservative measures?", "pico": { "population": "Adults with symptomatic hemorrhoids (internal or external, including acute thrombosed external hemorrhoids)", "intervention": "Topical application of ice or cold packs to the perianal/anorectal area", "comparator": "No ice application, usual care, or warm sitz baths", "outcomes": [ "Pain score (e.g., visual analog scale)", "Time to symptom resolution", "Reduction in hemorrhoid size or swelling", "Need for further intervention (e.g., surgery)", "Recurrence of symptoms", "Skin irritation or cold injury from ice application" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Icing hemorrhoids doesn't appear to ease pain more than not icing them, in the trials that tested it.", "detail": "Three randomised trials applied a cooling device or cold water to the anal area in people with hemorrhoids, after a banding procedure, or after childbirth, and compared this with standard care or warm water. None found a meaningful difference in pain relief. These trials did not test whether ice reduces swelling, speeds healing, or prevents the need for further treatment — those questions remain unanswered for ice applied to the skin.", "studyIds": [ "pmid:8412917", "pmid:22527920", "pmid:20580349" ] }, "strength": { "level": "moderate", "why": "One well-conducted randomised trial addresses this question directly.", "override": null }, "direction": { "level": "no-meaningful-benefit", "why": "Most of the evidence found no meaningful difference.", "override": null }, "counts": { "recordsRetrieved": 63, "recordsScreened": 63, "included": 15, "rcts": 4, "systematicReviews": 0, "observational": 0, "participants": 3186, "yearFrom": 1978, "yearTo": 2014, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Pain score", "status": "no-improvement", "note": "Three randomised trials compared a cooling device or cold water with no cooling (or with hot water) and found no meaningful difference in pain scores.", "studyIds": [ "pmid:22527920", "pmid:20580349", "pmid:8412917" ] }, { "name": "Time to symptom resolution", "status": "no-improvement", "note": "One trial tracking overall symptom relief after childbirth found no difference in pain resolution between a cooling device and standard care without it.", "studyIds": [ "pmid:8412917" ] }, { "name": "Reduction in hemorrhoid size or swelling", "status": "not-studied", "note": "None of the trials testing simple ice or cooling devices measured hemorrhoid size or swelling directly.", "studyIds": [] }, { "name": "Need for further intervention (e.g., surgery)", "status": "not-studied", "note": "No trial of ice packs or cooling devices tracked whether people later needed surgery or another procedure.", "studyIds": [] }, { "name": "Recurrence of symptoms", "status": "not-studied", "note": "No trial of simple ice or cooling devices followed people long enough to report whether symptoms came back.", "studyIds": [] }, { "name": "Skin irritation or cold injury from ice application", "status": "not-studied", "note": "No trial specifically measured skin irritation or cold injury. One device trial noted some people had trouble inserting the cooling device, but this was a practical complaint, not a measured injury.", "studyIds": [ "pmid:8412917" ] } ], "benefits": [], "limitations": [ { "text": "The trials tested manufactured cooling devices, like the Anurex, or cold-water sitz baths, not a plain ice cube or ice pack wrapped in a cloth. A simple home ice pack might feel different even though this is the closest evidence available.", "studyIds": [ "pmid:22527920", "pmid:8412917", "pmid:20580349" ] }, { "text": "The populations tested were narrow: women right after childbirth, patients right after a rubber band procedure, and people with acute anal pain in an emergency setting. These groups may not represent everyone who tries icing at home.", "studyIds": [ "pmid:8412917", "pmid:22527920", "pmid:20580349" ] }, { "text": "Most of the other research turned up by this search is about cryosurgery, a surgical freezing procedure done by a clinician using special equipment. That is very different from holding an ice pack against the skin, so it cannot be used to answer this question.", "studyIds": [ "pmid:9601185", "pmid:2336600", "pmid:6606660", "pmid:6870130", "pmid:6337671", "pmid:6979469", "pmid:703664", "pmid:305516" ] }, { "text": "The trials were small, ranging from 24 to 129 people, which limits how confident anyone can be in the finding of no benefit.", "studyIds": [ "pmid:22527920", "pmid:20580349", "pmid:8412917" ] } ], "risks": [], "whyPeopleTryIt": [ { "text": "Ice is a cheap, easy home remedy that many people already use for swelling and bruises elsewhere on the body." }, { "text": "Cold can feel numbing and soothing on sore skin, which may bring short-term comfort even if it doesn't change the underlying problem." }, { "text": "Ice packs are commonly listed in general home-care advice for hemorrhoids, so people assume the practice is proven." } ], "keyStudies": [ "pmid:8412917", "pmid:22527920", "pmid:20580349" ], "studies": [ { "id": "pmid:24742083", "pmid": "24742083", "doi": null, "nctId": null, "pmcid": null, "title": "Anorectal conditions: hemorrhoids", "firstAuthor": "Fox", "multipleAuthors": true, "journal": "FP Essent", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with prolapsed and strangulated hemorrhoids", "intervention": "stool softeners, analgesics, rest, warm soaks, and ice packs", "comparator": "", "primaryOutcome": "recovery from prolapsed and strangulated hemorrhoids", "result": "abstract states this combination is the best management until recovery, with no comparative data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review statement of expert-recommended management, not a study with data comparing ice to no ice", "directness": "indirect", "limitations": "no study design, data, or comparison is given for this recommendation; ice is only one part of a combined treatment approach", "followUp": "", "plainFinding": "Ice suggested, but not tested alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24742083/", "sourceText": "Hemorrhoids are engorged fibrovascular cushions lining the anal canal. Constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids. Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids. Bright red, painless rectal bleeding during defecation is the most common presentation. Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer (eg, adults older than 50 years) should still undergo colonoscopy to exclude cancer as the etiology. Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs. If nonsurgical management is unsuccessful, rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids. Surgical hemorrhoidectomy is indicated after failure of nonsurgical management and office-based procedures and also as initial management for grades III and IV hemorrhoids. Several different procedures can be used. For acutely thrombosed external hemorrhoids, excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management. Prolapsed and strangulated hemorrhoids are best managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery; residual hemorrhoids are banded or excised later.", "provenance": [ { "field": "population", "quote": "Prolapsed and strangulated hemorrhoids" }, { "field": "intervention", "quote": "stool softeners, analgesics, rest, warm soaks, and ice packs until recovery" }, { "field": "primaryOutcome", "quote": "are best managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery" }, { "field": "result", "quote": "Prolapsed and strangulated hemorrhoids are best managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery; residual hemorrhoids are banded or excised later." } ] }, { "id": "pmid:22527920", "pmid": "22527920", "doi": "10.1007/s10151-012-0824-7", "nctId": null, "pmcid": "PMC3368112", "title": "A novel device reduces anal pain after rubber band ligation: a randomized controlled trial", "firstAuthor": "Lam", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2012, "design": "rct", "n": 100, "nField": "reported", "population": "patients who had rubber band ligation for hemorrhoids", "intervention": "a frozen plastic anal cooling device used for pain", "comparator": "no anal cooler (control group)", "primaryOutcome": "anal pain after the procedure, measured with a pain diary", "result": "no significant difference in need for painkillers between groups; among those who used the cooler, 25% noticed improvement, while those who did not use it had lower pain scores than those who did", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small trial with inconsistent results and no clear reduction in overall pain or need for medication.", "directness": "indirect", "limitations": "Comparison of pain scores between users and non-users of the cooler was not randomized (self-selected use), and most pain after banding was described as mild overall.", "followUp": "3-6 weeks", "plainFinding": "No clear pain relief from cooling.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22527920/", "sourceText": "BACKGROUND: Anal pain is a well-known sequel of rubber band ligation (RBL). A plastic device, the anal cooler which can be frozen in a freezer, has been developed to reduce anal pain. It contains a mixture of glycols and has a minimum temperature of 4 °C. This study was designed to investigate the efficacy of the anal cooler in pain relief after RBL. METHODS: Between 2009 and 2010, 100 patients who underwent RBL were prospectively randomized into an anal cooler group (n = 50) or a control group (n = 50). The anal cooler group was instructed to use the cooler when they had pain. All patients were asked to keep a pain diary (0 = no pain; 10 = extreme pain), and follow-up was performed after 3-6 weeks. RESULTS: It was found that 24/50 patients (48 %) in the anal cooler group and 31/50 (62 %) in the control group needed oral analgesics (NS). In total, 36/50 patients (72 %) used the anal cooler. Of these, 9/36 patients (25 %) noticed improvement. Of the remaining 27/36 patients (75 %) who did not notice improvement, 5/36 patients (14 %) found the insertion of the cooler uncomfortable and 1/36 patients (3 %) experienced nausea. No complications occurred during or after the use of the cooler. The 14/50 patients (28 %), who did not use the cooler, had a lower post-banding pain score compared with patients who used the cooler (1.4 vs 6.4; P < 0.001). CONCLUSIONS: Although post-banding pain after RBL is usually mild, the anal cooler seems to relieve anal pain in 25 % of the patients who used the device.", "provenance": [ { "field": "n", "quote": "100 patients who underwent RBL were prospectively randomized into an anal cooler group (n = 50) or a control group (n = 50)" }, { "field": "population", "quote": "100 patients who underwent RBL" }, { "field": "intervention", "quote": "a plastic device, the anal cooler which can be frozen in a freezer" }, { "field": "comparator", "quote": "control group" }, { "field": "primaryOutcome", "quote": "All patients were asked to keep a pain diary (0 = no pain; 10 = extreme pain)" }, { "field": "result", "quote": "24/50 patients (48 %) in the anal cooler group and 31/50 (62 %) in the control group needed oral analgesics (NS)" }, { "field": "result", "quote": "Of these, 9/36 patients (25 %) noticed improvement" }, { "field": "result", "quote": "The 14/50 patients (28 %), who did not use the cooler, had a lower post-banding pain score compared with patients who used the cooler (1.4 vs 6.4; P < 0.001)" } ] }, { "id": "pmid:21988040", "pmid": "21988040", "doi": null, "nctId": null, "pmcid": null, "title": "[Haemorrhoidal disease: role of conservative outpatient treatments]", "firstAuthor": "Serventi", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2011, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with haemorrhoidal disease treated as outpatients", "intervention": "cryotherapy (ice-based treatment) among other office treatments like rubber band ligation, sclerotherapy, infrared photocoagulation, bipolar diathermy and direct current therapy", "comparator": "other conservative outpatient techniques", "primaryOutcome": "procedure, indications, contraindications, results and limits of each outpatient technique", "result": "abstract does not give a specific outcome or result for cryotherapy; it only lists it among reviewed techniques and states opinions are discordant across studies", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review without pooled data or a randomized comparison of all techniques, and it admits that opinions are discordant even among randomized studies.", "directness": "indirect", "limitations": "The abstract states there is no randomized trial comparing all these treatments, and many techniques are based on small or anecdotal series.", "followUp": "", "plainFinding": "No specific result reported for ice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21988040/", "sourceText": "AIM: This study is a critical review of conservative office treatments of haemorrhoidal disease. MATERIAL OF STUDY: Many are outpatient techniques proposed in current literature; several with small series, anecdotal ones or some ones yet abandoned for excessive morbidity (for example anal divulsion, dilatation and so on); among most used we describe procedure, indications, contraindications, results and limits about rubber band ligation, sclerotherapy, cryotherapy, infrared photocoagulation, bipolar diathermy and direct current therapy. RESULTS: Each method has its supporters, indications and limits; therefore in literature there are discordant opinions even when randomized studies are compared. Indeed each technique is been compared with one or more other ones but there is not a randomized trial which compares all these treatments. CONCLUSIONS: Conservative office techniques, and rubber band ligation in particular, have an important role in second degree haemorrhoidal disease, in non-responsive to medical treatment first degree and also in third degree haemorrhoids in elderly patients with comorbidity or with sectorial or moderate prolapse.", "provenance": [ { "field": "population", "quote": "conservative office treatments of haemorrhoidal disease" }, { "field": "intervention", "quote": "rubber band ligation, sclerotherapy, cryotherapy, infrared photocoagulation, bipolar diathermy and direct current therapy" }, { "field": "comparator", "quote": "Many are outpatient techniques proposed in current literature" }, { "field": "primaryOutcome", "quote": "we describe procedure, indications, contraindications, results and limits" }, { "field": "result", "quote": "Each method has its supporters, indications and limits; therefore in literature there are discordant opinions even when randomized studies are compared." } ] }, { "id": "pmid:20580349", "pmid": "20580349", "doi": "10.1016/j.ciresp.2010.04.007", "nctId": null, "pmcid": null, "title": "[Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial]", "firstAuthor": "Maestre", "multipleAuthors": true, "journal": "Cir Esp", "year": 2010, "design": "rct", "n": 24, "nField": "reported", "population": "patients with acute anal pain from hemorrhoids or anal fissures", "intervention": "sitz baths with cold water (below 15°C)", "comparator": "sitz baths with hot water (above 30°C)", "primaryOutcome": "pain level and quality of life at 7 days", "result": "no significant difference in pain control between cold and hot sitz baths", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "very small number of patients (only 24) makes it hard to detect a true difference", "directness": "direct", "limitations": "small sample size of only 24 randomised patients", "followUp": "7 days", "plainFinding": "No difference found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20580349/", "sourceText": "INTRODUCTION: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. AIM: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. MATERIAL AND METHODS: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. RESULTS: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. CONCLUSION: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).", "provenance": [ { "field": "n", "quote": "24 were randomised (Group 1: n=12 y Group 2: n=12)" }, { "field": "population", "quote": "patients with acute anal pain due to haemorrhoids or anal fissures" }, { "field": "intervention", "quote": "Sitz baths with water at a temperature of less than 15 degrees C" }, { "field": "comparator", "quote": "Baths with a water temperature above 30 degrees C" }, { "field": "primaryOutcome", "quote": "An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36)" }, { "field": "result", "quote": "There were no statistical differences in pain" } ] }, { "id": "pmid:19762183", "pmid": "19762183", "doi": "10.1016/j.gcb.2009.07.030", "nctId": null, "pmcid": null, "title": "[Nonsurgical therapy of hemorrhoids]", "firstAuthor": "Coulom", "multipleAuthors": false, "journal": "Gastroenterol Clin Biol", "year": 2009, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "cryotherapy (ice treatment)", "comparator": "", "primaryOutcome": "", "result": "Cryotherapy has not been studied in controlled studies.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review and it states plainly that cryotherapy has never been tested in a controlled study, so there is no real evidence to judge it by.", "directness": "direct", "limitations": "The abstract does not describe any study design, sample size, or outcome measures for cryotherapy specifically, only noting its absence from controlled research.", "followUp": "", "plainFinding": "No controlled studies done.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19762183/", "sourceText": "Hemorrhoids are a clinical and anatomical subject that has not been completely investigated. A link between the anatomy and the symptoms has still not been established. For this reason, it is difficult to class the different treatments. Non-surgical treatment is intended not to remove but to reposition and hold the hemorrhoids in an anatomically correct position and the reduce the vascularity. Different techniques have been studies but not all of them have been approved. For the moment, the recognised techniques include: infrared therapy, sclerotherapy, rubber band ligation. Cryotherapy has not been studied in controlled studies. One hopes that new techniques such as Doppler-guided artery ligation will soon be tested and validated.", "provenance": [ { "field": "intervention", "quote": "Cryotherapy has not been studied in controlled studies." }, { "field": "result", "quote": "Cryotherapy has not been studied in controlled studies." }, { "field": "population", "quote": "Hemorrhoids are a clinical and anatomical subject that has not been completely investigated." } ] }, { "id": "pmid:11302778", "pmid": "11302778", "doi": null, "nctId": null, "pmcid": null, "title": "Hemorrhoids and varicose veins: a review of treatment options", "firstAuthor": "MacKay", "multipleAuthors": false, "journal": "Altern Med Rev", "year": 2001, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "cryotherapy (one of several non-surgical treatments listed)", "comparator": "other non-surgical treatments for hemorrhoids", "primaryOutcome": "", "result": "not stated - cryotherapy is only mentioned as one treatment option among several, with no outcome data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review listing treatment options without reporting any study results or data for cryotherapy specifically.", "directness": "indirect", "limitations": "Abstract does not report any specific study, trial design, participant numbers, or outcome data for cryotherapy; it only lists it among several treatment modalities.", "followUp": "", "plainFinding": "No outcome data reported for ice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11302778/", "sourceText": "Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids.", "provenance": [ { "field": "intervention", "quote": "cryotherapy" }, { "field": "population", "quote": "Hemorrhoids and varicose veins are common conditions seen by general practitioners." }, { "field": "comparator", "quote": "injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation" }, { "field": "result", "quote": "When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation." } ] }, { "id": "pmid:9601185", "pmid": "9601185", "doi": null, "nctId": null, "pmcid": null, "title": "Cryohaemorrhoidectomy for primary haemorrhoids: an evaluation of the procedure in the Indian population", "firstAuthor": "Singh", "multipleAuthors": false, "journal": "J Indian Med Assoc", "year": 1998, "design": "case-series", "n": 174, "nField": "reported", "population": "people with primary hemorrhoids in India", "intervention": "cryotherapy (freezing) procedure for hemorrhoids", "comparator": "no comparison group reported", "primaryOutcome": "how well patients accepted the procedure, cost, and complication rate", "result": "procedure was well accepted, cost effective, and had a low complication rate", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this was a small case series with no comparison group, so it can't show whether the treatment actually worked better than nothing.", "directness": "indirect", "limitations": "No control group; abstract does not report symptom or efficacy outcomes, only acceptability and complications.", "followUp": "", "plainFinding": "Well tolerated, but effectiveness unclear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9601185/", "sourceText": "Cryotherapy is one of the available modalities for the management of primary haemorrhoids. It is a simple non-invasive procedure conducted without anaesthesia, ideal for surgery outpatients' department. Though practically given up in the west due to a distressing side-effect in the local population, it was evaluated for its efficacy and acceptability in the Indian population. The study of 174 patients revealed the procedure to be well accepted, extremely cost effective and with a low complication rate in the Indian population, in contrast to the western experience.", "provenance": [ { "field": "n", "quote": "The study of 174 patients" }, { "field": "population", "quote": "evaluated for its efficacy and acceptability in the Indian population" }, { "field": "intervention", "quote": "Cryotherapy is one of the available modalities for the management of primary haemorrhoids" }, { "field": "comparator", "quote": "The study of 174 patients revealed the procedure to be well accepted, extremely cost effective and with a low complication rate in the Indian population, in contrast to the western experience." }, { "field": "primaryOutcome", "quote": "evaluated for its efficacy and acceptability in the Indian population" }, { "field": "result", "quote": "revealed the procedure to be well accepted, extremely cost effective and with a low complication rate in the Indian population" } ] }, { "id": "pmid:8412917", "pmid": "8412917", "doi": null, "nctId": null, "pmcid": null, "title": "Postpartum haemorrhoids--evaluation of a cooling device (Anurex) for relief of symptoms", "firstAuthor": "Thomas", "multipleAuthors": true, "journal": "Med J Aust", "year": 1993, "design": "rct", "n": 129, "nField": "reported", "population": "women with hemorrhoids after childbirth", "intervention": "Anurex cooling device applied to the anal area", "comparator": "standard care without the cooling device", "primaryOutcome": "relief of hemorrhoid pain", "result": "No difference in pain resolution between groups; other symptoms like bleeding and itching also not significantly improved", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial but modest in size and only in postpartum women, not people with hemorrhoids generally.", "directness": "indirect", "limitations": "Small sample size; some participants had difficulty inserting the device; population limited to postpartum women.", "followUp": "", "plainFinding": "No benefit over standard care.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8412917/", "sourceText": "Postpartum haemorrhoids are a common problem, for which the recently marketed cooling device, Anurex (Roussel Uclaf Australia, Pennant Hills, NSW), was evaluated in 129 women randomly allocated to treatment and control groups. There was no difference in the rate of resolution of pain between the groups. The test group estimated a greater duration of pain relief, but this was not statistically significant. Anal bleeding and itching were not significantly reduced in the test group. There was no difference between discomfort scores related to application of the device in the groups, but a significant number in the test group encountered difficulty in insertion of the device. It is concluded that the introduction of the Anurex device as a standard method of treatment of postpartum haemorrhoids is not justified.", "provenance": [ { "field": "n", "quote": "129 women randomly allocated to treatment and control groups" }, { "field": "population", "quote": "Postpartum haemorrhoids are a common problem" }, { "field": "intervention", "quote": "the recently marketed cooling device, Anurex" }, { "field": "comparator", "quote": "treatment and control groups" }, { "field": "primaryOutcome", "quote": "There was no difference in the rate of resolution of pain between the groups." }, { "field": "result", "quote": "There was no difference in the rate of resolution of pain between the groups. The test group estimated a greater duration of pain relief, but this was not statistically significant. Anal bleeding and itching were not significantly reduced in the test group." } ] }, { "id": "pmid:2336600", "pmid": "2336600", "doi": null, "nctId": null, "pmcid": null, "title": "[Cryotherapy of benign and malignant processes]", "firstAuthor": "Madron", "multipleAuthors": true, "journal": "Rozhl Chir", "year": 1990, "design": "case-series", "n": 35, "nField": "reported", "population": "patients with inflamed hemorrhoid nodes", "intervention": "cryosurgery (deep freezing) of hemorrhoid tissue", "comparator": "none reported", "primaryOutcome": "resolution of hemorrhoid symptoms", "result": "symptoms went away quickly after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series with no comparison group, so it can't show whether the treatment itself caused the improvement.", "directness": "indirect", "limitations": "No control group, no randomization, no blinding, and this is surgical freezing rather than simple ice application; outcomes described only as 'favourable' without data.", "followUp": "", "plainFinding": "Hemorrhoid symptoms improved quickly", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2336600/", "sourceText": "Cryosurgery is a method using brisk cooling of the tissue well beneath the freezing point with subsequent destruction and removal of necrotic tissue. Recovery is by scarification or tissue regeneration. It is used in the treatment of benign and malignant diseases. At the surgical department of the hospital and polyclinic in Pelhrimov the authors used between April 1986 and July 1987 this method in 35 patients with inflammations of haemorrhoidal nodes, 10 patients with haemangiomas and warts, the results being favourable. The authors recommend acute treatment of haemorrhoids, as complaints recede rapidly. As to malignant diseases, the authors applied cryalization repeatedly in one patient with a tubulovilous adenoma and in seven patients with adenocarcinoma of the rectum. They indicate the method only as a palliative procedure in inoperable tumours of the rectum.", "provenance": [ { "field": "population", "quote": "35 patients with inflammations of haemorrhoidal nodes" }, { "field": "intervention", "quote": "Cryosurgery is a method using brisk cooling of the tissue well beneath the freezing point" }, { "field": "comparator", "quote": "the authors used between April 1986 and July 1987 this method in 35 patients with inflammations of haemorrhoidal nodes, 10 patients with haemangiomas and warts, the results being favourable" }, { "field": "primaryOutcome", "quote": "The authors recommend acute treatment of haemorrhoids, as complaints recede rapidly." }, { "field": "result", "quote": "the results being favourable" }, { "field": "n", "quote": "35 patients with inflammations of haemorrhoidal nodes" } ] }, { "id": "pmid:6606660", "pmid": "6606660", "doi": "10.1111/j.1532-5415.1984.tb05152.x", "nctId": null, "pmcid": null, "title": "Cryosurgery for life-threatening bleeding hemorrhoids in the elderly", "firstAuthor": "Mashiah", "multipleAuthors": true, "journal": "J Am Geriatr Soc", "year": 1984, "design": "case-series", "n": 43, "nField": "reported", "population": "elderly patients with severe, massive bleeding hemorrhoids", "intervention": "cryosurgery (freezing treatment using nitrous oxide gas) in an outpatient session", "comparator": "none; no control group", "primaryOutcome": "resolution of bleeding and symptoms after treatment", "result": "results were excellent in all but one patient, who needed a repeat treatment after bleeding recurred, with no complications or deaths", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series from 1984 with no comparison group, so it can't reliably show whether cryosurgery works better than doing nothing.", "directness": "indirect", "limitations": "No control group, no randomization, small sample, single-session case series design, old study.", "followUp": "two to five years", "plainFinding": "Freezing surgery stopped bleeding hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6606660/", "sourceText": "Forty-three elderly patients with massive bleeding of hemorrhoidal varices were treated by cryosurgery at a single outpatient session, using nitrous oxide gas, without premedication or anesthesia. The results were excellent in all but one patient, who had ulcerative colitis and required another session of cryotherapy following a recurrence of bleeding. There was no morbidity and no mortality. The patients have remained free of symptoms over follow-up periods ranging from two to five years. The authors believe that cryosurgery is the treatment of choice and indeed may sometimes be life-saving for elderly, poor-risk patients who are unfit for general anesthesia and surgical hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "Forty-three elderly patients with massive bleeding of hemorrhoidal varices were treated by cryosurgery" }, { "field": "population", "quote": "Forty-three elderly patients with massive bleeding of hemorrhoidal varices" }, { "field": "intervention", "quote": "treated by cryosurgery at a single outpatient session, using nitrous oxide gas, without premedication or anesthesia" }, { "field": "comparator", "quote": "treated by cryosurgery at a single outpatient session" }, { "field": "primaryOutcome", "quote": "The results were excellent in all but one patient" }, { "field": "result", "quote": "The results were excellent in all but one patient, who had ulcerative colitis and required another session of cryotherapy following a recurrence of bleeding. There was no morbidity and no mortality." }, { "field": "followUp", "quote": "follow-up periods ranging from two to five years" } ] }, { "id": "pmid:6870130", "pmid": "6870130", "doi": null, "nctId": null, "pmcid": "PMC2494305", "title": "Haemorrhoids treated by cryotherapy: a critical analysis", "firstAuthor": "Southam", "multipleAuthors": false, "journal": "Ann R Coll Surg Engl", "year": 1983, "design": "case-series", "n": 104, "nField": "reported", "population": "patients with second, third degree or thrombosed prolapsed hemorrhoids", "intervention": "cryotherapy (freezing treatment) of hemorrhoids", "comparator": "none", "primaryOutcome": "treatment results, complications and recurrence rate", "result": "careful patient selection gave good results and low recurrence; limiting the ice-ball to the mucosal part reduced pain and bleeding", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an uncontrolled case series with no comparison group, so it cannot show whether cryotherapy actually works better than no treatment.", "directness": "direct", "limitations": "no control group, no randomization, and outcomes described only in general terms without detailed statistics", "followUp": "", "plainFinding": "Good results with careful patient choice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6870130/", "sourceText": "One hundred and four patients with second, third degree or thrombosed prolapsed piles, treated by cryotherapy, were studied pre- and postoperatively. A computer analysis was made of all relevant data such as pile mass, freezing time and results of treatment. The method, which is easy to perform and cost effective, is aided by the use of a specially insulated speculum. To minimise complications such as pain and haemorrhage the ice-ball should be limited to the mucosal part of the haemorrhoid alone. Careful selection of patients will produce good results and a low recurrent rate. It is suggested that valium, fortral and, where necessary, a local anaesthetic should be used and that the patients remain in hospital for one night.", "provenance": [ { "field": "n", "quote": "One hundred and four patients with second, third degree or thrombosed prolapsed piles, treated by cryotherapy, were studied pre- and postoperatively." }, { "field": "population", "quote": "patients with second, third degree or thrombosed prolapsed piles" }, { "field": "intervention", "quote": "treated by cryotherapy" }, { "field": "comparator", "quote": "treated by cryotherapy, were studied pre- and postoperatively" }, { "field": "primaryOutcome", "quote": "results of treatment" }, { "field": "result", "quote": "Careful selection of patients will produce good results and a low recurrent rate." } ] }, { "id": "pmid:6337671", "pmid": "6337671", "doi": "10.1002/bjs.1800700121", "nctId": null, "pmcid": null, "title": "Trial of maximal anal dilatation, cryotherapy and elastic band ligation as alternatives to haemorrhoidectomy in the treatment of large prolapsing haemorroids", "firstAuthor": "Lewis", "multipleAuthors": true, "journal": "Br J Surg", "year": 1983, "design": "rct", "n": 112, "nField": "reported", "population": "patients with large prolapsing hemorrhoids that didn't respond to standard phenol injection treatment", "intervention": "cryotherapy (freezing treatment) for hemorrhoids", "comparator": "surgical removal (haemorrhoidectomy), anal stretching, and rubber band ligation", "primaryOutcome": "reduction in hemorrhoid symptoms and signs", "result": "cryotherapy was less effective than surgery or anal dilation, and more patients needed surgery later due to recurrent symptoms", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but with a small number of patients per treatment group and uneven follow-up times", "directness": "direct", "limitations": "follow-up time varied widely between patients (6 months to 5 years), and the number of patients per treatment arm is not given, only the total.", "followUp": "between 6 months and 5 years", "plainFinding": "Less effective, more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6337671/", "sourceText": "A selected group of 112 patients with prolapsing haemorrhoids which had failed to respond to injections of phenol in oil or which required manual replacement after defecation, were randomly allocated treatment by haemorrhoidectomy, maximal anal dilation, elastic band ligation or cryotherapy. When results were assessed 5 weeks after treatment, haemorrhoidectomy and maximal anal dilatation were equally effective in reducing symptoms, although more physical signs remained after maximal anal dilatation; cryotherapy and elastic band ligation were less effective in both respects. When patients were followed up between 6 months and 5 years haemorrhoidectomy was found to be the most effective method. Patients in the other three groups developed recurrent symptoms requiring haemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "A selected group of 112 patients with prolapsing haemorrhoids" }, { "field": "population", "quote": "A selected group of 112 patients with prolapsing haemorrhoids which had failed to respond to injections of phenol in oil or which required manual replacement after defecation" }, { "field": "intervention", "quote": "cryotherapy" }, { "field": "comparator", "quote": "haemorrhoidectomy, maximal anal dilation, elastic band ligation" }, { "field": "primaryOutcome", "quote": "reducing symptoms" }, { "field": "result", "quote": "cryotherapy and elastic band ligation were less effective in both respects" }, { "field": "result", "quote": "Patients in the other three groups developed recurrent symptoms requiring haemorrhoidectomy." }, { "field": "followUp", "quote": "followed up between 6 months and 5 years" } ] }, { "id": "pmid:6979469", "pmid": "6979469", "doi": "10.1007/BF02553608", "nctId": null, "pmcid": null, "title": "In defense of cryotherapy for hemorrhoids. A modified method", "firstAuthor": "MacLeod", "multipleAuthors": false, "journal": "Dis Colon Rectum", "year": 1982, "design": "case-series", "n": 528, "nField": "reported", "population": "people with hemorrhoids at various stages", "intervention": "cryotherapy (freezing) applied to internal hemorrhoids", "comparator": "", "primaryOutcome": "correction of prolapse and bleeding from hemorrhoids", "result": "abstract states cryotherapy is most effective and has fewest side effects when directed at internal hemorrhoids only, but gives no specific outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a descriptive report of procedures with no comparison group and no numeric outcome data, so it can't show whether the treatment actually worked.", "directness": "direct", "limitations": "No control group, no specific outcome measurements reported, and it describes the author's own modified technique rather than a formal study.", "followUp": "", "plainFinding": "No clear result reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6979469/", "sourceText": "The rationale of nonoperative hemorrhoid treatment, whether injection, ligation, or cryotherapy, consists of correction of prolapse and bleeding by the creation of submucosal fibrosis. Cryotherapy of hemorrhoids is most effective and has the least side effects when directed at the internal hemorrhoids only, at a high level, and in stages, each application being for a period of one minute only. A plan of treatment selection is presented, based on the stage of the hemorrhoids. The results of 528 treatment procedures are reported.", "provenance": [ { "field": "n", "quote": "The results of 528 treatment procedures are reported." }, { "field": "intervention", "quote": "Cryotherapy of hemorrhoids is most effective and has the least side effects when directed at the internal hemorrhoids only, at a high level, and in stages, each application being for a period of one minute only." }, { "field": "population", "quote": "A plan of treatment selection is presented, based on the stage of the hemorrhoids." }, { "field": "primaryOutcome", "quote": "correction of prolapse and bleeding by the creation of submucosal fibrosis" }, { "field": "result", "quote": "Cryotherapy of hemorrhoids is most effective and has the least side effects when directed at the internal hemorrhoids only" } ] }, { "id": "pmid:703664", "pmid": "703664", "doi": null, "nctId": null, "pmcid": null, "title": "[Combined rubber band ligation and cryosurgery of hemorrhoids (author's transl)]", "firstAuthor": "Lurz", "multipleAuthors": true, "journal": "Med Klin", "year": 1978, "design": "case-series", "n": 200, "nField": "reported", "population": "patients with hemorrhoids, including large prolapsing (third degree) hemorrhoids", "intervention": "combined rubber band ligation and cryosurgery (freezing) of hemorrhoids", "comparator": "cryotherapy (freezing) alone without banding", "primaryOutcome": "treatment success and postoperative discomfort", "result": "good results with less postoperative discomfort than freezing alone", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is just a report on a series of patients with no control group and no statistics, so it can't really prove the treatment works.", "directness": "indirect", "limitations": "No control group, no statistical comparison, vague patient numbers, and this combines freezing with a separate banding procedure rather than ice alone.", "followUp": "", "plainFinding": "Combined freezing and banding seemed to help.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/703664/", "sourceText": "By means of the combined rubber band ligation and cryosurgery of hemorrhoids a good therapy result was achieved on more than 200 patients. For the treatment of not too large hemorrhoid nodes and confluent hemorrhoids the aspiration ligation is quite sufficient. In third degree hemorrhoids, particularly in large prolapsing hemorrhoids, the rubber band ligation should include also the cryodestruction. In some cases two or three weeks later the cryodestruction has to be carried out again, depending on the finding and stage progredience. The advantage of this combined method is that the treatment can be performed on outpatients, and without much pains it is an effective therapy in any kind of hemorrhoid ailments. In addition, the postoperative complaints are less than by using the cryosond only. The application of cryotherapy shows also good results in the case of marriscae and anal fissures.", "provenance": [ { "field": "n", "quote": "more than 200 patients" }, { "field": "population", "quote": "In third degree hemorrhoids, particularly in large prolapsing hemorrhoids" }, { "field": "intervention", "quote": "combined rubber band ligation and cryosurgery of hemorrhoids" }, { "field": "comparator", "quote": "postoperative complaints are less than by using the cryosond only" }, { "field": "primaryOutcome", "quote": "a good therapy result was achieved on more than 200 patients" }, { "field": "result", "quote": "it is an effective therapy in any kind of hemorrhoid ailments" } ] }, { "id": "pmid:305516", "pmid": "305516", "doi": null, "nctId": null, "pmcid": null, "title": "[Cryotherapy for haemorrhoids (author's transl)]", "firstAuthor": "Wienert", "multipleAuthors": false, "journal": "Med Klin", "year": 1978, "design": "case-series", "n": 1737, "nField": "reported", "population": "patients with hemorrhoids", "intervention": "cryotherapy (cryosurgery) treatment of hemorrhoids", "comparator": "none reported", "primaryOutcome": "satisfactory treatment result and pain after therapy", "result": "90% had a satisfactory result; 14% had severe pain immediately after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is just a case review of patients who all got the treatment, with no comparison group and no long-term follow-up, so it can't really prove the treatment works.", "directness": "indirect", "limitations": "No follow-up results are reported, and there is no control/comparison group described.", "followUp": "", "plainFinding": "Mostly satisfactory, but caused pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/305516/", "sourceText": "Case reports of 1737 patients who were treated by cryotherapy have been analysed. The technique, indications, contraindications, complications and results of this therapy are described. This method gave a satisfactory result in 90% of the patients and 14% of the patients had severe pain immediately after the therapy. There are no follow-up results, because the treatment of haemorrhoids by cryosurgery is fairly new.", "provenance": [ { "field": "n", "quote": "Case reports of 1737 patients who were treated by cryotherapy have been analysed." }, { "field": "population", "quote": "Case reports of 1737 patients who were treated by cryotherapy have been analysed." }, { "field": "intervention", "quote": "treated by cryotherapy" }, { "field": "comparator", "quote": "There are no follow-up results, because the treatment of haemorrhoids by cryosurgery is fairly new." }, { "field": "primaryOutcome", "quote": "This method gave a satisfactory result in 90% of the patients and 14% of the patients had severe pain immediately after the therapy." }, { "field": "result", "quote": "This method gave a satisfactory result in 90% of the patients and 14% of the patients had severe pain immediately after the therapy." } ] } ], "faqs": [ { "q": "Should I stop using ice on my hemorrhoids?", "a": "You don't have to. The trials found it didn't help more than not using it, but they also didn't find it caused harm. If it feels soothing to you, there's no evidence here that continuing is a problem." }, { "q": "Is ice the same as cryotherapy for hemorrhoids?", "a": "No. Cryotherapy, also called cryosurgery, is a medical procedure that freezes hemorrhoid tissue using special equipment. Putting an ice pack on the skin at home is much milder, and most of the research found in this search was actually about the surgical procedure, not home ice packs." }, { "q": "What did the strongest trial actually test?", "a": "A moderate-quality randomised trial gave women with hemorrhoids after childbirth a cooling device called Anurex, compared with standard care without it. It found no difference in pain relief between the two groups." }, { "q": "Does cold work better than warm sitz baths?", "a": "One small trial compared cold sitz baths with hot sitz baths in people with acute anal pain and found no difference in pain control between the two temperatures." }, { "q": "What should I do instead for hemorrhoid pain?", "a": "These studies didn't test other treatments like fiber, stool softeners, or topical medications, so this review can't say how well those work. If pain or bleeding continues, it's worth talking to a doctor." } ], "patientTakeaway": "Based on these trials, putting ice or a cooling device on hemorrhoids is unlikely to reduce pain more than not using it. It probably won't hurt to try if it feels comforting, but don't expect it to shrink swelling, speed up healing, or prevent the need for further treatment. If your symptoms are severe, don't improve, or you notice bleeding, see a doctor — these trials didn't look at what to do in that situation.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "\"Hemorrhoids\"[Mesh] AND (\"Cryotherapy\"[Mesh] OR ice[tiab] OR \"ice pack\"[tiab] OR \"cold application\"[tiab] OR \"cold pack\"[tiab] OR cryotherapy[tiab])" }, "pubmedQueryTranslation": "\"Hemorrhoids\"[MeSH Terms] AND (\"Cryotherapy\"[MeSH Terms] OR \"ice\"[Title/Abstract] OR \"ice pack\"[Title/Abstract] OR \"cold application\"[Title/Abstract] OR \"cold pack\"[Title/Abstract] OR \"Cryotherapy\"[Title/Abstract])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Does Ice Help Hemorrhoids? What the Trials Show", "description": "Three randomised trials found ice or cooling devices didn't reduce hemorrhoid pain more than no ice. Here's what the evidence shows." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }