Why does it hurt to sit on my butt after pooping?

In these studies, sharp pain that lingers after a bowel movement was most often linked to an anal fissure, a small tear in the lining of the anus. Trials found that creams like diltiazem or nifedipine healed most of these within weeks.

Why does anal hurt but pooping doesn't?

One guideline in this review notes that hemorrhoids usually don't cause pain unless a clot has formed inside them, so ongoing pain not tied to the act of passing stool may point to something other than typical hemorrhoids. This wasn't tested in a formal trial, so it's not a sure answer.

What to do when your anus hurts while pooping?

Trials found that more fiber and fluids, warm water (sitz) baths, and over-the-counter or prescription creams eased pain and healed most fissures within weeks. See a doctor if the pain lasts more than a couple of weeks, or if there's a lump or bleeding, since rare but serious causes have been reported behind what looked like ordinary hemorrhoids.

Is it hemorrhoids or an anal fissure?

A guideline included here says fissures usually cause sharp pain during or right after passing stool, while hemorrhoids mostly cause pain only if a clot has formed. But a separate study found that symptoms often don't match what's actually found on examination, so this can't be reliably self-diagnosed.

Should I just treat it myself, or should I see a doctor instead?

Most cases in these trials improved with simple conservative care — fiber, sitz baths, and topical creams — so trying those first is reasonable. But see a doctor rather than continuing to self-treat if pain lasts more than a couple of weeks, there's a lump, or you notice bleeding, because case reports found rare but serious causes, including a cancer, mistaken for ordinary hemorrhoids.

Why does my anus hurt after pooping?

Name: Why does my anus hurt after pooping?
Published: 2026-10-13
Keywords: why does it hurt to sit on my butt after pooping, why does my anus hurt so bad after pooping, why does my butt hurt when i poop, why does my butthole hurt after pooping, why does my anus hole hurt after i poop, why does anal hurt but pooping doesnt, what to do when your anus hurts while pooping, why everytime i poop my anus hurts

In adults with pain localized to the anus during or after defecation, what are the most common underlying causes (e.g., anal fissure, hemorrhoids, proctalgia), and what clinical features distinguish them?

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Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

In these studies, pain right after a bowel movement is most often caused by an anal fissure — a small tear — while hemorrhoids themselves usually only hurt when a clot has formed inside them.

Three well-conducted randomised trials show that creams like diltiazem, nifedipine, or GTN heal most anal fissures and ease pain within weeks, and surgery works even better when creams fail. But five other studies flagged real harms: a rare cancer was once mistaken for a hemorrhoid, sphincter-cutting surgery can cause gas or stool leakage, pre-surgery enemas increased pain, and hemorrhoids often came back years after surgery — so pain that doesn't fit the usual pattern, or doesn't settle, is worth having examined rather than assumed.

How certain

High

3 well-conducted randomised trials address this question directly.

What it shows

Signal of harm

5 studies reported harm or tissue damage, including laboratory evidence.

studies found: 185studies found
randomised trials: 56randomised trials
people studied: 40,779people studied
reviews of trials: 18reviews of trials
years covered: 2011–2026years covered

Read this first

A rare anal cancer (melanoma) caused pain after straining and was initially treated as a hemorrhoid before a biopsy found the true cause.
In one retrospective study, a small number of patients (0.4%) who had sphincterotomy surgery for chronic anal fissure developed gas incontinence that improved over time; a separate study found no significant difference in postoperative complication rates between sphincterotomy and botulinum toxin injection.
Giving an enema right before hemorrhoid surgery was linked to more pain afterward, not less.

What the research shows

Diagnosis of anal fissure (sharp, tearing pain)
A clinical practice guideline (not a trial) states that sharp pain starting during or right after a bowel movement is most often caused by a fissure, a small tear in the anal lining. This is expert opinion, not formally graded evidence.[1]
Possible improvement
Diagnosis of hemorrhoids as the cause of pain
The same guideline states hemorrhoids usually only cause real pain when a clot forms inside them (thrombosis); otherwise they tend to cause bleeding, itching or a lump rather than pain. A separate study found that reported symptoms often didn't match what doctors found on examination, so symptoms alone are an unreliable way to diagnose the cause.[1,2]
Insufficient evidence
Presence of rectal bleeding
Bleeding was tracked as part of symptom scores in anal fissure treatment trials, but these studies do not compare it against hemorrhoid patients, so bleeding alone can't be used to tell the two conditions apart from this evidence.[1,2,3]
Insufficient evidence
Duration and timing of pain relative to defecation
No trial here directly tracked how the timing of pain (during versus hours after a bowel movement) predicts the cause. The idea that fissure pain comes with passing stool while hemorrhoid pain only comes from a clot is based on clinical experience, not a study that tested timing itself.[1]
Insufficient evidence
Resolution of pain with conservative treatment
Randomised trials of topical creams (diltiazem, nifedipine, glyceryl trinitrate) found that pain scores dropped and about 51% to 77% of fissures healed within 6 to 8 weeks of treatment; a review of sitz baths found roughly 80% of fissures healed, but noted that surgical sphincterotomy achieved higher healing rates than conservative treatment overall.[1,2,3,4,5,6]
Improvement shown
Need for surgical intervention
When creams didn't work, trials found that cutting the anal sphincter muscle (sphincterotomy) healed fissures faster and more completely than continuing ointment, but it carried a small risk of gas or stool leakage that ointment did not.[1,2,3,4]
Possible improvement
Rare serious conditions mistaken for hemorrhoids or fissures
No trial screened for rare mimics. Case reports describe a cancer (melanoma), a benign tumor, and rectal polyps that were initially mistaken for ordinary hemorrhoids or fissures and found only after biopsy or surgery.[1,2,3]
Not studied

What it may help with

In randomised trials, topical diltiazem, nifedipine, or glyceryl trinitrate creams eased fissure pain within days to weeks, and healed roughly half to three-quarters of fissures after 3 to 8 weeks of treatment, with some trials finding no clear difference between the specific creams used.[1,2,3,4,5]
Simple conservative steps — more fiber, fluids, and warm water (sitz) baths — relieved fissure pain and healed about 80% of fissures in one study.[1]
When creams failed, surgery to cut the anal sphincter muscle healed fissures more completely and relieved pain faster than continuing with ointment alone.[1,2,3]
An expert guideline states hemorrhoids themselves usually only cause real pain once a clot has formed inside them, which helps explain why ordinary hemorrhoids are often blamed for pain that actually has another cause.[1]

Important limitations

Almost all of the 185 studies here looked at pain after hemorrhoid *surgery*, not the everyday pain of someone who just had a normal bowel movement — so most of this evidence doesn't directly answer why an unoperated person's anus hurts.[1,2,3,4]
The guideline that links symptom pattern to cause is expert opinion; it was not tested in a trial and is not formally graded for evidence quality.[1]
A study comparing patients' reported symptoms to what was actually found on examination showed symptoms often don't match the underlying problem, so judging the cause from pain alone is unreliable.[1]
Information on rare but serious causes comes only from single case reports, not from studies designed to measure how often they actually occur.[1,2,3]

What the studies found

Found a benefit96 · 52%
Found no clear effect15 · 8%
Mixed or unclear69 · 37%
Found possible harm5 · 3%

What kind of studies

Randomised trial56 · 30%
Retrospective39 · 21%
Case series30 · 16%
Narrative review18 · 10%
Meta-analysis14 · 8%
Prospective cohort14 · 8%
Systematic review4 · 2%
Case-control4 · 2%
Registered trial, no results posted2 · 1%
Guideline1 · 1%
Registry1 · 1%
Animal study1 · 1%
Laboratory study1 · 1%

The studies that decided it

Qureshi et al. 2026
AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review
Sharp pain after pooping likely means fissure.GuidelineLow quality
size not given2026
Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure.
Who was studied
patients with symptoms such as bleeding, itching, discomfort, and pain around the anus
Main outcome
identifying the cause of anal pain after bowel movements
Quality
This is an expert opinion guideline based on review of literature and expert opinion, not a systematic review or trial, so it carries less weight as direct evidence.
Limitations
Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
Taken word for word from the abstract
- result Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure.
- primaryOutcome Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse.
- population Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse.
- limitations Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
Clin Gastroenterol Hepatol · PMID 42067175 · Read it on PubMed ↗
Kumar et al. 2026
A Double-Blind Randomised Controlled Trial Comparing the Efficacy of Nifedipine and Diltiazem Ointments in the Treatment of Anal Fissure
Both creams eased fissure pain equally.Randomised trialModerate quality
110 people6 weeks
Both ointments reduced symptom scores similarly, with comparable healing rates (70.9% vs 67.3%) and few side effects
Who was studied
people with anal fissures (short-term or long-term)
What they received
nifedipine with lidocaine ointment applied twice daily for 6 weeks
Compared with
diltiazem with lidocaine ointment applied twice daily for 6 weeks
Main outcome
change in pain, bleeding and quality of life score (REALISE score) after 6 weeks
Quality
This was a well-designed double-blind randomized trial but of modest size and short follow-up, so it mainly shows the two treatments are about equally effective rather than how well either works compared to no treatment.
Limitations
Short follow-up and single-centre study; long-term outcomes not assessed.
Taken word for word from the abstract
- population 110 patients with acute, chronic, or acute-on-chronic anal fissures
- intervention 0.3% Nifedipine and 2% lidocaine
- comparator 2% Diltiazem and 2% lidocaine ointments twice daily for 6 weeks
- primaryOutcome The primary outcome was assessed using the REALISE score, which measures pain, bleeding, and overall quality of life.
- result Healing rates were comparable between groups (70.9% for Nifedipine and 67.3% for Diltiazem), and both treatments were well-tolerated with minimal side effects.
- n 110 patients with acute, chronic, or acute-on-chronic anal fissures were randomized
World J Surg · PMID 41989019 · Read it on PubMed ↗
Parajuli et al. 2025
Malignant melanoma of the anal canal: a case report
Rare case: melanoma, not hemorrhoidsCase seriesVery low qualityRelated question
1 people2025
histopathology revealed invasive malignant melanoma
Who was studied
a 71-year-old male with a year-long history of perianal pain and painful defecation
What they received
hemorrhoidectomy for presumed hemorrhoids
Main outcome
diagnosis of the cause of anal pain
Quality
This is a single patient case report, so it cannot show how common this cause is or how it compares to other causes.
Limitations
Limited to case reports, the literature offers little guidance on standardized treatment.
Taken word for word from the abstract
- n a 71-year-old male
- population a 71-year-old male with a year-long history of perianal pain and painful defecation
- intervention He underwent hemorrhoidectomy for presumed hemorrhoids
- primaryOutcome histopathology revealed invasive malignant melanoma
- result histopathology revealed invasive malignant melanoma
- limitations Limited to case reports, the literature offers little guidance on standardized treatment.
J Surg Case Rep · PMID 40904593 · Read it on PubMed ↗
Mert 2023
The importance of topical metronidazole in the treatment of acute anal fissure: a double-blind study controlled for prospective randomization
Faster healing, less pain with metronidazole added.Randomised trialModerate quality
200 people6 weeks
pain was lower and healing was faster with added metronidazole starting from week 1
Who was studied
adults with anal fissure lasting less than 8 weeks
What they received
topical diltiazem plus metronidazole cream
Compared with
topical diltiazem cream alone
Main outcome
pain level and fissure healing
Quality
it was a randomized double-blind trial with a reasonable number of patients, but details on blinding success and dropout were limited.
Limitations
short follow-up of only 6 weeks and no mention of long-term recurrence or dropout rates
Taken word for word from the abstract
- population patients older than 18 years from our General Surgery Clinic with anal fissure complaints for less than 8 weeks
- intervention topical diltiazem and metronidazole treatment in group 2
- comparator Topical diltiazem treatment was started in group 1
- primaryOutcome Pain levels were evaluated by the visual analogue scale (VAS) score, and recovery status was evaluated by physical examination findings
- result fissure epithelialization and healing rates were higher in group 2 (P<0.001); group 2 VAS score levels were lower than in group 1 (P<0.001)
- n 2 groups of 100 patients older than 18 years
Ann Coloproctol · PMID 35038820 · Read it on PubMed ↗
Goddard et al. 2021
Self-reported anal symptoms and their association with anal pathology among gay and bisexual men: a cross-sectional observational analysis
Pain often doesn't match actual anal problemsProspective cohortLow qualityRelated question
616 people2021
most men with anal problems like fissures, fistulae, haemorrhoids or skin conditions had no symptoms, and symptoms were not useful markers of most anal pathology
Who was studied
gay and bisexual men aged 35 and older recruited from community settings
What they received
self-reported anal symptoms such as pain when pooping, itching, discharge, lumps, bleeding, sores, tearing, and tenesmus
Compared with
anal pathology found on physical examination (high-resolution anoscopy) such as fissures, fistulae, ulcers, warts, haemorrhoids and skin conditions
Main outcome
whether reported anal symptoms matched up with actual anal pathology found on examination
Quality
this is a one-time self-report survey compared to exam findings in a specific group of men, so recall and selection issues limit how much it tells us about pooping pain in general.
Limitations
cross-sectional design limits ability to show cause and effect; relies on self-reported symptoms which may be inaccurate; studied only gay and bisexual men, a specific population with higher STI risk
Taken word for word from the abstract
- n Among 616 participants (median age 49 years, 35.9% HIV positive)
- population GBM aged ≥35 years were recruited from community settings between September 2010 and August 2015
- intervention Information about anal symptoms (discharge, itch, pain defecating, lump, bleeding, 'sores', tearing, tenesmus), STIs and sexual behaviours was collected.
- comparator High-resolution anoscopy (HRA) and STI testing were performed.
- primaryOutcome Logistic regression analyses on baseline data were performed to assess associations with each symptom.
- result Among participants diagnosed with fissure, fistulae, haemorrhoids and perianal dermatoses, 61.9%, 100%, 62.0% and 63.9% respectively were asymptomatic.
- result Anal symptoms do not appear to be useful markers of most anal pathology in GBM.
Sex Health · PMID 33958029 · Read it on PubMed ↗
Al-Thoubaity 2020
Safety and efficacy of the treatment of chronic anal fissure by lateral internal sphincterotomy: A retrospective cohort study
Surgery relieved fissure pain safely.RetrospectiveLow quality
691 people2020
very few fissures came back (0.3%) and few patients had minor gas incontinence (0.4%), which went away over time, with major improvement in pain
Who was studied
women with chronic anal fissure (tear near the anus) causing pain during bowel movements
What they received
lateral internal sphincterotomy, a surgery that cuts part of the anal sphincter muscle
Compared with
none - all patients received the surgery, no comparison group
Main outcome
safety and how well symptoms improved, including recurrence and incontinence rates
Quality
this was a retrospective study of one surgery with no comparison group, all patients from a single surgeon and all female, so it can't show how much better this is than other options.
Limitations
retrospective design, no control group, single surgeon, all-female patient population limits how broadly results apply
Taken word for word from the abstract
- population all the patients were female, with an average age of 45.77 years (ranging from 17 to 82 years)
- population patients treated for chronic anal fissure
- intervention lateral internal sphincterotomy (LIS) surgical procedure for the treatment of chronic anal fissure
- comparator 691 patients included in the study, all the patients were female
- primaryOutcome we aimed to evaluate the safety and efficacy of lateral internal sphincterotomy (LIS) surgical procedure
- n included 691 patients treated for chronic anal fissure
- result Recurrence was reported in 2 patients (0.3%) while, 3 patients (0.4%) developed gas incontinence.The complaints of all patients with gas incontinence regressed over a period of time.
- result leading to a reduction in recurrence, incontinence rate and substantially improves symptoms, especially pain
Ann Med Surg (Lond) · PMID 32904150 · Read it on PubMed ↗
Bellio et al. 2018
Stapled Hemorrhoidopexy: Results at 10-Year Follow-up
High recurrence, declining satisfaction over years.RetrospectiveLow qualityRelated question
86 people119.0 months
39% had recurrent hemorrhoidal prolapse and satisfaction was 68% at 10 years, with some patients reporting urge to defecate or gas leakage
Who was studied
adults with grade 3 hemorrhoidal prolapse
What they received
stapled hemorrhoidopexy surgery for hemorrhoids
Compared with
no control group; outcomes tracked over time in same patients
Main outcome
patient satisfaction and recurrence of hemorrhoid prolapse
Quality
This was a small study without a comparison group, so it can't reliably show whether the surgery works better than other options long-term.
Limitations
small sample size and lack of a control group
Taken word for word from the abstract
- n Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse
- population Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse between January and December 2006 were included.
- intervention underwent stapled hemorrhoidopexy
- comparator The study was limited by its small sample size and lack of a control group.
- primaryOutcome Patients satisfaction and recurrence rates were measured.
- result 30 patients (39%) experienced a recurrent hemorrhoidal prolapse, 8 of whom needed a reoperation.
- result Satisfaction rate at 10-year follow-up was 68%.
- followUp median duration of 119.0 months (range 115.4-121.8 mo)
Dis Colon Rectum · PMID 29521831 · Read it on PubMed ↗
de Rosa et al. 2013
Conservative versus surgical treatment for chronic anal idiopathic fissure: a prospective randomized trial
Surgery healed fissures faster, less pain.Randomised trialModerate quality
142 people8 weeks
more surgery patients healed by 8 weeks (88.2% vs 68.9%) and fewer reported pain after defecation, pain at 3 days, and pain at 7 days compared with the ointment group
Who was studied
people with chronic anal fissure (tear in anal lining with painful bowel movements) lasting at least 2 months, with tight anal sphincter muscle
What they received
surgery to cut part of the internal anal sphincter muscle (lateral internal sphincterotomy)
Compared with
topical nifedipine ointment applied with a warm anal dilator twice daily for 4 weeks
Main outcome
complete healing of the fissure at 8 weeks, and pain after bowel movements
Quality
it was a randomized trial comparing two treatments directly, but it did not include a placebo-only group and relied on patient-reported pain scales.
Limitations
no mention of blinding; outcomes relied on self-reported pain scores; no long-term follow-up beyond 8 weeks reported
Taken word for word from the abstract
- n One hundred and forty-two consecutive patients with a chronic anal fissure
- population Anal fissure was defined chronic if the patient presented with history of anal pain during defecation for at least 2 months with the observation of sphincter fibers at the base of the lesion.
- intervention Patients who underwent lateral internal sphincterotomy (LIS) were operated as day surgery procedures under local or epidural anesthesia.
- comparator Patients randomized to conservative treatment were prescribed to use warm anal dilator with a nifedipine ointment 5 min twice daily for 4 weeks.
- primaryOutcome Patients were clinically examined after 2, 4 and 8 weeks of treatment to evaluate if there was complete healing of the fissure.
- result Fifty-one patients of topical nifedipine group (68.9 %) and 60 patients of LIS group (88.2 %) presented an anal fissure healed at 8 weeks with a p value of 0.0077.
- result 43 patients of LIS group (63.2 %) and 25 patients of topical nifedipine group (33.7 %) referred first defecation as painless
Updates Surg · PMID 23737323 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 185 studiesEvery study that answered the question, with its design, size and result.

The other 178 studiesEverything else the search returned, including anything retracted.

Hu et al. 2026
Clinical evidence and practice of moist wound healing in Hemorrhoidectomy: A narrative review
Unclear whether dressings reduce post-surgery painNarrative reviewLow qualityRelated question
size not given2026
may speed wound healing but effect on pain is unclear, with limited surgery-specific evidence
Who was studied
people recovering from hemorrhoidectomy surgery (not general post-poop anal pain)
What they received
moist wound dressings/management of the surgical wound
Compared with
other dressing strategies or standard wound care
Main outcome
wound healing time (epithelialization) and postoperative pain
Quality
it's a narrative (not systematic) review of a surgical-wound topic, admitting the evidence is limited and studies are too small to rule out rare complications
Limitations
narrative (not systematic) review; procedure-specific comparative evidence is limited; studies are underpowered to exclude differences in uncommon complications; no cost-effectiveness data
Taken word for word from the abstract
- population Hemorrhoidectomy creates an open perianal wound that is repeatedly exposed to contamination, mechanical irritation during defecation, and substantial postoperative discomfort.
- intervention Moist wound management aims to maintain an appropriate wound interface that supports re-epithelialization while balancing hydration, exudate control, wound protection, and patient comfort.
- comparator dressing-specific effects on postoperative pain are less certain
- primaryOutcome selected dressing strategies may shorten epithelialization time
- result Current evidence suggests that selected dressing strategies may shorten epithelialization time, although direct hemorrhoidectomy-specific comparative evidence remains limited.
- result In contrast, dressing-specific effects on postoperative pain are less certain, whereas topical pharmacological and sphincter-targeted interventions have separate evidence supporting analgesic benefit.
J Tissue Viability · PMID 42822092 · Read it on PubMed ↗
Zohalinezhad et al. 2026
Efficacy of an Herbal Cream on Patients with Hemorrhoids: a randomized triple-blind controlled trial
No extra benefit over standard cream.Randomised trialLow quality
110 people28 days
Both creams reduced symptoms over time but there was no significant difference between the herbal cream and conventional cream
Who was studied
outpatients with grade I-II hemorrhoids
What they received
herbal cream (common myrtle, chamomile, wild leek, Russian olive extracts)
Compared with
conventional cream
Main outcome
anal pain, difficult defecation, burning, bleeding and itching scores
Quality
Small trial with high dropout (only 49 of 110 analyzed) and no significant difference found between treatments, limiting confidence.
Limitations
high dropout rates and limited sample size
Taken word for word from the abstract
- n 110 outpatients with hemorrhoids were randomly assigned to intervention (n = 58) and control (n = 52) groups
- population patients with grade I-II hemorrhoids
- intervention an herbal cream (HC) containing common myrtle, chamomile, wild leek, and Russian olive extracts
- comparator a conventional cream (CC)
- primaryOutcome anal pain, difficult defecation, and burning sensation) and four-point Likert scale anal bleeding and anal pruritus
- result both HC and CC reduced hemorrhoidal symptoms over time (p = 0.011). However, no significant treatment-group effect (p = 0.50) or treatment-by-time interaction (p = 0.77) was observed.
- limitations potentially due to high dropout rates and limited sample size
- followUp follow-up (28 days)
J Pharmacopuncture · PMID 42812757 · Read it on PubMed ↗
Bustamante et al. 2026
Perianal Hidradenoma Papilliferum Mimicking a Chronic Hemorrhoid: A Case Report
Rare tumor mimicked hemorrhoid, cured by surgeryCase seriesVery low qualityRelated question
1 people2026
surgery removed the lesion, which was confirmed as a rare benign tumor (hidradenoma papilliferum), not a hemorrhoid
Who was studied
50-year-old woman with pain after straining to poop and a perianal lump for three years
What they received
surgical removal of the lump (excisional biopsy)
Compared with
none
Main outcome
diagnosis and cure of the perianal lesion
Quality
this is a single patient case report, which cannot show how common this cause is or how it compares to other treatments
Limitations
only one patient; no comparison group; findings may not generalize to typical post-defecation pain
Taken word for word from the abstract
- n a 50-year-old female patient
- population a 50-year-old female patient reporting acute perianal pain following defecation straining, accompanied by the sensation of an asymptomatic perianal mass present for three years
- intervention Excisional biopsy was performed under local anesthesia with 1 cm margins, allowing the wound to heal by secondary intention
- comparator Complete surgical excision remains the definitive, curative treatment.
- primaryOutcome Histopathological evaluation confirmed perianal HP
- result Histopathological evaluation confirmed perianal HP, characterized by an arboriform papillary architecture, a double-layered epithelium, and classic apocrine decapitation secretion without cytological atypia.
Case Rep Med · PMID 42746068 · Read it on PubMed ↗
Lu et al. 2026
Analgesic Efficacy of Shangdiao Music Combined with Diclofenac Sodium Suppositories after Mixed Haemorrhoid Surgery
Added music reduced pain after hemorrhoid surgery.RetrospectiveLow qualityRelated question
130 people7 days
the group given music plus suppositories had significantly greater reductions in pain scores at all time points than suppositories alone
Who was studied
patients who had surgery for mixed hemorrhoids
What they received
Shangdiao music combined with diclofenac sodium suppositories
Compared with
diclofenac sodium suppositories alone
Main outcome
pain levels after surgery measured by a pain scale
Quality
This was a retrospective, non-randomized comparison of two treatment groups, which cannot rule out other differences between the groups explaining the result.
Limitations
Retrospective design, not randomized, so groups may differ in unmeasured ways; studies pain after hemorrhoid surgery rather than typical pain after a normal bowel movement.
Taken word for word from the abstract
- n a pharmacotherapy group ( n = 70) receiving diclofenac sodium suppositories alone and a combined therapy group ( n = 60) receiving diclofenac sodium suppositories combined with Shangdiao music
- population 130 patients who underwent mixed haemorrhoid surgery
- intervention diclofenac sodium suppositories combined with Shangdiao music
- comparator diclofenac sodium suppositories alone
- primaryOutcome postoperative pain conditions (Visual Analogue Scale [VAS])
- result the combined therapy group showing significantly greater reductions than the controls at all timepoints ( P < 0.001; Cohen's d : 1.78-3.91)
Noise Health · PMID 42085096 · Read it on PubMed ↗
Ma et al. 2026
Effect of transcutaneous electrical acupoint stimulation at Zusanli (ST36) on postoperative pain following mixed hemorrhoidectomy: a retrospective study
Less post-surgery pain with acupoint stimulation.RetrospectiveLow qualityRelated question
185 people2026
patients getting the electrical acupoint stimulation had significantly less pain and faster gut recovery than those getting sham stimulation
Who was studied
patients who had surgery to remove hemorrhoids
What they received
electrical stimulation at an acupuncture point (Zusanli/ST36) plus standard pain medication
Compared with
fake (sham) stimulation plus standard pain medication
Main outcome
pain levels (at rest and during bowel movements) and recovery of gut function
Quality
this was a retrospective study (not randomized) in people recovering from hemorrhoid surgery, so it carries less weight and may not reflect everyday post-poop pain unrelated to surgery.
Limitations
Retrospective design (not randomized), and population is specifically post-surgical hemorrhoidectomy patients rather than general anal pain after defecation.
Taken word for word from the abstract
- population 185 patients undergoing hemorrhoidectomy were retrospectively enrolled
- intervention TEAS (95 cases receiving TEAS at ST36 post-operation)
- comparator control (90 cases receiving postoperative sham stimulation) groups
- primaryOutcome comparatively assessed for pain (at rest and during defecation with the Visual Analogue Scale [VAS]), gastrointestinal function, recovery indices
- result In the TEAS group, postoperative pain was significantly reduced relative to the control group, together with accelerated gastrointestinal function and postoperative recovery
- n 185 patients undergoing hemorrhoidectomy were retrospectively enrolled
Am J Transl Res · PMID 42007108 · Read it on PubMed ↗
Bilgiç et al. 2026
Clinical outcomes of arterial detection ligation technique for grade II/III versus grade IV hemorrhoidal disease
More early pain after larger hemorrhoid surgeryRetrospectiveLow qualityRelated question
78 people1 month
Grade IV patients required more opioid analgesia and reported higher 24-hour pain scores, but 1-month satisfaction and recurrence rates were similar between groups
Who was studied
Patients who underwent ADL-mucopexy between July 2022 and March 2024
What they received
ADL-mucopexy surgery in patients with grade IV hemorrhoidal disease
Compared with
ADL-mucopexy surgery in patients with grade II/III hemorrhoidal disease
Main outcome
Postoperative pain and recurrence
Quality
This was a retrospective study with unequal, fairly small groups comparing disease severity rather than testing a treatment against no treatment, so it can't explain general post-bowel-movement pain.
Limitations
Retrospectively analyzed; unequal group sizes (54 vs 24); short follow-up period
Taken word for word from the abstract
- n Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24).
- population Patients who underwent ADL-mucopexy between July 2022 and March 2024 were retrospectively analyzed.
- intervention grade IV patients required more opioid analgesia, experienced longer times to first flatus and defecation, and reported higher 24-hour visual analog scale pain scores
- comparator Patients were classified into grade II/III and grade IV groups according to the Goligher classification.
- primaryOutcome Primary outcomes included postoperative pain and recurrence
- result Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up.
Medicine (Baltimore) · PMID 41894272 · Read it on PubMed ↗
Kumassah et al. 2026
Laser-based treatment of chronic anal fissures: a report of two cases
Laser treatment healed fissures, no incontinence.Case seriesVery low quality
2 people6 months
both patients had rapid pain relief and complete healing within weeks, with no incontinence at 6 months
Who was studied
two men aged 28 and 47 with chronic anal fissures causing severe pain after bowel movements that hadn't improved with medical treatment
What they received
laser fissuroplasty (LaFiP), a minimally invasive laser procedure
Compared with
none (no comparison group; patients had previously failed medical therapy)
Main outcome
healing of the fissure, symptom relief, and continence
Quality
This is just two patients with no comparison group, so it can't reliably show the treatment works better than other options.
Limitations
Only two cases, short six-month follow-up, long-term durability unknown
Taken word for word from the abstract
- n We report two male patients aged 28 and 47 years, respectively, with CAF unresponsive to medical therapy
- population Both presented with severe post-defecation anal pain and were diagnosed with posterior midline fissures
- intervention LaFiP was performed under pudendal block using 350-400 joules of energy from a 1470 nm diode laser
- comparator Chronic anal fissures (CAF) are painful and often resistant to medical therapy
- primaryOutcome Postoperatively, both experienced rapid symptom resolution and complete healing within weeks, with no incontinence at 6-month follow-up
- result Postoperatively, both experienced rapid symptom resolution and complete healing within weeks, with no incontinence at 6-month follow-up
- followUp Although limited by a short follow-up of six months
J Surg Case Rep · PMID 41768320 · Read it on PubMed ↗
Do et al. 2026
Surgical management of anal stenosis following hemorrhoid treatment: a single-center case series
Surgery fixed narrowing after hemorrhoid opCase seriesVery low qualityRelated question
13 people13.3 months
12 of 13 patients had good results, healing in about 2 months
Who was studied
patients with anal narrowing (stenosis) after hemorrhoid surgery
What they received
surgery to release scar tissue, sometimes combined with tissue flap repair
Compared with
no comparison group
Main outcome
normal pooping without pain or bleeding afterward
Quality
This is a very small, uncontrolled case series from one hospital, so it can't reliably prove the surgery works.
Limitations
Retrospective, no control group, only 13 patients, single center
Taken word for word from the abstract
- n This retrospective case series included 13 patients with anal stenosis after hemorrhoidectomy.
- population 13 patients with anal stenosis after hemorrhoidectomy
- intervention Surgical techniques applied were fibrotic ring release alone, fibrotic ring release with rectal mucosal advancement, fibrotic ring release with horizontal suturing of the rectal mucosa, and fibrotic ring release with V-Y flap reconstruction.
- comparator This retrospective case series included 13 patients with anal stenosis after hemorrhoidectomy.
- primaryOutcome Outcomes were assessed based on patients' ability to achieve normal defecation, stool caliber, and the absence of anal pain or bleeding postoperatively.
- result Surgical outcomes were favorable in 12 out of 13 patients (92.3%), with an average healing time of 2.0 ± 1.1 months.
- followUp The mean follow-up was 13.3 months (range 6-24 months; minimum 6 months).
Int J Colorectal Dis · PMID 41748755 · Read it on PubMed ↗
Zhu et al. 2026
The effect of methylene blue infiltrating injection on anal pain after Milligan-Morgan surgery: A randomized controlled clinical study
Less pain after hemorrhoid surgeryRandomised trialLow qualityRelated question
60 people72 hours
study group had significantly lower pain scores and needed much less additional pain medication
Who was studied
patients with mixed hemorrhoids undergoing Milligan-Morgan surgery
What they received
methylene blue injection into the surgical wound during hemorrhoid surgery
Compared with
same standard pain medication protocol without methylene blue injection
Main outcome
anal pain intensity measured by visual analog scale after surgery
Quality
small single trial of only 60 surgical patients, so results may not generalize or hold up in larger studies
Limitations
small sample size of 60 patients; studies a specific surgical population (hemorrhoidectomy patients), not general post-defecation anal pain
Taken word for word from the abstract
- n 60 patients with mixed hemorrhoids undergoing Milligan-Morgan surgery were divided into 2 groups: a study group (n = 30) and a control group (n = 30)
- population 60 patients with mixed hemorrhoids undergoing Milligan-Morgan surgery
- intervention patients in the study group received an intraoperative MBI to the surgical incisions
- comparator All patients, in both groups, then received the same standard postoperative on-demand intravenous lornoxicam protocol
- primaryOutcome The primary outcome was anal pain intensity assessed by the visual analog scale scores at 6, 24, 48, and 72 hours
- result The study group exhibited significantly lower visual analog scale scores at all time points (all P < .001) and required substantially less supplemental lornoxicam (22.67 ± 17.01 mg vs 56.80 ± 9.32 mg, P < .001)
Medicine (Baltimore) · PMID 41686620 · Read it on PubMed ↗
Seow-En et al. 2025
Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids
Less pain after pooping post-surgeryRandomised trialLow qualityRelated question
50 people30 days
no significant difference in rest pain on day 1, but less pain after bowel movements with cryotherapy
Who was studied
patients having surgery for grade III hemorrhoids
What they received
ice placed in the anus after surgery (intra-anal cryotherapy)
Compared with
standard post-surgery care without ice
Main outcome
pain at rest the day after surgery
Quality
small trial of only 50 people and the main pain measure did not reach significance.
Limitations
small sample size; main outcome (rest pain day 1) not statistically significant; this studies post-surgical pain, not ordinary pain after a bowel movement without surgery
Taken word for word from the abstract
- n A total of 50 patients were randomized (25 per group).
- population Patients with symptomatic grade III hemorrhoids were randomized 1:1
- intervention 1 minute of intra-anal cryotherapy
- comparator standard postoperative care
- primaryOutcome The primary outcome was pain at rest on postoperative day (POD) 1.
- result The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046).
Ann Coloproctol · PMID 41486911 · Read it on PubMed ↗
Sulaiman et al. 2025
Treatment of chronic anal fissure in Crohn's disease patients with freshly collected autologous adipose tissue: a pilot study
Fat injections healed fissures in Crohn's patients.Case seriesVery low qualityRelated question
9 people3 months
5 of 9 patients (56%) had complete healing; pain, discomfort, disease activity, and incontinence scores all improved significantly
Who was studied
patients with Crohn's disease who have chronic anal fissures
What they received
injection of freshly collected autologous fat tissue into the fissure
Compared with
none (before-and-after comparison in same patients)
Main outcome
complete healing of the fissure (full re-epithelialization and no pain) at 3 months after last treatment
Quality
This was a tiny uncontrolled pilot study in only 9 people with no comparison group, so the improvement could be due to other factors.
Limitations
Small pilot study with no control group; patients had Crohn's disease specifically, not general post-defecation anal pain.
Taken word for word from the abstract
- n Nine patients with CD with anal fissures were included.
- population Nine patients with CD with anal fissures were included.
- intervention freshly collected autologous adipose tissue injection (AATI)
- comparator Five patients (56%) achieved CH after one (n = 4) or two (n = 1) AATI.
- primaryOutcome The primary outcome was complete healing (CH) at 3 months after last AATI, defined as full fissure re-epithelialization and complete pain relief.
- result Five patients (56%) achieved CH after one (n = 4) or two (n = 1) AATI. Partial healing was observed in four patients (44%).
- followUp complete healing (CH) at 3 months after last AATI
Tech Coloproctol · PMID 41275461 · Read it on PubMed ↗
Huang et al. 2025
Liposomal bupivacaine versus ropivacaine perianal infiltration for postoperative analgesia of haemorrhoidectomy: a multicentre, randomised controlled trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
264 people72 hours
pain scores were lower with liposomal bupivacaine at rest, during exercise, during walking, and during bowel movements, and fewer patients needed extra pain medicine
Who was studied
adults having surgery for grade III or IV mixed hemorrhoids
What they received
liposomal bupivacaine injected around the anus at the end of surgery
Compared with
ropivacaine injected around the anus at the end of surgery
Main outcome
pain scores at rest after surgery, measured at several time points up to 72 hours
Quality
it is a reasonably large multicentre randomised trial, but it only studied pain after surgery for hemorrhoids, not everyday pain after a bowel movement, and the abstract does not mention blinding.
Limitations
abstract does not report blinding of patients or assessors, and population is limited to surgical hemorrhoidectomy patients rather than general anal pain after defecation
Taken word for word from the abstract
- population Eligible patients were aged 18-75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids).
- n A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group.
- intervention Patients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery.
- comparator Patients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery.
- primaryOutcome The primary outcomes were the resting numerical rating scale (NRS) pain scores (0-10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours.
- result Resting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0-2.0 vs 2.0-4.0 for ropivacaine, p<0.001).
- result By 72 hours after surgery, 78.8% of the patients in the liposomal bupivacaine group had defecated, reporting lower defecation NRS pain scores (median, 3.0 vs 5.0, p<0.001).
- result Fewer patients in this group required rescue analgesics (43.9% vs 83.3%, p<0.001).
BMJ Open · PMID 41067778 · Read it on PubMed ↗
Schmuck et al. 2026
Incidence, Diagnosis, and Management of Proctological Conditions during Pregnancy
Straining causes fissures and hemorrhoids that hurt.Narrative reviewLow qualityRelated question
size not given2026
anal pain is linked to constipation, straining, hemorrhoids, anal fissures and perianal thrombosis, and usually improves with conservative care
Who was studied
pregnant and postpartum women with proctological problems
What they received
conservative treatment such as fluids, stool softeners, and topical ointments
Compared with
surgical treatment
Main outcome
cause and management of anal pain after bowel movements
Quality
this is a general narrative review about pregnancy-related conditions, not a controlled study testing a specific treatment, and it focuses on pregnant women rather than the general population.
Limitations
Abstract does not report study methodology, sample size, or comparative outcome data; focused specifically on pregnancy.
Taken word for word from the abstract
- population Proctological diseases are highly prevalent during pregnancy
- intervention Conservative treatment includes increased fluid intake, the use of stool softeners, and local cooling measures.
- comparator Surgical interventions should be reserved for refractory cases and only considered when absolutely necessary.
- primaryOutcome Anal pain, which is often intense, is commonly associated with constipation and is due to the high density of sensory nerve endings in the anal canal.
- result Straining during defecation further aggravates proctological conditions, facilitating the development of hemorrhoids, anal fissures, and perianal thrombosis.
Visc Med · PMID 41064523 · Read it on PubMed ↗
Erkek et al. 2025
Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease
High recurrence after stapling for severe hemorrhoids.RetrospectiveLow qualityRelated question
77 people2025
23.6% of grade IV patients had recurrence, while none of the grade III patients did; both groups had complications like bleeding, incontinence, and anal fissure
Who was studied
adults with grade III or IV hemorrhoids who had stapled hemorrhoidopexy surgery
What they received
stapled hemorrhoidopexy surgery
Compared with
grade III hemorrhoids compared with grade IV hemorrhoids
Main outcome
hemorrhoid recurrence and complications after surgery
Quality
This was a small, single-center look-back study with no comparison to other treatments, so it can't prove cause and effect.
Limitations
Retrospective, single-center design; small sample size; no control group treated with a different method.
Taken word for word from the abstract
- n This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.
- population patients with grade III/IV hemorrhoids
- intervention Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease
- comparator Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.
- primaryOutcome To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.
- result Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids.
- result Postoperative bleeding, incomplete defecation, urgent defecation, incontinence, skin tags, and anal fissure were complications reported by both groups.
World J Gastrointest Surg · PMID 40949368 · Read it on PubMed ↗
Dixit et al. 2026
Paeonia officinalis for Acute Anal Fissure: A Prospective, Single-Group, Open-Label, Pre-Post Comparison Study
Less pain, fissures mostly healedCase seriesVery low qualityRelated question
34 people12 weeks
pain scores dropped sharply, straining decreased, and most fissures healed by 12 weeks
Who was studied
people with acute anal fissures
What they received
oral homeopathic Paeonia officinalis tincture plus dietary/supportive care
Compared with
no separate control group; outcomes compared before and after treatment in the same patients
Main outcome
pain intensity during and after bowel movements, measured on a pain scale
Quality
this was a small, uncontrolled, open-label study where everyone knew they were getting treatment, so it cannot show the remedy itself caused the improvement.
Limitations
no control group, not blinded, small number of patients, and the authors themselves note other factors could explain the improvement.
Taken word for word from the abstract
- n conducted on 34 participants diagnosed with acute AF
- population participants diagnosed with acute AF
- intervention Paeonia officinalis Q was administered orally (10 drops in 50 mL of water, once daily) for 12 weeks alongside supportive care that included dietary advice
- comparator open-label, prospective, pre-post comparison cohort study
- primaryOutcome pain intensity assessed using a Visual Analog Scale (VAS; range: 0-10)
- result VAS score reduced significantly from baseline (8.94 ± 0.81) at 12 weeks (0.11 ± 0.32), with a mean decrease of 8.82 ± 0.13 (p < 0.001)
- result By 12 weeks, fissures healed completely in 30 (88.2%) participants, with no serious adverse events reported.
Homeopathy · PMID 40834876 · Read it on PubMed ↗
Ashburn 2025
Hemorrhoidal Disease: A Review
Hemorrhoids can cause anal pain and bleeding.Narrative reviewModerate quality
size not given2025
Different treatments show different results: for example, excisional hemorrhoidectomy achieves low recurrence (2%-10%) but longer recovery (9-14 days), while rubber band ligation resolves symptoms in 89% of patients
Who was studied
People with hemorrhoidal disease, a condition of the anal canal tissue
What they received
Various treatments for hemorrhoids, including fiber and water intake, phlebotonics, rubber band ligation, sclerotherapy, infrared coagulation, and surgery
Compared with
No single comparator; review compares treatment effects to no treatment or to stopping treatment
Main outcome
Symptoms such as bleeding, anal pain, irritation, and tissue prolapse
Quality
This is a general clinical overview summarizing many studies rather than a systematic review with its own pooled analysis, so it carries moderate weight for guiding specific treatment decisions.
Limitations
The abstract does not explicitly state limitations of the underlying evidence or the review methodology.
Taken word for word from the abstract
- population Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US.
- intervention Initial treatment of all hemorrhoidal disease involves increasing intake of dietary fiber and water and avoiding straining during defecation.
- comparator although symptom recurrence reaches 80% within 3 to 6 months after treatment cessation
- primaryOutcome Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse.
- result Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days).
- result Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%.
JAMA · PMID 40824576 · Read it on PubMed ↗
Docter et al. 2025
Pediatric external hemorrhoids: clinical characteristics and outcomes of conservative treatment versus injection sclerotherapy
Hemorrhoid treatment works but has trade-offs.RetrospectiveLow qualityRelated question
44 people2025
Sclerotherapy resolved the hemorrhoid in 90.3% of children after two injections but caused skin erosion in over a third; watchful waiting led to symptom resolution within a year, though the lump often remained
Who was studied
children with external hemorrhoids (swelling near the anus)
What they received
injection sclerotherapy
Compared with
conservative management (watchful waiting)
Main outcome
resolution of symptoms/treatment success
Quality
This is a small retrospective review of children's records, not a controlled trial comparing the two treatments directly.
Limitations
Retrospective design, small sample, diagnosis often based on parent photos rather than exams, no randomization between treatment groups
Taken word for word from the abstract
- n Forty-four patients (86.4% male) were included.
- population Pediatric external hemorrhoids are rare and often misdiagnosed.
- intervention injection sclerotherapy
- comparator conservative therapy (watchful waiting)
- primaryOutcome treatment outcomes, and complications
- result with a 69.2% success rate after one, and 90.3% after two injections
- result Thirteen patients (29.5%) were treated conservatively with watchful waiting, with symptoms resolving within one year, although the lesion(s) persisted
- result Skin erosion occurred in 35.5% of patients treated with injection sclerotherapy, leading to constipation and defecation anxiety in 9.1% of patients
Eur J Pediatr · PMID 40813828 · Read it on PubMed ↗
Hemantha Kumar et al. 2025
A Rare Presentation of Juvenile Rectal Polyps in an Adolescent Male With Rectal Bleeding: A Case Report
Rare polyps, not hemorrhoids, caused bleeding.Case seriesVery low qualityRelated question
1 people2025
polyps were found and surgically removed, confirming diagnosis of juvenile rectal polyps
Who was studied
13-year-old boy with years of difficulty pooping and rectal bleeding
What they received
surgical removal of rectal polyps
Compared with
none
Main outcome
diagnosis and treatment of rectal bleeding and mass
Quality
this is a single patient case report, so it cannot show whether a treatment works for most people
Limitations
single case report with no comparison group, describing a rare diagnosis rather than typical post-defecation pain
Taken word for word from the abstract
- population a 13-year-old boy with a five-year history of difficulty in defecation, intermittent rectal bleeding that progressively worsened over the past year, along with abdominal pain and prolapse of a rectal mass
- intervention Surgical excision was performed
- comparator Initial evaluations by multiple clinicians misdiagnosed the condition as hemorrhoids, delaying the correct diagnosis.
- primaryOutcome Colonoscopy revealed multiple large polyps in the lower rectoanal region.
- result histopathological examination confirmed the presence of juvenile rectal (retention) polyps with unusual features, including torsion and mucin extravasation
- n a 13-year-old boy
Cureus · PMID 40575234 · Read it on PubMed ↗
Zhang et al. 2025
The Comparison Between Endoscopic Ligation and Sclerotherapy on the Treatment Effect and Anorectal Function in Patients With Internal Hemorrhoids
Both procedures similarly effective; pain improved more with sclerotherapy.Randomised trialLow qualityRelated question
32 people3-month follow-up
no significant difference between the two procedures overall, though each had some specific advantages (ligation better for constipation, sclerotherapy better for pain/bleeding)
Who was studied
people with internal hemorrhoids
What they received
endoscopic ligation of hemorrhoids
Compared with
cap-assisted endoscopic sclerotherapy (CAES)
Main outcome
treatment effect, symptom relief, complications, psychological condition, and anorectal function
Quality
Very small study with only 32 patients split into two small groups, short 3-month follow-up, and it's not clear from the abstract that patients were randomly assigned.
Limitations
Small sample size (14 vs 18 patients), short follow-up of 3 months, and this concerns treatment of diagnosed internal hemorrhoids rather than general post-defecation pain of unclear cause.
Taken word for word from the abstract
- population patients with internal hemorrhoids
- n Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited
- intervention Group A undergoing endoscopic ligation (n=14)
- comparator Group B receiving CAES (n=18)
- primaryOutcome Clinical efficacy and anorectal function between the 2 groups before and after treatment were compared
- result There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding.
- followUp with a 3-month follow-up
Surg Laparosc Endosc Percutan Tech · PMID 40530787 · Read it on PubMed ↗
Long et al. 2025
Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Less pain after combined hemorrhoid surgery.RetrospectiveLow qualityRelated question
255 people12 months after surgery
recurrence was lower and satisfaction was higher with the combined procedure, with no difference in severity score; pain scores at the first postoperative bowel movement and on days 1, 3, and 7 were also lower with the combined procedure
Who was studied
adults with grade III/IV hemorrhoids who had surgery
What they received
Milligan-Morgan hemorrhoidectomy plus rubber band ligation and polidocanol foam sclerotherapy
Compared with
Milligan-Morgan hemorrhoidectomy alone
Main outcome
recurrence rate, hemorrhoid severity score, and patient satisfaction at 12 months after surgery
Quality
this was a retrospective, single-center study comparing two surgical techniques, not a randomized trial, so bias cannot be ruled out.
Limitations
retrospective design, single center, and comparison is between two surgical techniques for severe hemorrhoids rather than addressing general post-defecation anal pain in the broader population
Taken word for word from the abstract
- n A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127)
- population A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study.
- intervention This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids.
- comparator between May 2022 and June 2023 were included in the study.
- primaryOutcome The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery.
- result The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05).
- result Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05).
- followUp Follow-up was conducted by telephone or outpatient visit 12 months after surgery.
BMC Gastroenterol · PMID 40346473 · Read it on PubMed ↗
Liu et al. 2025
The comparison of doppler-guided haemorrhoidal artery ligation and the tissue selecting technique for patients with grade III/IV haemorrhoids: a retrospective cohort study
Both surgeries help; techniques trade pain versus recurrence.RetrospectiveLow qualityRelated question
251 people3 years
DG-HAL caused less pain and fewer complications right after surgery, but more hemorrhoids came back by 3 years compared to TST
Who was studied
adults with grade III or IV hemorrhoids
What they received
Doppler-guided hemorrhoid artery ligation (DG-HAL) surgery
Compared with
tissue-selecting technique (TST) surgery
Main outcome
pain after bowel movements, complications, and hemorrhoid recurrence after surgery
Quality
This is a retrospective, non-randomized comparison of two surgeries, so differences could be due to other factors rather than the treatment itself.
Limitations
Retrospective design without randomization, comparing two specific surgical techniques rather than addressing general causes of post-defecation anal pain.
Taken word for word from the abstract
- n We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021.
- population patients with grade III/IV hemorrhoids
- intervention Doppler-guided hemorrhoid artery ligation (DG-HAL)
- comparator tissue-selecting technique (TST)
- primaryOutcome post-operative visual analog scale (VAS) for pain, post-operative bleeding, post-operative defecation, urinary retention, and recurrence rate (prolapse and bleeding)
- result DG-HAL had fewer complications, lower bleeding rates, and less early post-operative pain but showed a higher recurrence rate than TST at the 3-year follow-up, especially in grade IV patients.
Updates Surg · PMID 40210842 · Read it on PubMed ↗
Quinn et al. 2025
Botulinum toxin injection for management of post-haemorrhoidectomy pain: an updated systematic review and meta-analysis of randomised clinical trials
Less pain, but only brieflyMeta-analysisModerate qualityRelated question
340 people14 days
botulinum toxin reduced pain on days 1, 2 and 4 after surgery but not after day 14, with no increase in incontinence or urinary retention
Who was studied
people who had surgical removal of haemorrhoids (grade III-IV)
What they received
botulinum toxin injection given during surgery
Compared with
placebo
Main outcome
pain levels after surgery, measured daily
Quality
This pools seven randomized trials but the total number of patients is small and the benefit faded by two weeks.
Limitations
The abstract notes results were short-lived and calls for further, more robust randomised controlled trials.
Taken word for word from the abstract
- population seven RCTs assessing 340 patients who underwent an excisional haemorrhoidectomy
- intervention concurrent botulinum toxin injection
- comparator botulinum toxin injection compared with placebo for management of post-haemorrhoidectomy pain
- primaryOutcome daily post-operative pain scores assessed using an analogue scale (0-10), pain at first defecation, analgesia use, complication rates and time to return to work
- n seven RCTs assessing 340 patients
- result found significant reduction in pain post-procedure with botulinum toxin use on day 1 (mean difference, MD -1.53; 95% confidence intervals, CI -2.12, -0.94; p < 0.00001), with similar findings on day 2 and 4
- result However, the analgesic effects were not seen on subsequent analyses up to day 14.
- result no significant difference in faecal incontinence (MD 1.05, 95% CI 0.40, 2.75; p = 0.93) or urinary retention (MD 0.37, 95% CI 0.09, 1.53; p = 0.17)
Tech Coloproctol · PMID 40192825 · Read it on PubMed ↗
Khalid et al. 2025
A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis
Not about everyday pooping pain.Meta-analysisLow qualityRelated question
292 people12-18 months
stapled surgery caused less pain, quicker recovery, and fewer bowel-control problems, but hemorrhoids came back more often later
Who was studied
adults with grade III and IV hemorrhoids undergoing surgery
What they received
stapled hemorrhoidectomy
Compared with
open hemorrhoidectomy
Main outcome
pain after surgery and how fast bowel function returns
Quality
it pools only seven small studies (292 patients) about surgical patients, which doesn't address ordinary post-bowel-movement anal pain.
Limitations
small number of studies and patients, only covers surgical hemorrhoid patients, not people with everyday anal pain after defecation
Taken word for word from the abstract
- n Seven studies involving 292 patients met the inclusion criteria.
- population patients with grade III and IV hemorrhoids
- intervention Stapled hemorrhoidectomy (SH)
- comparator open hemorrhoidectomy (OH)
- primaryOutcome The primary outcomes were gastrointestinal recovery, measured by time to resumption of normal diet and bowel movements, and pain management, assessed by postoperative pain scores.
- result SH patients reported significantly lower pain scores, reduced analgesic use by 35% on average, and faster recovery, with statistically significant results (p<0.05).
- result though a higher recurrence rate was noted in the SH group, especially at 12-18 months post-surgery
- followUp especially at 12-18 months post-surgery
Cureus · PMID 40125221 · Read it on PubMed ↗
Groshilin et al. 2025
[Treatment of acute hemorrhoids according to the results of a multicenter observational study]
Hemorrhoid drug reduced pain and swelling.Prospective cohortLow qualityRelated question
220 people30 days
Pain, discomfort, itching and blood streaks during defecation decreased by day 7 of treatment, hemorrhoidal node size was reduced in 73% of patients, and quality of life improved significantly by day 30, with no reported side effects.
Who was studied
adults aged 18 to 64 with grade I-II acute hemorrhoids (thrombosed hemorrhoidal nodes, with or without bleeding)
What they received
Phlebodia 600 (diosmin) tablets taken for at least 35-40 days
Compared with
none (before-and-after comparison within the same patients, no control group)
Main outcome
resolution of symptoms such as pain, bleeding, itching and hemorrhoidal node size, plus quality of life (SF-36)
Quality
This was an observational study with no comparison group, so improvements over time cannot be separated from the drug's effect.
Limitations
No control or placebo group was used, so it cannot be determined whether improvement was due to the drug or natural resolution over time.
Taken word for word from the abstract
- n The total sample size analyzed was 220 patients
- population Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids
- intervention Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms
- comparator RESULTS: The use of Phlebodia 600 for grade I-II acute hemorrhoids allowed for the resolution of complaints and stabilization of all key clinical parameters
- primaryOutcome evaluate the dynamics of patients' quality of life with acute hemorrhoids of grades I-II
- result early resolution and reduction of complaints such as pain, discomfort, itching, and blood streaks during defecation were observed by the control visit after seven days of therapy, compared to baseline. In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period.
Khirurgiia (Mosk) · PMID 40103253 · Read it on PubMed ↗
Arslan et al. 2025
Retrospective analysis on the efficacy of botulinum toxin alone versus combined botulinum toxin and topical diltiazem
Adding diltiazem didn't help fissure healing.RetrospectiveLow qualityRelated question
217 people53 (22-101) months
both treatments led to similar healing rates (about 74%) and about 7 days to pain-free defecation, with no added benefit from diltiazem
Who was studied
patients with chronic anal fissures
What they received
botulinum toxin injection plus topical diltiazem applied after injection
Compared with
botulinum toxin injection alone
Main outcome
fissure healing at 2 months and days until pain-free bowel movements
Quality
This was a retrospective study without a placebo group, so it can't fully prove whether the added drug truly makes no difference.
Limitations
Retrospective design and no placebo control for the topical diltiazem.
Taken word for word from the abstract
- population 217 patients who met the inclusion criteria were analyzed
- intervention TD was applied twice daily for 10 days immediately following the BT injection
- comparator 143 receiving BT alone
- primaryOutcome Primary outcome measures were fissure healing at 2 months and days to pain-free defecation
- result At 2 months, complete healing was observed in 74.4% of patients, with no significant difference between groups: 74.8% for BT and 74.3% for BT + TD
- result The median time to pain-free defecation was 7 days across the entire series, with no statistical difference between groups
- n A total of 217 patients who met the inclusion criteria were analyzed
- followUp median follow-up of 53 (22-101) months
- limitations its retrospective design and the absence of a placebo control for TD
Int J Colorectal Dis · PMID 40009123 · Read it on PubMed ↗
Shankar Km et al. 2025
Efficacy and Safety of Murivenna Anal Infiltration Compared to Diltiazem Topical Application in Chronic Anal Fissure: Protocol for a Prospective, Randomized, Open-Label Clinical Trial
No results yet available.Registered trial, no results postedVery low quality
66 people4 weeks
This is a trial protocol; recruitment is ongoing and results are not yet available
Who was studied
people with chronic anal fissure (a tear in the anal lining causing pain after pooping)
What they received
murivenna oil injected into the anal area (Ayurvedic treatment)
Compared with
diltiazem cream applied topically
Main outcome
proportion of participants with complete healing after 4 weeks of treatment
Quality
This is only a study protocol with no results reported yet, so no conclusions about effectiveness can be drawn.
Limitations
Open-label design (no blinding); results not yet available as recruitment and data analysis are still in progress.
Taken word for word from the abstract
- n a sample size of 66 participants
- population chronic anal fissure
- intervention murivenna anal infiltration
- comparator topical application of diltiazem
- primaryOutcome The primary outcome will be the proportion of participants demonstrating complete healing after 4 weeks of treatment.
- result The data analysis will be complete by June 2025, and the results are expected to be published by August 2025.
JMIR Res Protoc · PMID 39899833 · Read it on PubMed ↗
Huang et al. 2025
Clinical observation on prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation
Less pain after bowel movementsRandomised trialLow quality
100 people1 year post-operatively
Treatment group had lower pain scores at 24 hours and at first defecation after surgery, faster healing, shorter hospital stay, higher effective rate, and fewer complications, with no difference in bleeding, anal stenosis, or recurrence
Who was studied
patients diagnosed with mixed hemorrhoids
What they received
polidocanol foam injection combined with automatic elastic thread ligation (RPH)
Compared with
procedure for prolapse and hemorrhoids (PPH) surgery
Main outcome
pain after surgery, including first bowel movement pain, plus healing time and complications
Quality
It was randomized but used dice rolling for allocation, had no blinding described, and is a single-center study, which limits confidence in the results.
Limitations
Randomization by dice rolling, no mention of blinding, single hospital, and short follow-up for recurrence assessment despite claiming long-term prognosis.
Taken word for word from the abstract
- population patients with mixed hemorrhoids
- intervention polidocanol foam injection + RPH
- comparator The procedure for prolapse and hemorrhoids (PPH) was adopted in the control group
- primaryOutcome pain situation (24 hours post-operative pain score, first defecation pain score)
- result The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group (P < 0.05)
- n A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group (n = 50) and the treatment group (n = 50) by rolling the dice
World J Gastrointest Surg · PMID 39872768 · Read it on PubMed ↗
Zhao et al. 2024
[Somatic symptoms often comorbid with benign anorectal disorders: a study of their significance]
Persistent pain may be psychological, not physicalNarrative reviewVery low qualityRelated question
size not given2024
the article recommends treating somatic symptom disorder first, before surgery, when anorectal disease coexists with psychological disorders, but reports no data or outcomes
Who was studied
people with anorectal conditions like fissures, hemorrhoids, or defecation problems who still have discomfort after treatment
What they received
treating psychological/somatic symptom disorder before or alongside anorectal treatment
Compared with
surgical treatment alone without addressing psychological symptoms
Main outcome
improvement in patient discomfort and rehabilitation outcomes
Quality
this is an opinion/narrative piece with no patient data, trial, or measured outcomes, so it can't show whether anything actually works.
Limitations
no study data, no defined population size, no outcome measurements; it is a conceptual/opinion article rather than original research
Taken word for word from the abstract
- population Some patients continue to experience discomfort such as perianal discomfort, perineal heaviness, defecation difficulties, and abdominal bloating even after anatomical issues have been addressed, severely impairing social functioning.
- intervention advocating for the establishment of a biopsychosocial medical model in the diagnosis and treatment of these conditions to enhance patient rehabilitation outcomes
- comparator Surgical treatment should be considered only after the improvement of psychological disorders and SSD.
- primaryOutcome to enhance patient rehabilitation outcomes
- result It is recommended that when benign anal diseases coexist with psychological disorders, SSD treatment should be used as a prerequisite.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 39710449 · Read it on PubMed ↗
Mou et al. 2024
Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure
New banding method may cut procedural painNarrative reviewLow qualityRelated question
size not givenone-year follow-up
EFSB was linked to less pain after the procedure and less return of prolapse compared with banding alone, but the abstract says larger and longer studies are needed
Who was studied
people with internal hemorrhoids (grades II and III)
What they received
endoscopic polidocanol foam sclerobanding (EFSB), a procedure that injects foam and bands hemorrhoids
Compared with
endoscopic rubber band ligation (ERBL) alone
Main outcome
pain after the procedure and return of prolapse
Quality
this is a commentary discussing another study's results rather than original data, and the commentary itself says the findings need confirmation in bigger, longer trials
Limitations
the abstract states that future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings
Taken word for word from the abstract
- population patients with grades II and III internal hemorrhoids
- intervention Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach
- comparator Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure
- primaryOutcome reduced 24-h post-procedural pain
- result Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings
- followUp one-year follow-up
World J Gastroenterol · PMID 39563748 · Read it on PubMed ↗
Della Casa et al. 2024
Feasibility of IAPWG protocol in performing high-definition three-dimensional anorectal manometry: A prospective, multicentric italian study
Study of a diagnostic test, not pain causes.Prospective cohortLow qualityRelated question
290 people2024
the full test protocol was completed in 97.9% of patients and was described as easy to perform and not time-consuming
Who was studied
patients referred for anorectal testing for reasons including constipation, fecal incontinence, anal pain, and other anorectal problems
What they received
3D high-definition anorectal manometry using a standardized testing protocol
Compared with
none; no comparison group
Main outcome
whether the standardized testing protocol could be successfully completed
Quality
this is a feasibility study of a diagnostic test's practicality, not a study testing treatments or causes of anal pain after bowel movements
Limitations
this abstract does not evaluate causes or treatments for anal pain after defecation; only 3.1% of patients were referred for anal pain, and no outcomes specific to anal pain are reported
Taken word for word from the abstract
- n A total of 84 males and 206 females (mean age 57.1 ± 15.7 years) were enrolled in six Italian centers.
- population The reasons for which the patients were sent to perform 3D-ARM were: constipation (53.1%), fecal incontinence (26.9%), anal pain (3.1%), postsurgical (3.8%) and presurgical evaluation (4.8%), prolapse (3.4%), anal fissure (2.8%), and other (2.1%).
- intervention The IAPWG protocol was applied in performing 3D-ARM.
- comparator Anorectal manometry (ARM) and a balloon expulsion test (BET) were performed according to IAPGW protocol in 290 patients.
- primaryOutcome The applicability and possible limitations of the IAPWG protocol in performing three-dimensional high-definition anorectal manometry (3D-ARM) have still to be extensively evaluated.
- result Overall, a complete 3D-ARM and BET following IAPWG protocol was carried out in 284 patients (97.9%).
Tech Coloproctol · PMID 39480607 · Read it on PubMed ↗
Riboni et al. 2024
Anal Fissure and Its Treatments: A Historical Review
Explains fissures, no treatment resultsNarrative reviewVery low qualityRelated question
size not given2024
the abstract traces the history of understanding and treating anal fissure without reporting outcome data
Who was studied
people with anal fissure (a tear near the anus)
What they received
historical review of medical and surgical treatments for anal fissure
Compared with
no comparator; historical overview
Main outcome
how understanding and treatment of anal fissure changed over time
Quality
this is a historical narrative review, not a study measuring outcomes, so it cannot show whether any treatment works
Limitations
no patient data, no outcome measures, and no comparison of treatment effectiveness are reported; it is a historical summary only
Taken word for word from the abstract
- population Anal fissure is one of the most common proctological pathologies.
- intervention The objective of this article is to highlight the historical evolution in the physiopathological understanding and treatment of this disease, underlining the key moments in this history.
- comparator This is the first article to summarize the milestones in the treatment of anal fissure from ancient to current times.
- primaryOutcome the historical evolution in the physiopathological understanding and treatment of this disease
- result Currently, multiple therapeutic options are available, both medical and surgical.
J Clin Med · PMID 38999495 · Read it on PubMed ↗
Kavraal et al. 2024
Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser
Laser hemorrhoid treatment, high satisfaction, few problemsRetrospectiveLow qualityRelated question
138 peopleup to five years
no complications during surgery, only mild symptoms for about a week, symptoms mostly resolved by six months, low recurrence, and 95% patient satisfaction
Who was studied
adults with symptomatic internal hemorrhoids (grades II, III, and IV)
What they received
laser treatment to shrink hemorrhoids (hemorrhoidal laser ablation with a 1470 nm diode laser)
Compared with
none (single group, before/after outcomes only)
Main outcome
symptom relief, hemorrhoid shrinkage, recurrence, and safety after the procedure
Quality
This was a retrospective study without a comparison group, so it can't prove the laser caused the improvement.
Limitations
Retrospective design with no control/comparison group; relies on data collected after the fact from three centers.
Taken word for word from the abstract
- n The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation
- population symptomatic grade II, III, and IV internal hemorrhoids
- intervention Hemorrhoidal Laser Ablation, a method for treating severe hemorrhoids
- intervention Patients were treated with a 1470 nm diode laser.
- comparator This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation
- primaryOutcome evaluate the efficacy and safety of this relatively recent technique
- result No evidence of intraoperative complications occurred.
- result The overall satisfaction rate was 95% with symptomatic relief.
- result the long-term recurrence rate was 5% over up to five years of follow-up
- design This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation
Pol Przegl Chir · PMID 38965992 · Read it on PubMed ↗
Kwiatkowska et al. 2024
The influence of supportive therapy with a six-component myophlebotropic preparation on the reduction of symptoms in patients with symptoms of hemorrhoidal disease
Less pain, burning and itching with supplement.Prospective cohortLow quality
61 people30 days
Patients on the active supplement had significantly greater improvement in pain, burning, itching and bleeding during defecation than those on placebo after 30 days
Who was studied
adults with stage II or III hemorrhoids who had pain, burning, itching or bleeding
What they received
a six-component myophlebotropic dietary supplement added to standard local hemorrhoid treatment
Compared with
standard local treatment plus a placebo supplement
Main outcome
severity of hemorrhoid symptoms such as pain, burning, itching and bleeding, measured over 30 days
Quality
The study was small, did not clearly state it was randomized or blinded, so results may be less reliable.
Limitations
Abstract does not mention randomization procedure, blinding method, or any adverse effects, and the sample size was small.
Taken word for word from the abstract
- n 29 patients
- n 32 patients
- population Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study.
- intervention a six-component myophlebotropic product
- comparator receiving standard local treatment plus placebo
- primaryOutcome Symptoms were analyzed at the time of inclusion in the study (day 0), after 4 and 10 days of therapy.
- result there was a statistically significant improvement in the VAS scale: spontaneous pain and pain during defecation
- followUp After 30 days of observation
Pol Przegl Chir · PMID 38940246 · Read it on PubMed ↗
Jin et al. 2024
A Randomized Controlled Trial of Topical Analgesia Posthemorrhoidectomy (TAPH Trial)
No extra pain relief after hemorrhoid surgery.Randomised trialModerate qualityRelated question
192 people2024
adding diltiazem or lidocaine to metronidazole did not significantly reduce pain or improve recovery compared to metronidazole alone
Who was studied
adults recovering after hemorrhoidectomy surgery
What they received
topical metronidazole combined with diltiazem and/or lidocaine applied to the anal area
Compared with
topical metronidazole alone
Main outcome
pain level on day 4 after surgery
Quality
it was a well-designed multicenter randomized double-blind trial, but the comparison group used an active drug rather than a true placebo, which limits certainty.
Limitations
Topical metronidazole was used in the control group rather than a pure placebo.
Taken word for word from the abstract
- n A total of 192 participants were randomly assigned (1:1:1:1) into 4 parallel arms.
- population Postoperative pain remains the greatest problem after hemorrhoidectomy.
- intervention Participants were randomly assigned into 1 of 4 groups receiving topical treatment with 10% metronidazole, 10% metronidazole + 2% diltiazem, 10% metronidazole + 4% lidocaine, or 10% metronidazole + 2% diltiazem + 4% lidocaine.
- comparator Topical metronidazole was used in the control group rather than a pure placebo.
- primaryOutcome The primary outcome was pain on the visual analog scale on day 4.
- result There was no significant difference in the pain and recovery scores when diltiazem or lidocaine was added to metronidazole
Dis Colon Rectum · PMID 38871679 · Read it on PubMed ↗
Liang et al. 2024
Ultrasound-guided intersphincteric space block combined with spinal anesthesia for hemorrhoidectomy: a randomized clinical trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
50 people48 hours
lower pain scores and less urinary retention with the nerve block plus low-dose spinal anesthesia
Who was studied
adults having surgery to remove hemorrhoids
What they received
nerve block near the anal muscle plus a low dose of spinal anesthesia
Compared with
standard dose of spinal anesthesia alone
Main outcome
pain level after surgery, including at the first bowel movement
Quality
it was a randomized trial but small, with only 50 patients, which limits how confident we can be in the findings
Limitations
small sample size; abstract does not mention blinding or multiple study centers
Taken word for word from the abstract
- n Fifty patients aged 20-65 years who underwent elective hemorrhoidectomy were stochastically assigned to one of two groups.
- population patients aged 20-65 years who underwent elective hemorrhoidectomy
- intervention ultrasound-guided intersphincteric space block combined with low-dose ropivacaine spinal anesthesia
- comparator conventional-dose ropivacaine spinal anesthesia
- primaryOutcome The primary outcome was the postoperative pain score, measured using the Visual Analog Scale (VAS) at 4, 8, 12, 24, and 48 hours and at the first defecation postoperatively.
- result The treatment group showed markedly lower VAS scores than those of the control group at 8, 12, 24, and 48 h, and at the first postoperative defecation time (P<0.05).
Minerva Anestesiol · PMID 38652448 · Read it on PubMed ↗
Fujimoto 2024
Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report
Sugar helped shrink severe prolapsed hemorrhoid.Case seriesVery low quality
1 people2 weeks
after sugar was applied, the swelling went down enough that the hemorrhoids could be pushed back in, and her pain improved
Who was studied
51-year-old woman with internal hemorrhoids that prolapsed every time she had a bowel movement, for 20 years
What they received
applying sugar directly to the hemorrhoids to shrink them before manually pushing them back in
Compared with
lidocaine gel and hydrocortisone ointment alone (tried first, did not work)
Main outcome
whether the prolapsed hemorrhoids could be manually pushed back in and pain improved
Quality
this is a single patient case report, so it cannot show whether this works reliably for others.
Limitations
only one patient was described, there was no comparison group, and this was an emergency strangulated hemorrhoid situation rather than everyday post-bowel-movement pain.
Taken word for word from the abstract
- population a 51-year-old female patient. Over the preceding 20 years, she experienced prolapsed internal hemorrhoids every time she defecated
- intervention we applied sugar directly to the hemorrhoids
- comparator After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult.
- primaryOutcome the manual reduction was still difficult
- result Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible.
- result the patient was discharged once it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved
- n we present a 51-year-old female patient
- followUp Two weeks later, a grade III internal hemorrhoid was observed, which had markedly reduced in size compared with the time of admission.
Cureus · PMID 38601399 · Read it on PubMed ↗
Porwal et al. 2024
Efficacy and Safety of Oral Euphorbia prostrata Tablet and Topical Cream in the Management of Hemorrhoids During Pregnancy: Results From a Prospective Multicenter Study
Less pain and bleeding over time.Case seriesVery low qualityRelated question
100 peopleeight weeks
Significant reduction in pain at defecation and other symptoms over eight weeks, with no adverse events
Who was studied
pregnant women with hemorrhoids
What they received
Euphorbia prostrata oral tablet and topical cream
Compared with
none (single-arm, no comparison group)
Main outcome
reduction in hemorrhoid symptoms like bleeding, pain during defecation, itching, swelling
Quality
This was a single-arm study with no comparison group, so improvement cannot be confidently attributed to the treatment alone.
Limitations
Non-randomized, open-label, single-arm design without a control group to rule out natural improvement or placebo effect.
Taken word for word from the abstract
- n A total of 100 patients (mean age 24.1 years) were included
- population hemorrhoids during pregnancy
- intervention Sitcom® tablet (Euphorbia prostrata 100 mg) once daily and Sitcom® cream (Euphorbia prostrata 1%w/w) for 14 days
- comparator non-randomized, open-label, prospective single-arm interventional multicentric study
- primaryOutcome to assess hemorrhoidal symptoms relief during the follow-up periods
- result The mean pain score at defecation, itching, exudates, and swelling showed a significant reduction of 77.6%, 96.9%, 100%, and 84.5% at eight weeks (p<0.001).
Cureus · PMID 38496090 · Read it on PubMed ↗
Şahin et al. 2024
The efficacy of topical sodium pentaborate formulation on hemorrhoid disease: A randomized, double-blind, placebo-controlled trial
Less pain and bleeding with gel.Randomised trialModerate qualityRelated question
206 peoplefour weeks
the sodium pentaborate gel group had less resting pain, less pain during defecation, less itching, less bleeding, and lower hemorrhoid degree than the placebo group
Who was studied
patients with grade 1, 2, and 3 hemorrhoid disease
What they received
topical gel containing sodium pentaborate pentahydrate 3%
Compared with
placebo gel
Main outcome
hemorrhoid symptom severity (including pain, itching, bleeding) and anoscopy findings
Quality
it was a randomized placebo-controlled trial with a reasonable number of patients, but it only looked at hemorrhoids specifically and lasted just four weeks.
Limitations
abstract does not report dropout rates, blinding success, or longer-term follow-up beyond the 4-week treatment period
Taken word for word from the abstract
- n we applied a topical gel consisting of sodium pentaborate pentahydrate 3% on 206 eligible patients
- population patients with the diagnosis of grade 1, 2, and 3 hemorrhoid diseases
- intervention topical gel consisting of sodium pentaborate pentahydrate 3%
- comparator placebo gel
- primaryOutcome Patient hemorrhoid symptoms severity, hemorrhoid degree, and anoscopy findings were compared before and after the trial.
- result resting pain [aMD (95% CI): -1.37 (-1.6 to -1.1), p = 0.015], pain during defecation [aMD (95% CI): -2.19 (-2.4 to -2.0), p = 0.005], feeling a lump in the anus (aMD (95% CI): -0.71 (-1.2 to -0.2), p = 0.011), bleeding during defecation (41.7% vs. 66.9%, p = 0.027), and hemorrhoid degree (p < 0.001) in the intervention group was less than the placebo group
Heliyon · PMID 38463771 · Read it on PubMed ↗
Lembo et al. 2024
Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States
Fewer hemorrhoids and bleeding with treatment.RetrospectiveLow qualityRelated question
690 people6 months
decreased proportions of patients with abdominal pain, abdominal distension, nausea, intestinal obstruction, hemorrhoids, and rectal bleeding after starting prucalopride, but no improvement in incomplete defecation
Who was studied
adults with chronic idiopathic constipation
What they received
prucalopride treatment
Compared with
same patients' symptoms before treatment
Main outcome
constipation-related symptoms and complications, including anal fissure, hemorrhoids, and rectal bleeding
Quality
This was a before-and-after claims study with no control group, so other reasons for the changes can't be ruled out.
Limitations
Retrospective design using insurance claims data; no comparator group; relies on diagnosis codes rather than direct symptom reporting.
Taken word for word from the abstract
- population adults with chronic idiopathic constipation (CIC)
- intervention prucalopride initiation
- comparator 6 months before and after prucalopride initiation
- primaryOutcome constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding)
- result hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]
- n This study included 690 patients
Clin Transl Gastroenterol · PMID 38357940 · Read it on PubMed ↗
Al-Masoudi et al. 2024
Prevalence of Hemorrhoids and the Associated Risk Factors Among the General Adult Population in Makkah, Saudi Arabia
Hemorrhoids often cause pain after pooping.RegistryLow quality
400 people2024
16% reported diagnosed hemorrhoids; among those, 76.2% had pain with defecation, 63.5% discomfort, and 55.6% swelling
Who was studied
general adult population in Makkah, Saudi Arabia
What they received
not applicable (observational survey on hemorrhoid prevalence and risk factors)
Main outcome
prevalence of hemorrhoids and associated symptoms
Quality
This is a self-reported online survey without clinical confirmation, so it can only suggest associations, not prove causes.
Limitations
Self-reported diagnosis and symptoms via online questionnaire; cross-sectional design cannot establish cause and effect.
Taken word for word from the abstract
- n A total of 400 participants completed the study questionnaire.
- population general adult population in the city of Makkah, Saudi Arabia
- primaryOutcome evaluate the prevalence of and risk factors for hemorrhoids among the general adult population
- result 64 participants (16%) reported that they were diagnosed with hemorrhoid disorder. The most reported symptoms among participants with hemorrhoids were pain with defecation (76.2%), discomfort (63.5%), and swelling (55.6%).
- intervention A descriptive cross-sectional study was conducted with a structured, prevalidated questionnaire
Cureus · PMID 38318578 · Read it on PubMed ↗
Lyle et al. 2024
Anal fissures: An update on treatment options
Pain is from an anal tear.Narrative reviewLow quality
size not given2024
this is a review describing current treatment options rather than reporting a specific trial result
Who was studied
people with anal fissures (a tear near the anus)
What they received
treatments for anal fissure, including fibre, sitz baths, topical nitrates, calcium channel blockers, botulinum toxin, or surgery
Compared with
different treatment steps compared to each other (no single control group)
Main outcome
healing or resolution of the anal fissure and pain with bowel movements
Quality
this is a narrative review summarizing guidelines and other studies rather than presenting new controlled data.
Limitations
no original data, patient numbers, or outcome statistics are given; it only describes general management approaches.
Taken word for word from the abstract
- population Anal fissure (AF) is the second most common anorectal complaint in healthcare settings.
- intervention Non-surgical and surgical interventions are available based on the severity and persistence of the fissure.
- intervention Addition of topical nitrates, topical calcium channel blockers or botulinum toxin injection is indicated with failure of conservative treatment or at medical discretion.
- comparator Acute AF is first treated with conservative therapy, including dietary fibre and sitz baths.
- primaryOutcome characterised by severe pain with defaecation that persists for one to two hours
- result The aim of this article is to review the pathophysiology, clinical presentation and management of AF under current guidelines.
Aust J Gen Pract · PMID 38316476 · Read it on PubMed ↗
Solis-Pazmino et al. 2024
Liposomal bupivacaine versus conventional anesthetic or placebo for hemorrhoidectomy: a systematic review and meta-analysis
Less post-surgery pain with special anesthetic.Meta-analysisModerate qualityRelated question
338 people72 h
patients given the long-acting anesthetic had lower pain scores at 72 hours, needed opioids later, and reported less pain during bowel movements than those given regular anesthetic or placebo
Who was studied
adults who had surgery to remove hemorrhoids (hemorrhoidectomy)
What they received
a long-acting local anesthetic (liposomal bupivacaine) given after hemorrhoid surgery
Compared with
regular bupivacaine anesthetic or placebo
Main outcome
pain levels and pain with bowel movements after hemorrhoid surgery
Quality
it pools only three small randomized trials, so the overall evidence is suggestive but not very robust.
Limitations
Only three trials included, relatively small total sample, and all patients had undergone hemorrhoid surgery rather than having ordinary pain after a bowel movement without surgery.
Taken word for word from the abstract
- n A total of 338 patients who underwent a hemorrhoidectomy procedure enrolled in three randomized clinical trials were included.
- population patients who underwent a hemorrhoidectomy procedure
- intervention Liposome bupivacaine (LB) is a long-acting anesthetic to enhance postoperative analgesia.
- comparator received either bupivacaine or placebo
- primaryOutcome comparing LB's analgesic efficacy and side effects to conventional/placebo anesthetic in hemorrhoidectomy patients
- result Pain scores at 72 h in the LB (199, 266, and 300 mg) were significantly lower than in the bupivacaine HCl group (p = 0.002).
- result the conventional anesthetic/placebo group reported more pain in bowel movement than LB groups (OR 2.60, 95% CI 1.31-5.16).
Tech Coloproctol · PMID 38294561 · Read it on PubMed ↗
Nada et al. 2024
Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial
Harmonic scalpel surgery had fewer recurrences.Randomised trialModerate qualityRelated question
70 people1 year
HSH took longer initially but had less bleeding, fewer recurrences, and higher satisfaction after 2 weeks, while SH caused less pain in the first 2 weeks but more lingering mild pain, bleeding, and recurrence
Who was studied
adults with third- and fourth-degree hemorrhoids (piles) undergoing surgery
What they received
harmonic scalpel hemorrhoidectomy (HSH)
Compared with
stapled hemorrhoidopexy (SH)
Main outcome
postoperative pain, patient satisfaction, wound infection, bleeding, incontinence and recurrence within 1 year
Quality
It was a randomized trial but was single-center, single-blind, and relatively small, which limits confidence in the results.
Limitations
Single-center, single-blind design with modest sample size and some subjective outcome reporting (e.g., reclassification of incontinence cases).
Taken word for word from the abstract
- population included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles
- intervention harmonic scalpel hemorrhoidectomy (HSH)
- comparator stapled hemorrhoidopexy (SH)
- primaryOutcome postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year
- result Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction.
- result There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).
- n The patients were divided into two groups of 35 patients each.
Chirurgie (Heidelb) · PMID 38157069 · Read it on PubMed ↗
Yang et al. 2023
[Application of a new-type of defecator in the treatment of rectal fecal impaction]
Procedure often caused anal pain.Case seriesLow qualityRelated question
42 people2023
all patients were successfully treated, but nearly half had moderate to severe anal pain and one had anal fissure bleeding
Who was studied
adults aged 18 to 80 with rectal fecal impaction confirmed by CT scan
What they received
a new manual defecator device used to break up and remove impacted stool
Compared with
none; single-group treatment with no control group
Main outcome
how well the device cleared the impaction and how much pain and complications occurred during use
Quality
It's a small retrospective case series with no comparison group, so it can't show whether the device is better or worse than other methods.
Limitations
Retrospective, single-center, no control group, and focused on a specific procedure for fecal impaction rather than everyday pain after a normal bowel movement.
Taken word for word from the abstract
- n clinical data from 42 patients with rectal fecal impaction who underwent treatment with the new defecator at Deyang People's Hospital between July 2020 and April 2023 were retrospectively analyzed.
- population constipated individuals among the ages of 18 and 80 years who met the diagnostic criteria for rectal fecal impaction and were identified with acute rectal fecal impaction through CT scans
- intervention this new defecator was administered to constipated individuals
- comparator In a descriptive case series
- primaryOutcome The study assessed the operation time, single treatment success rate, pain levels during treatment, and the occurrence of complications.
- result All 42 patients successfully underwent treatment with the new defecator device, achieving a single treatment success rate of 100%.
- result During treatment, 20 cases (47.6%) reported moderate to severe anal pain, with 1 case (2.4%) experiencing anal fissure bleeding, and 6 cases (14.3%) reporting discomfort such as palpitations and sweating.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 38110281 · Read it on PubMed ↗
He et al. 2023
The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study
Less pain after first bowel movementRetrospectiveLow qualityRelated question
222 peoplefive-year
Recurrence rates were similar between groups, but C-PSH patients had less pain and fewer complications after surgery
Who was studied
Patients with grade IV hemorrhoids undergoing surgery
What they received
C-shaped partial stapled hemorrhoidopexy (C-PSH)
Compared with
Circular stapled hemorrhoidopexy (CSH)
Main outcome
Five-year hemorrhoid recurrence rate
Quality
This was a retrospective, single-center study without randomization, which limits how confident we can be in its results.
Limitations
Retrospective design, single center, not randomized
Taken word for word from the abstract
- n 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed
- population patients with grade IV hemorrhoids
- intervention accessible C-shaped partial stapled hemorrhoidopexy (C-PSH)
- comparator circular stapled hemorrhoidopexy (CSH)
- primaryOutcome The primary outcome was the five-year recurrence rate of hemorrhoids.
- result Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05).
- result fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05)
- result Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03).
BMC Gastroenterol · PMID 38104065 · Read it on PubMed ↗
Zhou et al. 2023
Traditional Chinese Medicine in the treatment of hemorrhoids-a review of preparations used and their mechanism of action
Review of TCM mechanisms, no outcome data.Narrative reviewVery low qualityRelated question
size not given2023
the abstract does not report a quantified outcome; it states TCM has an advantage in reducing pain and symptoms based on reviewed mechanisms
Who was studied
people with hemorrhoids
What they received
Traditional Chinese Medicine preparations
Compared with
not reported (review discusses surgery and TCM mechanisms generally)
Main outcome
reducing hemorrhoid symptoms like pain, bleeding, and improving quality of life
Quality
This is a narrative review summarizing mechanisms rather than testing treatment effectiveness with data.
Limitations
No original data, no comparator outcomes, no quantified results, and it covers general hemorrhoid treatment rather than specifically post-defecation anal pain.
Taken word for word from the abstract
- population Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain
- intervention Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients
- comparator Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively
- primaryOutcome reducing pain, and improving the quality of life
- result this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids, hoping to provide a basis for the better application of TCM in clinical and experimental research
Front Pharmacol · PMID 37927595 · Read it on PubMed ↗
Oberi et al. 2023
Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia
Hemorrhoid symptoms very common, tied to lifestyle.RetrospectiveLow qualityRelated question
361 people2023
59% reported at least one hemorrhoid symptom, and lack of exercise, prolonged sitting, high-fat diet, family history and constipation were linked to more symptoms
Who was studied
adults in the Jazan region of Saudi Arabia
What they received
no treatment tested; survey of hemorrhoid symptoms and risk factors
Compared with
no comparison group, cross-sectional survey of the general population
Main outcome
how common hemorrhoid symptoms were and what risk factors were linked to them
Quality
This was a self-reported survey without physician confirmation in most cases, so recall and reporting bias are likely.
Limitations
Self-administered questionnaire, only 34% had an actual physician diagnosis, cross-sectional design cannot show cause and effect.
Taken word for word from the abstract
- n which recruited 361 participants
- population adult subjects in Jazan, Saudi Arabia
- intervention This study aims to investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia.
- comparator This investigation was a cross-sectional study targeting adults diagnosed with hemorrhoids in the Jazan region.
- primaryOutcome investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia
- result 59% (216 individuals) reported experiencing at least one symptom of hemorrhoids
- result The most common risk factors identified were lack of regular physical activity (83%), prolonged sitting during office work (51%), and consuming food with saturated fat (50%)
Cureus · PMID 37885500 · Read it on PubMed ↗
Tsunoda et al. 2023
Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
Low pain, good hemorrhoid treatment success.RetrospectiveLow qualityRelated question
size not givenone, three, and five years
low pain scores, few complications, high success rates and high satisfaction after treatment
Who was studied
patients with grade III hemorrhoids
What they received
ALTA sclerotherapy combined with rectal mucopexy (AM surgery)
Compared with
none reported (no comparison group)
Main outcome
postoperative pain scores, complication rates, success rates, and patient satisfaction
Quality
this is a retrospective single-center study without a comparison group, so it can't prove the treatment caused the improvement.
Limitations
retrospective analysis of prospectively collected data, single institution, no control group mentioned
Taken word for word from the abstract
- population Patients with grade III hemorrhoids who underwent AM surgery
- intervention ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse
- comparator This study investigated the midterm outcomes of AM surgery in patients with hemorrhoids.
- primaryOutcome Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed.
- result The median postoperative pain score (0 = no pain at all, 10 = worst pain imaginable) at rest or during defecation were ≤2.
- result Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively.
- result Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year.
- followUp Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively.
Tech Coloproctol · PMID 37848640 · Read it on PubMed ↗
Perivoliotis et al. 2023
Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of randomized controlled trials
No clearly best pain cream found.Meta-analysisLow qualityRelated question
2,132 people14 days
different creams ranked best at different time points, with no single agent clearly best overall
Who was studied
patients who had surgery to remove hemorrhoids
What they received
topical ointments or creams applied after hemorrhoid surgery (such as EMLA, aloe vera, metronidazole, lidocaine)
Compared with
different topical agents compared against each other
Main outcome
pain after hemorrhoid surgery, including pain during bowel movements
Quality
it combines many small trials of different creams after surgery, and the authors themselves say the results are inconclusive and limited.
Limitations
abstract states results were inconclusive and there were several study limitations
Taken word for word from the abstract
- n 26 RCTs and 2132 patients were included
- population patients submitted to excisional procedures for hemorrhoids
- intervention locally applied medications
- comparator the various topical medications
- primaryOutcome Regarding postoperative pain
- result Metronidazole ointments had the highest scores at 7 and 14 days postoperatively. Aloe vera had the best analgesic profile (24-h SUCRA 84.8% and 48-h SUCRA 80.6%) during defecation.
- limitations Due to the inconclusive results and several study limitations, further RCTs are required.
Langenbecks Arch Surg · PMID 37837466 · Read it on PubMed ↗
Yu et al. 2024
The beneficial effect of Sanhuang ointment and its active constituents on experimental hemorrhoids in rats
Herbal ointment reduced hemorrhoid inflammation in rats.Animal studyVery low qualityRelated question
size not given11 days
Sanhuang ointment reduced inflammation, swelling, and abnormal levels of pain and blood vessel growth markers in rat anal tissue
Who was studied
rats with chemically induced hemorrhoids
What they received
Sanhuang ointment applied to the anal area
Compared with
other hemorrhoid creams (Mayinglong musk ointment and Taining cream) and untreated controls
Main outcome
inflammation, pain-related markers, and tissue swelling in the anal area
Quality
This is an animal study using rats with induced hemorrhoids, so it may not reflect what happens in humans with pain after bowel movements.
Limitations
Animal study only, not in humans; does not address general post-defecation anal pain unrelated to hemorrhoids.
Taken word for word from the abstract
- population Hemorrhoids were induced by 6% balsam and glacial acetic acid respectively in the anorectal region of rats.
- intervention SHO was administered externally to the anorectal region of rats at doses of 185 mg/g (crude drug/ointment), 370 mg/g (crude drug/ointment) and 740 mg/g (crude drug/ointment) for 11 days.
- comparator Mayinglong musk hemorrhoids ointment (1 g/kg) and Taining cream (1 g/kg) were used as reference anti hemorrhoids drugs.
- primaryOutcome hemorrhoids were evaluated by measuring the biochemical parameters of hemorrhoids in rats and the histology of anorectal tissues
- result SHO can effectively improve hemorrhoids by inhibiting the production of inflammatory cytokines in serum, reversing the down-regulation of vanillin subtype 1 (TRPV1), calcitonin gene related peptide (CGRP) and substance P (SP) levels of pain related genes in anal tissues, and the up regulation of Vascular endothelial growth factor (VEGF) levels of vascular growth related genes.
J Ethnopharmacol · PMID 37741471 · Read it on PubMed ↗
Onder et al. 2023
A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease
Less pain, quicker recovery with artery ligation.RetrospectiveLow qualityRelated question
91 people2023
ADHL had shorter operative time, shorter hospital stay, quicker resolution of bleeding, and seemed to cause less post-defecation pain than LH, with similar recurrence rates
Who was studied
patients with hemorrhoidal disease treated surgically at a surgery clinic
What they received
Doppler-guided ligation of the hemorrhoidal arteries (ADHL)
Compared with
Ligasure hemorrhoidectomy (LH)
Main outcome
operation time, bleeding, hospital stay, and postoperative pain
Quality
It is a retrospective, non-randomized comparison of two surgical techniques in a small group of patients, so the findings are not strong evidence.
Limitations
Retrospective design without randomization; authors state prospective randomized controlled studies are needed.
Taken word for word from the abstract
- n The number of patients included in the study was 91.
- population Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study.
- intervention the vascular plexus is provided by Doppler-guided ligation of the hemorrhoidal arteries (ADHL)
- comparator Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure, which is basically an electrosurgical device, is one of the treatment methods Ligasure hemorrhoidectomy (LH).
- primaryOutcome operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results were evaluated from the patient files.
- result Although the ADHL technique seems to be superior to LH in terms of post-defecation pain and shorter hospital stay
Asian J Surg · PMID 37659951 · Read it on PubMed ↗
Long et al. 2023
Milligan-Morgan hemorrhoidectomy combined with non-doppler hemorrhoidal artery ligation for the treatment of grade III/IV hemorrhoids: a single centre retrospective study
Combined hemorrhoid surgery caused less pain.RetrospectiveLow qualityRelated question
115 people12 months
the combined surgery group had lower pain scores, less bleeding, less blood loss, less swelling, and less urinary retention than the standard surgery alone group
Who was studied
adults with grade III or IV hemorrhoids needing surgery
What they received
combined surgery: Milligan-Morgan hemorrhoidectomy plus non-Doppler hemorrhoidal artery ligation
Compared with
Milligan-Morgan hemorrhoidectomy alone
Main outcome
pain after surgery (measured by pain scale) and other surgical complications
Quality
this was a retrospective, single-center study comparing two surgery types without randomization, so it cannot reliably rule out bias.
Limitations
retrospective design, single center, not randomized, and focuses on comparing two surgical techniques for hemorrhoids rather than explaining the general cause of pain after bowel movements.
Taken word for word from the abstract
- n We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids, 53 patients had received MMH + ND-HAL, and the remaining 62 patients received MMH.
- population We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids
- intervention 53 patients had received MMH + ND-HAL
- comparator the remaining 62 patients received MMH
- primaryOutcome postoperative visual analog scale (VAS) for pain, analgesic consumption, postoperative bleeding, perianal incision edema, urinary retention, anal stenosis, anal incontinence incidence, recurrence rate (prolapse or bleeding), and patient satisfaction
- result The VAS pain score of the first postoperative defecation and at the postoperative 12 h, 1 day, 2 days, 3 days, and 7 days, as well as the total analgesic consumption within 7 days, for the MMH + ND-HAL group were lower than those for the MMH group (P < 0.05).
BMC Gastroenterol · PMID 37653473 · Read it on PubMed ↗
Yuan et al. 2023
Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: a network meta-analysis
Pain after hemorrhoid surgery varies by technique.Meta-analysisModerate qualityRelated question
3,573 people2023
different procedures were best for different outcomes; Ferguson had the least pain after 24 hours while PPH had the most pain after 24 hours
Who was studied
patients with hemorrhoids undergoing surgery
What they received
different surgical procedures for hemorrhoids (e.g., Ligasure, Milligan-Morgan, Ferguson, Harmonic, PPH, TST, STARR)
Compared with
the other surgical procedures compared against each other
Main outcome
operative time, blood loss, hospital stay, time to first bowel movement, recurrence, anal narrowing, and pain after surgery
Quality
It pools many randomized trials, but the abstract gives no detail on bias risk or consistency of evidence, so confidence is limited.
Limitations
The abstract does not describe study quality, heterogeneity, or long-term follow-up, and findings apply only to surgical hemorrhoid patients, not general post-defecation pain.
Taken word for word from the abstract
- n involved 3573 patients and 10 interventions
- population patients with hemorrhoids treated by different surgical procedures
- intervention L (Ligasure), M-M (Milligan-Morgan), F (Ferguson), H (Harmonic), OH (open Harmonic), CH (closed Harmonic), PPH (procedure for prolapse and hemorrhoids), TST (tissue selecting technique), T-S (TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection)
- comparator Network meta-analysis results showed that L has the shortest mean operating time and STARR has the longest mean operating time
- primaryOutcome evaluate the efficacy and safety of different surgical approaches in patients with hemorrhoids
- result F had the least postoperative pain after 24 h and PPH had the most postoperative pain after 24 h
Tech Coloproctol · PMID 37634164 · Read it on PubMed ↗
Liu et al. 2024
Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial
Antibiotics didn't reduce post-surgery pain.Randomised trialModerate qualityRelated question
150 people1 year
pain scores were no different between the antibiotic and no-antibiotic groups at any time point measured
Who was studied
adults with grade III to IV hemorrhoids having surgery to remove them
What they received
antibiotics given through a vein before and/or after hemorrhoid surgery
Compared with
no antibiotics
Main outcome
pain scores after surgery, plus wound swelling, bleeding, urinary retention and infection markers
Quality
it was a randomized trial but only in people having hemorrhoid surgery, so it does not tell us about ordinary pain after pooping without surgery.
Limitations
study only covers patients undergoing a specific surgical procedure for severe hemorrhoids, not general post-defecation pain; single tertiary-hospital setting
Taken word for word from the abstract
- population A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids
- intervention group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation
- comparator Group A did not receive any prophylactic antibiotic
- primaryOutcome There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05)
- result there was no significant difference in the outcome comparison between all 3 groups' basal and the 3rd day postoperatively no matter in WBC, NUET% or CRP (p> 0.05)
- n A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH)
Asian J Surg · PMID 37451888 · Read it on PubMed ↗
Liu et al. 2023
Efficacy and safety of Lingnan surgery for the treatment of multi-quadrant acute incarcerated hemorrhoids: A retrospective study
Pain and symptoms improved after surgery.RetrospectiveLow qualityRelated question
44 people6-month follow-up
pain scores dropped from 6.8 before surgery to 1.4 by day 5 after, with no major complications or recurrence over 6 months
Who was studied
patients with severe, acutely painful hemorrhoids affecting multiple areas around the anus
What they received
Lingnan surgery (a surgical procedure for multi-quadrant hemorrhoid crisis)
Compared with
none (before-and-after comparison, no control group)
Main outcome
pain levels and complications after surgery
Quality
this was a small, retrospective study with no comparison group, so it can't prove the surgery itself caused the improvement.
Limitations
Retrospective design, no control/comparator group, single center, small sample size.
Taken word for word from the abstract
- n A total of 44 patients were studied.
- population patients with acute incarcerated hemorrhoids
- intervention a surgical procedure for multiple-quadrant hemorrhoid crisis, namely Lingnan surgery
- comparator We performed a retrospective analysis of patients with acute incarcerated hemorrhoids who underwent Lingnan surgery
- primaryOutcome The mean Visual Analog Scale pain score was 6.8 ± 0.8 preoperatively and 2.9 ± 1.2, 2.0 ± 0.7, and 1.4 ± 0.6 at 1, 3, and 5 days postoperatively, respectively.
- result no recurrence of hemorrhoids and anal dysfunction occurred during the 6-month follow-up after surgery
- followUp 6-month follow-up after surgery
Asian J Surg · PMID 37419805 · Read it on PubMed ↗
Higuero 2023
[Management of anal fissure]
Fiber and topical meds help; surgery most effective long-term.Narrative reviewLow quality
size not given6 to 8 weeks
Medical treatment can control symptoms but surgery remains most effective long-term; surgery is offered if medical treatment fails
Who was studied
people with anal fissure
What they received
medical treatment (fiber, laxatives, topical medications)
Compared with
surgery (sphincterotomy or fissurectomy/anoplasty)
Main outcome
healing and pain control of anal fissure
Quality
This is a narrative review/opinion article without original data, numbers of patients, or study methods described.
Limitations
No study design, patient numbers, or data presented; appears to be expert opinion/narrative summary.
Taken word for word from the abstract
- population MANAGEMENT OF ANAL FISSURE.
- intervention Healthy bowel movements combining a sufficient fiber intake and soft laxatives must be continued for at least 6 months.
- intervention Topicals, specific (in case of sphincter hypertonia) or not, must be maintained for 6 to 8 weeks.
- comparator Surgery is proposed (apart a no medically control of the pain or a fistula associated) in the event of failure of well-conducted medical treatment.
- result It remains the most effective long-term treatment.
- primaryOutcome Pain control is important.
- followUp maintained for 6 to 8 weeks
Rev Prat · PMID 37289116 · Read it on PubMed ↗
Purnama et al. 2023
Anal Repair and Diamond Flap in Patient with Moderate Anal Stenosis After Open Hemorrhoidectomy Surgery: A Case Report
Surgery fixed narrowing, no complications.Case seriesVery low qualityRelated question
1 people10 days
flap healed well with no complications 10 days after surgery
Who was studied
57-year-old woman with anal stenosis (narrowing) causing pain and difficulty pooping, 2 years after hemorrhoid surgery
What they received
surgical repair with diamond-shaped skin flap graft
Compared with
none
Main outcome
healing and complications after surgery
Quality
this is a single patient case report, so it cannot show whether this treatment works in general.
Limitations
only one patient, very short follow-up, no comparison group, and the stenosis was caused by a prior hemorrhoidectomy rather than ordinary post-bowel-movement anal pain.
Taken word for word from the abstract
- n A 57-year-old female patient
- population reported difficulty and discomfort in defecation caused by anal stenosis 2 years after a hemorrhoidectomy surgery
- intervention underwent an anal repair and diamond flap procedure in which the scar tissue at 6 and 9 o'clock was excised and a diamond graft was incised carefully
- comparator The patient underwent an anal repair and diamond flap procedure
- primaryOutcome the diamond flap was in good condition and without any complications
- result Ten days after surgery, the diamond flap was in good condition and without any complications.
- followUp Ten days after surgery
Am J Case Rep · PMID 37208893 · Read it on PubMed ↗
Gkegkes et al. 2023
Anal Cryptitis: A misdiagnosed condition
Misdiagnosed anal crypt infection, cause unclear.Case seriesVery low quality
1 people2023
the abstract reports the procedure was performed but does not state the outcome or whether symptoms improved
Who was studied
a 42-year-old woman with anal pain and itching for a year
What they received
surgical opening of the inflamed anal crypt (cryptotomy)
Compared with
previous conservative treatment for anal fissure
Main outcome
anal pain and pruritus after defecation
Quality
this is a single patient case report, so it cannot show whether treatment works in general.
Limitations
only one patient; no outcome data given after treatment; diagnosis delayed for a year with prior misdiagnosis
Taken word for word from the abstract
- n A 42-year-old woman presented to our practice
- population A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year.
- intervention a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open
- comparator she was treated conservatively for anal fissure without any evident improvement
- primaryOutcome The referred symptoms were increased often after defecation.
- result Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open.
Clin Ter · PMID 37199352 · Read it on PubMed ↗
B J et al. 2023
A Pilot, Prospective, Randomized-Controlled Study to Evaluate the Efficacy and Safety of Arsha Hita™ in the Treatment of Anal Fissures
Herbal treatment eased fissure pain and bleeding better.Randomised trialLow quality
53 peoplesix weeks
More patients on Arsha Hita had a 90% reduction in symptom scores, with better pain relief, less bleeding, and better overall impression than standard treatment
Who was studied
People with anal fissures
What they received
Arsha Hita tablets and ointment (herbal treatment)
Compared with
Standard treatment: lidocaine-nifedipine cream plus oral fiber (Isabgol)
Main outcome
Reduction in combined symptom score (pain, bleeding, healing) after six weeks
Quality
This was a small pilot study with only 53 participants, so results need confirming in larger trials.
Limitations
Pilot study with small sample size; authors say larger randomized trials are needed to confirm findings.
Taken word for word from the abstract
- n The study included 53 participants with anal fissures
- population Participants were screened for anal fissures and randomized
- intervention a combination of Arsha Hita™ tablets and ointment
- comparator a combination of lidocaine 1.5% w/w + nifedipine 0.3% w/w cream for local application and Isabgol powder (6 g) orally as an active comparator
- primaryOutcome compare the number/proportion of participants achieving primary and secondary endpoints
- result 11 participants in Group B achieved a 90% reduction in composite scores compared to only three patients in Group A (p<0.05)
- result Group B had significantly better results in terms of VAS score, resolution of per-anal bleeding, and physician's global impression score (p<0.05)
- limitations These findings suggest the need for further research through larger, randomized controlled trials
Cureus · PMID 37193430 · Read it on PubMed ↗
Sissoko et al. 2023
Associations between functional constipation and non-IgE-mediated food allergy in infants and children
Food allergy linked to painful defecationRetrospectiveVery low qualityRelated question
305 people2023
15% of children with functional constipation had food allergy, mostly non-IgE-mediated, with symptoms including anal fissure, abdominal pain, and pain during defecation
Who was studied
infants and children with constipation
What they received
testing for food allergy (IgG, IgE, skin prick test, food avoidance and reintroduction)
Compared with
children with constipation without food allergy
Main outcome
presence of food allergy and related symptoms such as anal fissure and pain during defecation
Quality
This is a small, uncontrolled study of a selected subgroup, so it can't reliably show cause and effect.
Limitations
Only a subset of constipated children with 'allergy-related indicators' were tested for food allergy, and there is no control group without constipation.
Taken word for word from the abstract
- n A total of 305 infants and children with constipation treated in the Department of Pediatric Gastroenterology, Children's Hospital of Nanjing Medical University, from July 2020 to December 2021 were included in this study.
- population infants and children with constipation
- intervention evaluated for food allergy by food-specific IgG antibody test, allergen- specific IgE antibody detection, skin prick test, and food avoidance and reintroduction
- comparator 81 cases with allergy-related indicators were further evaluated for food allergy
- primaryOutcome The main clinical symptoms or signs included anal fissure, abdominal pain, and pain during defecation.
- result A total of 45 cases with FC were diagnosed with food allergy, and the incidence rate was 15%. Among the 45 patients, 35 cases (77.8%) had FC with non-IgE-FA.
Allergol Immunopathol (Madr) · PMID 37169574 · Read it on PubMed ↗
Kumar et al. 2023
A Prospective Study Comparing Stapler and Open Surgical Technique of Hemorrhoidectomy
Less pain after stapler surgery.Randomised trialLow qualityRelated question
60 peoplethree months
stapled hemorrhoidectomy had less postoperative pain, shorter operating time and hospital stay, and no recurrence at three months compared to open surgery
Who was studied
patients with grade III and IV hemorrhoids undergoing surgery
What they received
stapled hemorrhoidectomy
Compared with
open hemorrhoidectomy
Main outcome
postoperative pain, operating time, hospital stay, complications, and recurrence
Quality
Small study of only 60 patients with short follow-up, so the results may not be reliable for larger populations.
Limitations
Small sample size of 60 patients; this is about surgical treatment for hemorrhoids, not general post-defecation anal pain.
Taken word for word from the abstract
- n The present prospective study was conducted among 60 patients
- population presenting with grade III and IV degree hemorrhoids
- intervention stapled hemorrhoidectomy
- comparator open hemorrhoidectomy
- primaryOutcome assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence
- result postoperative pain (visual analogue scale) was less in the stapler hemorrhoidectomy group with 36.7% of patients presenting with pain at one week, 23.3% at one month and 3.3% at three months in the open hemorrhoidectomy group whereas 13.3% presenting as pain in one week, 10% presenting at one month and none presenting at three months in the stapler hemorrhoidectomy group
- followUp three months
Cureus · PMID 37077600 · Read it on PubMed ↗
Tomasicchio et al. 2023
Safety and efficacy of Levorag emulgel in the treatment of anal fissures using a validated scoring system
Gel reduced fissure pain and healed most casesProspective cohortLow quality
40 people30 days
Pain and other symptom scores dropped significantly over 30 days, with most fissures healed by day 30
Who was studied
adults with anal fissures (both new and long-lasting)
What they received
Levorag emulgel applied topically
Compared with
before vs after treatment (no control group)
Main outcome
pain, bleeding, and quality of life measured by the REALISE score
Quality
This was a small study with no comparison group, so it can't rule out that symptoms would have improved anyway.
Limitations
Observational study without a control group, single arm, relatively small sample size
Taken word for word from the abstract
- n Forty patients (median age 46 years, IQR 29-57, 70% women) with acute (22, 55%) or chronic (18, 45%) anal fissures entered the study.
- population patients with anal fissures between February and May 2022
- intervention Levorag® Emulgel
- comparator recorded after 10, 20 and 30 days from the beginning of treatment
- primaryOutcome rates VAS for pain, NSAID use, pain duration, bleeding, and quality of life (QoL)
- result The median anal pain score according to the VAS scale decreased significantly from 7 (IQR 4.7-8) at baseline to 1 (IQR 0-3.2, p = 0.05) after 20 days.
- result At day 30, complete fissure healing was achieved in 30 patients (80%).
Front Surg · PMID 37035554 · Read it on PubMed ↗
Albazee et al. 2023
Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials
No difference between two surgery tools.Meta-analysisLow qualityRelated question
size not given2023
no significant difference between the two surgical methods in complications including pain, bleeding, urinary retention, anal stenosis, and wound healing
Who was studied
people having surgery to remove hemorrhoids (third and fourth degree prolapse)
What they received
hemorrhoid removal surgery using a harmonic scalpel device
Compared with
hemorrhoid removal surgery using bipolar diathermy device
Main outcome
complications during and after surgery, including pain, bleeding, and recovery time
Quality
This pools nine trials but does not report total patient numbers and calls for larger trials to confirm the findings.
Limitations
Abstract does not report sample size; authors state additional RCTs with larger sample sizes are needed to consolidate the power and quality of the evidence.
Taken word for word from the abstract
- population patients undergoing hemorrhoidectomy
- intervention harmonic scalpel (HS)
- comparator bipolar diathermy (BD) methods
- primaryOutcome efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy
- result there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints
- limitations Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.
Cureus · PMID 36755770 · Read it on PubMed ↗
Falsarella et al. 2023
Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial
Embolization caused much less pain than surgery.Randomised trialLow quality
33 people12 months
pain after the first bowel movement was much lower with embolization (score 0) than with surgery (score ~6), and far fewer pain pills were needed
Who was studied
adults with hemorrhoids (grade 2 or 3) needing treatment
What they received
artery embolization procedure to shrink the hemorrhoids
Compared with
surgical hemorrhoid removal (Ferguson technique)
Main outcome
pain level after bowel movements and need for pain medication in the week after treatment
Quality
this was a very small randomized trial (fewer than 30 people analyzed), so the results could easily be due to chance or not apply broadly.
Limitations
Small sample size with four patients excluded from analysis; outcomes measured mainly by patient-reported pain scales.
Taken word for word from the abstract
- population 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3
- intervention superior rectal artery embolization group
- comparator Ferguson closed hemorrhoidectomy surgical group
- primaryOutcome Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period.
- result The mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001).
- n 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups
J Vasc Interv Radiol · PMID 36736690 · Read it on PubMed ↗
Yaghoobi Notash et al. 2022
Effectiveness of Local Botulinum Toxin Injection for Perianal Pain after Hemorrhoidectomy
Found a benefitRandomised trialLow qualityRelated question
40 peopleseven days
botulinum toxin injection reduced pain scores on days 1, 3, 5, and 7 after surgery and reduced pain during defecation, compared to no treatment
Who was studied
patients who had surgery to remove hemorrhoids
What they received
botulinum toxin injection near the anal muscle after hemorrhoid surgery
Compared with
no injection after hemorrhoid surgery
Main outcome
pain levels after surgery, including pain during bowel movements
Quality
this was a small trial of only 40 people studying pain after hemorrhoid surgery, not everyday post-poop pain without surgery.
Limitations
small sample size; authors state further studies are needed to prove clinical value
Taken word for word from the abstract
- n A total of 40 patients undergoing hemorrhoidectomy
- population patients undergoing hemorrhoidectomy who were referred to Shariati Hospital
- intervention injection of botulinum toxin was done in intersphincteric area
- comparator there was no intervention after hemorrhoidectomy
- primaryOutcome Local botulinum toxin injection (MASPORT® 500) significantly reduced post-operative perianal pain
- result significantly reduced post-operative perianal pain on the first, third, fifth, and seventh days after the operation compared with the second group (P<0.05)
- result pain during defecation was significantly lower for the experimental group (P<0.05)
Middle East J Dig Dis · PMID 36619264 · Read it on PubMed ↗
Yang et al. 2023
Comparing the efficacy and safety of different analgesic strategies after open hemorrhoidectomy: a systematic review and network meta-analysis
Certain ointments ease pain after hemorrhoid surgeryMeta-analysisModerate qualityRelated question
731 people7 d
Diltiazem was the most effective at reducing pain in the week after surgery, with botulinum toxin and sucralfate also helpful, GTN helpful at 24 hours, and electroacupuncture reducing pain specifically during the first bowel movement after surgery
Who was studied
patients with pain after open hemorrhoidectomy (hemorrhoid removal surgery)
What they received
different pain-relief treatments applied after hemorrhoid surgery
Compared with
placebo
Main outcome
pain scored on a Visual Analogue Scale at various times after surgery
Quality
it combines 13 randomized trials but the abstract notes safety data were limited and calls for more high-quality trials.
Limitations
The abstract states there is limited evidence on the safety of the interventions, and this concerns pain after surgical hemorrhoid removal, not pain after an ordinary bowel movement.
Taken word for word from the abstract
- n 731 patients were included in the network meta-analysis
- population pain after open hemorrhoidectomy
- intervention glyceryl trinitrate (GTN)
- intervention diltiazem
- intervention botulinum toxin
- intervention sucralfate
- intervention electroacupuncture
- comparator Most interventions are more effective than placebo in relieving postoperative pain.
- primaryOutcome 24 h postoperative Visual Analogue Scale (VAS)
- result Diltiazem ointment may be the most effective medication for pain relief following open hemorrhoidectomy, and it can dramatically reduce pain within one week of surgery.
- followUp 7 d postoperative VAS
Int J Colorectal Dis · PMID 36609578 · Read it on PubMed ↗
Shahid et al. 2022
Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial
Faster healing and less pain with added metronidazoleRandomised trialLow quality
137 people3 weeks
More patients healed faster and had less pain with metronidazole plus GTN than with GTN alone
Who was studied
Adults aged 18-70 with acute anal fissures causing pain after bowel movements
What they received
Topical metronidazole combined with glyceryl trinitrate (GTN) cream
Compared with
Topical glyceryl trinitrate (GTN) cream alone
Main outcome
Healing of the anal fissure, confirmed by finding a scar
Quality
It was a single-blinded trial at one hospital with some patients lost to follow-up, so results may not be fully reliable.
Limitations
Single-blinded design, conducted at a single hospital, three patients lost to follow-up
Taken word for word from the abstract
- n Out of the remaining 137, 70 (51.1%) patients were male.
- population Patients of both genders, aged 18 to 70 years, with acute anal fissures, were included.
- intervention Group A contained patients who got metronidazole combination with GTN
- comparator in Group B, patients treated with GTN alone without metronidazole
- primaryOutcome The primary endpoint was fissure healing, confirmed as finding a scar where the fissure was.
- result On week 3 follow-up, in group A out of 69 patients, 47 (68.1%) had complete healing, and 22 (31.8%) had partial healing, while in group B out of 68 patients, 16 (23.5%) had complete healing, 49 (72%) had partial healing (p = < 0.001, significant).
- result Mean VAS score of group A was 0.61 ± 1.38 while that of group B was 2.57 ± 2.50 (p = < 0.001, significant).
Cureus · PMID 36440295 · Read it on PubMed ↗
Al-Ubaide et al. 2022
Lateral Internal Anal Sphincterotomy of Chronic Anal Fissure: An Experience of 165 Cases
Surgery resolved fissure pain in most.RetrospectiveLow qualityRelated question
165 peopletwo months postoperatively
163 of 165 patients had complete healing with pain resolved by two months after surgery; 5 developed flatus incontinence
Who was studied
people with chronic anal fissure (longstanding tear near the anus)
What they received
surgery cutting part of the anal sphincter muscle (lateral internal anal sphincterotomy)
Compared with
none (no comparison group, before/after outcomes only)
Main outcome
complete healing and resolution of pain after surgery
Quality
This is a retrospective case series without a comparison group, so it cannot prove the surgery caused the improvement.
Limitations
Retrospective design, no control group, and the abstract does not describe how pain or healing were measured.
Taken word for word from the abstract
- n Of 165 participants, there were 91 men.
- population patients with CAF who were subjected to LIAS under local anesthesia
- intervention lateral internal anal sphincterotomy (LIAS)
- comparator This retrospective study was conducted at the Al-Muqdadiya General Hospital
- primaryOutcome There was complete healing with a resolution of the pain at two months postoperatively in 163 subjects.
- result There was complete healing with a resolution of the pain at two months postoperatively in 163 subjects. The most common complication in our study was flatus incontinence (n = 5).
Cureus · PMID 36415415 · Read it on PubMed ↗
Alnasser et al. 2022
The Efficacy of Sitz Baths as Compared to Lateral Internal Sphincterotomy in Patients with Anal Fissures: A Systematic Review
Sitz baths ease pain, heal most fissuresSystematic reviewLow quality
11 people2022
Sitz baths eased pain and healed about 80% of fissures with no reported side effects, but surgery healed fissures better, though surgery risked incontinence
Who was studied
people with anal fissures (pain with pooping, sometimes with blood)
What they received
sitz baths (warm water soaks)
Compared with
lateral internal sphincterotomy (surgery cutting the anal sphincter muscle)
Main outcome
pain relief, healing rate, and side effects
Quality
It is a systematic review of mixed, mostly older studies without pooled statistics, so the comparison is not very precise.
Limitations
Conflicting evidence on pain relief between studies; review did not statistically combine results; quality of included studies not detailed beyond a basic check.
Taken word for word from the abstract
- population An anal fissure is a common condition that affects patients of all ages. Its clinical presentation is a sharp pain on defecation with or without blood.
- intervention the efficacy of a sitz bath
- comparator as compared to lateral internal sphincterotomy
- primaryOutcome Four aspects of sitz bath outcomes were evaluated in the articles.
- result In terms of healing, most articles had similar recovery rates of around 80%.
- result When compared to lateral internal sphincterotomy, the recovery rates of lateral internal sphincterotomy are superior to those of conservative treatment, including sitz baths.
- result studies showed incontinence as a side effect of lateral internal sphincterotomy, and no studies reported side effects from the sitz baths
- n A quality assessment check was done on the articles leaving 11 articles.
Cureus · PMID 36337820 · Read it on PubMed ↗
Lie et al. 2023
Utility of botulinum toxin injection for post-operative pain management after conventional hemorrhoidectomy: a systematic review and meta-analysis of clinical trials
Less pain after hemorrhoid surgery, not plain pooping painMeta-analysisLow qualityRelated question
260 people2023
botulinum toxin reduced pain at 24 hours and shortened time to return to work, but did not change time to first bowel movement, incontinence or urinary retention
Who was studied
patients who had surgery to remove hemorrhoids
What they received
botulinum toxin injection into the anal sphincter muscle
Compared with
placebo injection
Main outcome
pain level 24 hours after surgery
Quality
Only five small trials with 260 patients total were pooled, so the results are not very reliable.
Limitations
Small number of trials and patients; authors say further randomized trials are needed to confirm results.
Taken word for word from the abstract
- n Five clinical trial studies with a total of 260 patients undergoing hemorrhoidectomy were included in the analysis
- population patients undergoing hemorrhoidectomy
- intervention botulinum toxin anal sphincter injection after conventional hemorrhoidectomy
- comparator BTX injection did not differ significantly from placebo
- primaryOutcome lower VAS at 24 h post-operative
- result BTX injection after hemorrhoidectomy was associated with lower VAS at 24 h post-operative [Mean Difference -1.35 (95% CI -1.90, -0.80), p < 0.00001, I2 = 0%] and shorter time to return work [Mean Difference -8.94 days (95% CI -12.57, -5.30), p < 0.00001, I2 = 0%]. However, BTX injection did not differ significantly from placebo in terms of time to first defecation (p = 0.22), fecal incontinence (p = 0.91) and urinary retention incidence (p = 0.18).
Scand J Gastroenterol · PMID 36048469 · Read it on PubMed ↗
Sameshima et al. 2022
Treatment Result of the Mucopexy-Recto Anal Lifting Method for Hemorrhoids in Comparison with Ligation and Excision, and Aluminum Potassium Sulfate and Tannic Acid Sclerotherapy
New hemorrhoid surgery, less pain, lower recurrence.RetrospectiveLow qualityRelated question
2,338 people3-year follow-up
MuRAL caused less pain than LE and had a lower recurrence rate than ALTA, but LE was the most curative overall
Who was studied
patients with hemorrhoids who had surgery
What they received
Mucopexy-Recto Anal Lifting (MuRAL) surgery
Compared with
ligation and excision (LE) surgery, and aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy
Main outcome
operative time, hospital stay, pain after surgery, complications, and recurrence of hemorrhoids
Quality
it is a retrospective comparison of surgical groups without randomization, so differences could be due to patient selection rather than treatment.
Limitations
retrospective design, no randomization mentioned, and focuses on surgical hemorrhoid treatment rather than general post-defecation anal pain
Taken word for word from the abstract
- n MuRAL (380 cases)
- n LE (1417 cases)
- n ALTA (541 cases)
- population hemorrhoid surgery
- intervention Mucopexy-Recto Anal Lifting (MuRAL)
- comparator ligation and excision (LE), and aluminum potassium sulfate and tannic acid sclerotherapy
- primaryOutcome Operative time, mean hospital stay, postoperative pain, postoperative complications, and recurrence were compared and examined retrospectively.
- result postoperative pain was clearly milder in MuRAL and ALTA than in LE
- result The recurrence rates were 3.2% with MuRAL, 1.1% with LE, and 12.4% with ALTA.
- followUp 3-year follow-up study
J Anus Rectum Colon · PMID 35979271 · Read it on PubMed ↗
Yano et al. 2022
Pain at the First Post-hemorrhoidectomy Defecation Is Associated with Stool Form
Softer stool, less pain after pooping.Prospective cohortLow qualityRelated question
179 people2022
softer stool was linked to less pain during the first bowel movement after surgery
Who was studied
people who had hemorrhoid surgery
What they received
softer stool consistency
Compared with
harder stool consistency
Main outcome
pain intensity during first bowel movement after surgery
Quality
This was an observational study in post-surgery patients, not people with ordinary post-bowel-movement pain, so it only weakly applies to the general question.
Limitations
Observational design without randomization; limited to patients who had hemorrhoid surgery, so may not generalize to people without surgery.
Taken word for word from the abstract
- population patients scheduled for hemorrhoidal surgery
- n A total of 179 patients were analyzed.
- intervention stool form consistency
- comparator hard stool
- primaryOutcome pain associated with the first defecation
- result the softer the stool, the less painful the defecation
J Anus Rectum Colon · PMID 35979270 · Read it on PubMed ↗
Kazachenko et al. 2022
Preemptive analgesia for hemorrhoidectomy: study protocol for a prospective, randomized, double-blind trial
No results yet; trial planned.Registered trial, no results postedLow qualityRelated question
144 people2022
this is a study protocol; no results are reported yet
Who was studied
patients with grade III-IV hemorrhoids undergoing surgical removal
What they received
ketoprofen painkiller pill given before surgery (preemptive analgesia)
Compared with
placebo starch pill before surgery
Main outcome
pain levels and opioid painkiller use after surgery
Quality
this is only a trial protocol describing planned methods, with no actual outcome data reported yet.
Limitations
no results are available; this describes planned methodology only, and concerns surgical hemorrhoidectomy pain rather than typical pain after a normal bowel movement
Taken word for word from the abstract
- n 72 participants per arm
- population hemorrhoids grade III-IV and the planned Milligan-Morgan hemorrhoidectomy
- intervention the first one gets a tablet with 100 mg ketoprofen
- comparator the second one gets a tablet containing starch per os 2 h before surgery
- primaryOutcome the pain at rest and during defecation, duration, and frequency of other analgesics intake
- result We hope to prove the efficacy of multimodal analgesia including preemptive one for patients undergoing excisional hemorrhoidectomy
Trials · PMID 35761383 · Read it on PubMed ↗
Lin et al. 2022
The necessity of preoperative enema preparation for hemorrhoidal surgery: a single-center comparative study
Enema before surgery increased painRetrospectiveLow qualityRelated question
270 people2022
The group that got an enema before surgery had higher pain scores on days 0, 1, and 2 after surgery, with no difference in other recovery measures or complications
Who was studied
patients having surgery for severe hemorrhoids
What they received
enema given before hemorrhoid surgery
Compared with
no enema before hemorrhoid surgery
Main outcome
pain after surgery and need for pain medicine
Quality
This was a retrospective comparison of medical records, not a randomized trial, so differences between groups could be due to other factors.
Limitations
Retrospective design using medical record and questionnaire data, not randomized, so groups may differ in unmeasured ways.
Taken word for word from the abstract
- n Data of 270 consecutive patients, with 130 and 140 in the PEP and non-PEP groups
- population Hemorrhoidal surgery is a common treatment for high-grade hemorrhoids.
- intervention preoperative enema preparation (PEP)
- comparator Patients were allocated to either the PEP or non-PEP group.
- primaryOutcome Primary outcome measurements were postoperative pain and oral analgesic use.
- result The mean pain score was significantly higher in PEP than in non-PEP group at day 0 (6.21 ± 3.23 vs 5.31 ± 3.14), day 1 (5.79 ± 2.89 vs 4.68 ± 3.02), and day 2 (5.35 ± 2.86 vs 4.42 ± 2.76). No significant differences in postoperative recovery or complications rate were noted between groups.
Langenbecks Arch Surg · PMID 35729398 · Read it on PubMed ↗
Medina-Gallardo et al. 2022
Infiltration of Bupivacaine and Triamcinolone in Surgical Wounds of Milligan-Morgan Hemorrhoidectomy for Postoperative Pain Control: A Double-Blind Randomized Controlled Trial
Less overall pain, no change during poopingRandomised trialModerate qualityRelated question
128 people48 hours
pain scores were lower with the injection (3 vs 6 points), but pain during pooping was not different between groups
Who was studied
patients who had surgery to remove grade III-IV hemorrhoids
What they received
injection of bupivacaine and triamcinolone into the surgical wound
Compared with
no injection (standard care)
Main outcome
worst pain level in the 48 hours after surgery
Quality
it was a randomized trial but had no placebo injection in the control group, which could bias how pain was reported.
Limitations
no placebo used in control group; 48-hour pain and complication data were pooled as medians rather than reported individually
Taken word for word from the abstract
- n A total of 128 patients were randomly assigned (64 in each group).
- population Patients who underwent an elective Milligan-Morgan hemorrhoidectomy for grade III-IV hemorrhoids were included.
- intervention Patients allocated in the intervention group received a single infiltration of bupivacaine and triamcinolone
- comparator patients allocated in the control group did not receive any intervention.
- primaryOutcome The primary end point was the median of maximum pain by visual analog scale during the 48 hours of hospital stay.
- result The median of maximum pain score at 48 hours was 3 points in the intervention group and 6 points in the control group, which was significantly different ( p < 0.05). No differences were observed regarding pain during defecation.
Dis Colon Rectum · PMID 35714359 · Read it on PubMed ↗
Jain et al. 2024
Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study
Less pain after laser hemorrhoid surgery.Prospective cohortLow qualityRelated question
30 people12 months
the laser procedure group had lower pain scores, especially pain with bowel movements, used less opioid pain medication, and returned to normal function and work faster than those who had traditional surgery
Who was studied
adults with symptomatic hemorrhoids who had not improved with non-surgical treatment
What they received
laser hemorrhoidoplasty (a laser-based procedure for hemorrhoids)
Compared with
traditional hemorrhoid removal surgery (Milligan-Morgan hemorrhoidectomy) in a historical group of past patients
Main outcome
pain after surgery, time to return to normal activity, and quality of life
Quality
this was a small pilot study comparing new patients to a historical (not simultaneous or randomized) group of only 43 people, which makes the comparison less reliable.
Limitations
Pilot study with a small sample, non-randomized design, and comparison to a historical rather than concurrent control group.
Taken word for word from the abstract
- population patients with symptomatic hemorrhoid disease that have failed conservative management
- intervention laser hemorrhoidoplasty (LH)
- comparator a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon
- primaryOutcome Postoperative pain, time to return to function, and quality of life (QoL) were determined
- result The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4.
- result The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001).
- n Thirty patients were prospectively enrolled to undergo LH.
Ann Coloproctol · PMID 35584917 · Read it on PubMed ↗
Chen et al. 2022
The Role of Acupuncture in Relieving Post-Hemorrhoidectomy Pain: A Systematic Review of Randomized Controlled Trials
Mixed evidence for acupuncture after hemorrhoid surgery.Systematic reviewLow qualityRelated question
275 people7 days after surgery
electro-acupuncture reduced pain compared to sham or local anesthetics at some time points, but manual acupuncture showed inconsistent results versus medications
Who was studied
patients who had hemorrhoidectomy surgery and experienced pain afterward
What they received
acupuncture (electro-acupuncture or manual acupuncture)
Compared with
sham acupuncture, local anesthetics, or active medications
Main outcome
pain level after hemorrhoidectomy, including pain during defecation
Quality
Only four small trials with variable quality and inconsistent results were combined without statistical pooling.
Limitations
Variability was found in the quality of included studies; evidence was not conclusive.
Taken word for word from the abstract
- n Four RCTs involving 275 patients were included in the analysis.
- population Post-hemorrhoidectomy pain (PHP) remains one of the complications of hemorrhoidectomy
- intervention the visual analog scale (VAS) score was significantly lower in the electro-acupuncture (EA) group compared to that in the sham acupuncture (SA) group
- comparator two studies evaluating manual acupuncture (MA) compared with active medications for PHP showed inconsistent results on effectiveness
- primaryOutcome The outcome measures on pain level after hemorrhoidectomy, dose of rescue analgesic drug used, quality of life, adverse events, etc., were extracted and analyzed
- result Although benefit of acupuncture on PHP, especially EA on defecation after surgery, was observed at some time points, evidence on effectiveness of acupuncture on PHP was not conclusive.
Front Surg · PMID 35419404 · Read it on PubMed ↗
Leventoglu et al. 2022
New Techniques in Hemorrhoidal Disease but the Same Old Problem: Anal Stenosis
Reviews surgery for anal narrowing, not routine painNarrative reviewVery low qualityRelated question
size not given2022
the abstract does not report quantitative outcomes; it states sphincterotomy does not give satisfactory results and flap surgery is used to rebuild anal width and flexibility
Who was studied
people with anal stenosis (narrowing of the anal canal), usually after hemorrhoid surgery
What they received
surgical reconstruction with skin flaps
Compared with
non-surgical treatment and lateral internal sphincterotomy
Main outcome
functional and surgical outcomes of anal stenosis treatment
Quality
this is a narrative summary of surgical techniques without original data, patient numbers, or comparative results.
Limitations
no original patient data, outcomes, or statistics are given; it is a general review of surgical methods, not a study of normal post-defecation pain
Taken word for word from the abstract
- population Anal stenosis, which develops as a result of aggressive excisional hemorrhoidectomy
- intervention Surgical treatment methods are based on the use of flaps of different shapes and sizes to reconstruct the anal caliber and flexibility.
- comparator Although non-surgical treatment is effective for mild anal stenosis, surgical reconstruction is unavoidable for moderate to severe anal stenosis
- primaryOutcome This article aims to summarize most-used surgical techniques for anal stenosis regarding functional and surgical outcomes.
- result the application of lateral internal sphincterotomy does not provide satisfactory results in the treatment of anal stenosis
Medicina (Kaunas) · PMID 35334538 · Read it on PubMed ↗
Lunsford et al. 2022
A Pain in the Butt: Hemorrhoids, Fissures, Fistulas, and Other Anorectal Syndromes
No specific finding reported.Narrative reviewVery low qualityRelated question
size not given2022
The abstract discusses diagnostic and management challenges without reporting a specific outcome result
Who was studied
people with painful anorectal conditions
Quality
This is a general narrative review discussing challenges in diagnosis and management, not a study testing a specific treatment or reporting outcome data.
Limitations
No specific population, intervention, or outcome data reported; general discussion of diagnostic/therapeutic challenges only.
Taken word for word from the abstract
- population Painful and bothersome anorectal syndromes can be a diagnostic and therapeutic challenge for clinicians
- result improving quality of life, treating coexistent conditions such as functional constipation and/or defecation disorders, addressing psychological comorbidities if present, and confirming there is no evidence of inflammatory or malignant conditions are top priorities
Gastroenterol Clin North Am · PMID 35135658 · Read it on PubMed ↗
Sofii et al. 2022
Combination of simple advancement flap and fistulectomy to treat complex anal fistula as a complication of hemorrhoidectomy: Case report
Surgery fixed fistula after hemorrhoid surgeryCase seriesVery low qualityRelated question
1 peoplefirst and second weeks
no complications and no symptoms returned at 1 and 2 week follow-up
Who was studied
50-year-old woman with severe anal narrowing and a fistula after hemorrhoid surgery
What they received
surgery combining fistula removal and skin advancement flap
Compared with
none
Main outcome
complications and return of symptoms after surgery
Quality
this is a single patient case report, which cannot show whether this treatment works in general
Limitations
only one patient, very short follow-up of two weeks, and this describes anal stenosis and fistula after hemorrhoid surgery rather than typical pain after bowel movements
Taken word for word from the abstract
- population A 50-year-old female patient with a history of hemorrhoidectomy 10 months prior to admission complained of difficulty defecating, pain, and incomplete evacuation sensation
- intervention The patient underwent fistulectomy and advancement flap with perianal skin
- comparator We performed a combination of simple cutaneous advancement flap and fistulectomy to manage the patient with severe anal stenosis following hemorrhoidectomy with concurrent anal fistula.
- primaryOutcome In the outpatient follow-up clinic in the first and second weeks, the patient showed no complications, and no recurrence of her complaints was found.
- result the patient showed no complications, and no recurrence of her complaints was found
- n A 50-year-old female patient
Ann Med Surg (Lond) · PMID 35028135 · Read it on PubMed ↗
D'Orazio et al. 2021
Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study
Adding Botox to fissure surgery eased pain fasterCase-controlLow qualityRelated question
30 peopleat least 2 years
pain after bowel movements decreased more, and wounds healed fully in all patients with the toxin injection versus only 80% without it
Who was studied
men with chronic anal fissure and a tight anal sphincter muscle
What they received
surgery (fissurectomy and tissue flap) plus a botulinum toxin injection into the sphincter muscle
Compared with
the same surgery without botulinum toxin injection
Main outcome
how much post-pooping pain decreased and how fast the wound healed
Quality
it is a small study of only 30 men comparing two surgical approaches rather than testing a cure for everyday post-pooping pain, so it says little about typical causes.
Limitations
small sample of 30 male patients; not randomized; findings apply only to surgical patients with a specific tight-sphincter type of chronic fissure
Taken word for word from the abstract
- population 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement
- intervention those in group II underwent surgery and a botulinum toxin injection directly into the IAS
- comparator those in group I underwent surgery alone
- primaryOutcome The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation
- result Forty days after surgery, we achieved complete wound healing in all the patients in group II but only in 80% of the patients in group I (P < 0.032)
- n involving 30 male patients affected by CAF with hypertonic IAS
- followUp They were followed up for at least 2 years.
World J Clin Cases · PMID 34877311 · Read it on PubMed ↗
Harvitkar et al. 2021
The Laser Therapy for Hemorrhoidal Disease: A Prospective Study
Laser hemorrhoid treatment reduced pain, low recurrence.Case seriesLow qualityRelated question
100 peoplenine months
pain was minimal or absent in most patients, symptoms like pain, bleeding, and itching dropped by 75-80%, and 7% of patients had recurrence within 12 months
Who was studied
patients with grade 2 or 3 hemorrhoids and mild rectal prolapse
What they received
hemorrhoidal laser procedure (HeLP)
Compared with
none (single-arm study, no comparison group)
Main outcome
postoperative pain, complications, and hemorrhoid resolution/recurrence
Quality
This was a small single-group study with no comparison treatment, so it can't prove the laser caused the improvement.
Limitations
No control group, only 9-month median follow-up, and results may not generalize beyond mild-to-moderate hemorrhoids.
Taken word for word from the abstract
- n 100 patients with grades 2 and 3 hemorrhoids
- population 100 patients with grades 2 and 3 hemorrhoids and minimum to a mild degree of rectal prolapse
- intervention hemorrhoidal laser procedure (HeLP)
- comparator Data were collected on the duration of the procedure, intraoperative complications, postoperative pain
- primaryOutcome postoperative pain, the declivity of hemorrhoids, persistency or complete resolution, and recurrence of hemorrhoids
- result The frequency of pain, bleeding, pruritus ani, and acute hemorrhoidal syndrome decreased by 75-80%. There was a significant reduction in hemorrhoids with the rate of recurrence being 7% over 12 months of follow-up.
Cureus · PMID 34804743 · Read it on PubMed ↗
Alvandipour et al. 2021
Postoperative outcomes of intrasphincteric botox injection during hemorrhoidectomy: A double-blind clinical trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
67 people14 days
Botox group had less pain at rest and during defecation, used fewer painkillers, and healed faster at one follow-up point
Who was studied
patients with grade 3 or 4 hemorrhoids having surgical hemorrhoid removal
What they received
Botox injection into the anal sphincter muscle during hemorrhoid surgery
Compared with
saline (salt water) injection during hemorrhoid surgery
Main outcome
pain after surgery and during bowel movements, and wound healing
Quality
it was a randomized double-blind trial but small and only in surgical hemorrhoidectomy patients, not people with ordinary post-bowel-movement pain.
Limitations
Small sample size (67 patients); applies only to patients undergoing surgical hemorrhoidectomy, not to general anal pain after defecation; operation time was longer in the Botox group.
Taken word for word from the abstract
- population patients with Grades 3 or 4 symptomatic hemorrhoids who underwent open (Milligan-Morgan) hemorrhoidectomy
- intervention The experimental group received intrasphincteric Botox injection during hemorrhoidectomy
- comparator the controls received normal saline injection
- primaryOutcome pain at rest and after defecation in six follow-up periods
- result Mean of postoperative pain at rest in Botox group was significantly lower at 12th, 24th, and 48th h and 7th and 14th days after operation (P < 0.01). Mean of postoperative pain in Botox group was significantly lower at 3rd to 5th defecation (P < 0.01).
- n 34 and 33 patients were randomly allocated in the experimental and control groups, respectively
J Res Med Sci · PMID 34729061 · Read it on PubMed ↗
Takada et al. 2022
Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
Less pain after hemorrhoid surgeryRetrospectiveLow qualityRelated question
54 people12 months
Pain scores during defecation were lower starting 4 days after surgery, and patients used fewer painkillers over 2 weeks (3.5 tablets vs 7.6 tablets) with the ALTA-mucopexy approach compared to the Doppler-guided surgery
Who was studied
patients with grade III (prolapsing) hemorrhoids
What they received
ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy combined with rectal mucopexy surgery
Compared with
Doppler-guided transanal hemorrhoidal dearterialization with mucopexy surgery
Main outcome
pain during bowel movements and painkiller use after surgery
Quality
This was not a randomized comparison but compared one group of patients to a separate group from an earlier trial, so differences between groups could explain the results.
Limitations
Compared to a historical cohort from a previous study rather than a concurrent randomized group; not described as blinded; small patient numbers.
Taken word for word from the abstract
- population patients with grade III hemorrhoids
- intervention ALTA therapy with a rectal mucopexy (AM)
- comparator Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (DM)
- n AM surgery was performed on 32 patients with grade III hemorrhoids and was compared with a cohort of 22 patients who underwent DM surgery
- primaryOutcome The pain scores during defecation were significantly lower in the AM patients beginning 4 days after surgery.
- result The total use of analgesics 2 weeks postoperatively was significantly lower in the AM patients than in the DM patients (3.5 tablets [range 1.6-5.5] vs. 7.6 tablets [range 3.3-11.9], P=0.04).
- followUp During 12 months follow-up, recurrence of prolapse occurred in 1 patient who underwent AM surgery.
Ann Coloproctol · PMID 34724727 · Read it on PubMed ↗
Retracted by the journal — not counted
Zeng et al. 2021
Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications
Herbal soak eased pain after hemorrhoid surgery.Randomised trialVery low qualityRelated question
106 people2021
the herbal bath group had less pain, bleeding and swelling, faster wound healing, shorter hospital stay, and better anal pressure measurements than the warm water group
Who was studied
adults who had surgery (PPH) for hemorrhoids
What they received
Kangfuxin solution fumigation bath after surgery
Compared with
warm water sitz bath after surgery
Main outcome
postoperative pain, bleeding, swelling, wound healing and anal function
Quality
this paper has been formally retracted, and it studied people recovering from hemorrhoid surgery rather than people with ordinary pain after a bowel movement.
Limitations
The publication is marked as a 'Retracted Publication,' and the population is specifically post-surgical hemorrhoid patients, not people with general anal pain after defecation.
Taken word for word from the abstract
- population A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery.
- n A total of 106 patients with hemorrhoids were included in this study
- intervention observation group treated with Kangfuxin solution fumigation bath
- comparator a control group treated with warm water sitz bath
- primaryOutcome We observed all patients' postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay.
- result the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group.
Evid Based Complement Alternat Med · PMID 34539803 · Read it on PubMed ↗
Eberspacher et al. 2021
Self-Mechanical Anal Dilatation: A Simple Trick to Minimize Postoperative Pain and Stenosis Following Hemorrhoidectomy With Radiofrequency
Less post-surgery anal pain with dilation.RetrospectiveLow qualityRelated question
78 people14 days to end of application (duration not specified in days)
pain scores were lower and satisfaction higher with self-mechanical anal dilation compared to the historical cohort, with fewer cases of anal stenosis
Who was studied
patients with hemorrhoidal disease who had radiofrequency hemorrhoidectomy and developed sphincter spasms with painful defecation at 3 weeks after surgery
What they received
self-mechanical anal dilation after hemorrhoidectomy
Compared with
historical cohort of matched patients who did not receive self-mechanical anal dilation
Main outcome
pain levels after surgery
Quality
this was a retrospective study comparing a small group to a historical group rather than a randomized trial, so bias cannot be ruled out.
Limitations
retrospective design, matched to a historical cohort rather than randomized, and the population is specifically post-surgical hemorrhoidectomy patients with sphincter spasm, not general people with pain after normal bowel movements
Taken word for word from the abstract
- n Thirty-nine patients performed the cycle of self-mechanical anal dilation (Group A).
- population All the patients that at 3 weeks presented sphincteric spasms with painful defecation, were considered.
- intervention postoperative use of self-mechanical anal dilation
- comparator This group was 1:1 matched with homogeneous patients from our historical cohort of patients (Group B).
- primaryOutcome The primary endpoint was the pain evaluation
- result In Group A mean VAS was 3.25 after 14 days of application and 1.15 at the end of the application. In Group B mean VAS was persistently higher, with a mean VAS of 5 (p = 0.000002) and 3.38 (p = 0.0000000000009).
Front Surg · PMID 34527696 · Read it on PubMed ↗
Porwal et al. 2021
Polyherbal formulation Anoac‑H suppresses the expression of RANTES and VEGF for the management of bleeding hemorrhoids and fistula
Herbal mix reduced hemorrhoid inflammation markers (lab study).Laboratory studyVery low qualityRelated question
size not given2021
Anoac-H reduced migration of fibroblast and immune cells and lowered RANTES and VEGF levels, and treated tissue samples showed less inflammation and lower RANTES/VEGF than untreated samples
Who was studied
human hemorrhoid and fistula tissue samples and fibroblast/macrophage cell lines in the lab
What they received
Anoac-H polyherbal formulation
Compared with
untreated cells and tissue samples
Main outcome
levels of inflammation markers RANTES and VEGF, and cell migration
Quality
This is lab and tissue-sample work without patient numbers, symptom outcomes, or a controlled clinical trial, so it cannot show whether people actually feel less pain.
Limitations
No sample size given, no clinical trial design, no report of pain or symptom outcomes in patients, findings are from cells and tissue samples rather than treated patients followed over time.
Taken word for word from the abstract
- population treated human hemorrhoid and fistula tissues as compared to untreated ones
- intervention polyherbal formulation Anoac‑H
- comparator as compared to untreated ones
- primaryOutcome Anoac‑H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages
- result inflammation, as well as the expression of RANTES and VEGF, were significantly reduced in treated human hemorrhoid and fistula tissues as compared to untreated ones, confirming the in vitro results
Mol Med Rep · PMID 34414451 · Read it on PubMed ↗
Vijayaraghavalu et al. 2021
The Role of Lateral Internal Sphincterotomy in Haemorrhoidectomy: A Study in a Tertiary Care Center
Less pain with added muscle-cutting stepRandomised trialModerate qualityRelated question
200 people24 months
adding the muscle cut reduced pain, bleeding, and urine retention after surgery, and lowered long-term anal narrowing and anal tears, but caused more temporary gas leakage
Who was studied
patients with grade 3 and grade 4 hemorrhoids having surgery
What they received
hemorrhoid surgery plus a small cut in the anal muscle (lateral internal sphincterotomy)
Compared with
standard hemorrhoid surgery alone (Milligan and Morgan technique)
Main outcome
pain after surgery, anal problems, and urine retention
Quality
it was a randomized trial with a reasonable number of patients, but it studied surgical hemorrhoid patients, not ordinary post-bowel-movement anal pain.
Limitations
study focused on surgical hemorrhoidectomy patients with grade 3-4 hemorrhoids, not general post-defecation anal pain; gas incontinence was increased with the added procedure
Taken word for word from the abstract
- n This randomized, prospective, and comparative study included 200 Grade 3 and Grade 4 hemorrhoids patients
- population 200 Grade 3 and Grade 4 hemorrhoids patients who were scheduled for surgical management
- intervention Group B underwent lateral internal sphincterotomy (LIS) in addition to Milligan and Morgan open hemorrhoidectomy
- comparator Group A underwent Milligan & Morgan open hemorrhoidectomy
- primaryOutcome the effect of lateral internal sphincterotomy with hemorrhoidectomy on postoperative pain, anorectal function, and retention of urine
- result postoperative pain, bleeding, and urinary retention were significantly lower after LIS, and gas incontinence was transient. The long-term outcomes, which included anal stenosis and anal fissure, were significantly lower after LIS.
Cureus · PMID 34306842 · Read it on PubMed ↗
Picciariello et al. 2021
The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures
New fissure pain scoring tool validated.Case-controlLow qualityRelated question
150 people2021
the REALISE score was significantly higher in anal fissure patients than controls, with high correlation between repeated assessments and good repeatability
Who was studied
patients with anal fissures compared to a control group with hemorrhoids, anal fistula, or obstructed defecation
What they received
a new symptom scoring questionnaire (REALISE score) covering pain, quality of life, duration of pain, painkiller use, and bleeding
Compared with
control group of patients with other anorectal conditions (haemorrhoids, anal fistula, or obstructed defecation syndrome)
Main outcome
reliability, inter-/intraobserver agreement, and repeatability of the new scoring system
Quality
this is a small single-center tool-validation study that does not test any treatment or explain the cause of pain, so it offers little direct evidence about why pooping hurts.
Limitations
abstract does not describe blinding details, does not address treatment outcomes, and is limited to one tertiary coloproctology centre over a short recruitment window
Taken word for word from the abstract
- n One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled.
- population patients with acute or chronic AF and a control group
- intervention The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points.
- comparator Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study.
- primaryOutcome Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability.
- result A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99).
Tech Coloproctol · PMID 33987779 · Read it on PubMed ↗
Mehdi et al. 2021
Efficacy and safety of Hemoheal cream in patients with hemorrhoids: a randomized double-blind placebo controlled clinical trial
Herbal cream eased some hemorrhoid pain.Randomised trialLow qualityRelated question
52 people3 weeks
significant improvement in anal irritation, bleeding, pain and swelling sense with Hemoheal vs placebo, but no significant difference in itching or defecation discomfort; overall subjective improvement was significantly better with Hemoheal
Who was studied
patients with symptomatic hemorrhoids
What they received
Hemoheal herbal cream (plant extract preparation)
Compared with
placebo cream
Main outcome
severity of anal irritation, bleeding, itching, pain, defecation discomfort, swelling, and overall improvement
Quality
Small trial of only 52 patients with short 3-week follow-up limits confidence in the findings.
Limitations
Small sample size; short treatment duration; studies hemorrhoids rather than general post-defecation anal pain.
Taken word for word from the abstract
- n Fifty-two patients with symptomatic hemorrhoids were randomized
- population patients with symptomatic hemorrhoids
- intervention Hemoheal cream consists of aqueous extract of Allium ampeloprasum L., Commiphora mukul (Hook. Ex Stocks) Engl and the oil of Sesamum indicum L.
- comparator receive hemoheal cream or placebo for 3 weeks
- primaryOutcome severity of anal irritation, bleeding, anal itching, pain, defecation discomfort and swelling sense, and overall subjective improvement (%)
- result distribution of anal irritation, bleeding, pain as well as swelling sense were significantly different (P < 0.05), while the analysis showed no significant differences between two groups for anal itching and defecation discomfort (P > 0.05)
- followUp after 3 weeks of treatment
J Tradit Chin Med · PMID 33825411 · Read it on PubMed ↗
Cakir et al. 2020
Comparison of the effectiveness of two treatment modalities for chronic anal fissure: Botox versus sphincterotomy
Botox and surgery gave similar relief.RetrospectiveLow quality
135 people2020
Surgery group had longer symptom duration, hospital stay, and time to remission, while the Botox group had more anal itching and more relapses; satisfaction and complication rates were similar between groups.
Who was studied
patients with chronic anal fissure
What they received
botulinum toxin (Botox) injection into the anal sphincter
Compared with
lateral internal sphincterotomy (surgical cutting of the anal sphincter muscle)
Main outcome
post-defecation pain, symptom remission, relapse, and treatment satisfaction
Quality
This was a retrospective, non-randomized study comparing two treatments without a placebo group, so differences could be due to patient selection rather than the treatments themselves.
Limitations
Retrospective design, multi-center data pooling, reliance on hospital records and patient recall, and no randomization between treatment groups.
Taken word for word from the abstract
- n This multi-center, retrospective study used data from 135 chronic anal fissure patients.
- population chronic anal fissure patients
- intervention botulinum toxin injection in the treatment of chronic anal fissure
- comparator lateral internal sphincterotomy (LIS)
- primaryOutcome post-defecation pain score, rectal bleeding or pruritus, and treatment satisfaction scores were recorded
- result Symptom duration, hospitalization period, and duration of remission of complaints after the treatment were significantly higher in the LIS group (p<0.001). However, pruritus in anus and relapses were found to be higher in the botulinum toxin group (p=¬ 0.04 and p= 0.043, respectively).
- result There was no significant difference in treatment satisfaction rates and postoperative complications.
Turk J Surg · PMID 33778381 · Read it on PubMed ↗
Li et al. 2021
Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials
Less pain after hemorrhoid surgery.Meta-analysisLow qualityRelated question
560 people2021
pudendal nerve block lowered pain scores, reduced need for analgesics and reduced side effects, with no difference in bleeding
Who was studied
patients having hemorrhoid surgery
What they received
pudendal nerve block for pain control after hemorrhoid surgery
Compared with
standard care without pudendal nerve block
Main outcome
pain scores and need for painkillers after hemorrhoid surgery
Quality
The review pooled only 7 small trials with likely differences between them, and the authors say bigger, better studies are still needed.
Limitations
Small number of trials and participants; authors state results need confirmation by high-quality, multi-center studies.
Taken word for word from the abstract
- n involved a total of 560 participants
- population postoperative analgesia of hemorrhoids
- intervention Pudendal nerve block (PNB) is one of the common anesthesia methods, which has been widely applied in postoperative analgesia of hemorrhoids
- comparator lower than those of controls
- primaryOutcome Visual analogue scale (VAS) scores on postoperative 6, 12, 24, 48 h and the first time of defecation were enhanced by the application of PNB.
- result The incidence of urinary retention, the need for analgesics [odds ratio (OR), 0.11; 95% CI, 0.04-0.37; P=0.0003] and the incidence of side effects (OR, 0.12; 95% CI, 0.04-0.39; P=0.004) in patients receiving PNB were lower than those of controls.
- result there was no significant difference in the incidence of bleeding between groups
- limitations Our results still need to be confirmed by high-quality, multi-center clinical studies.
Ann Palliat Med · PMID 33549027 · Read it on PubMed ↗
Gualtieri et al. 2021
Perianal streptococcal disease in childhood: systematic literature review
Strep bacteria cause childhood anal pain.Systematic reviewLow qualityRelated question
size not given3½ months
perianal pain, itch, bleeding or fissure with sharply demarcated redness were typical; diagnosis often took 3+ weeks; infection recurred in about 20% of cases; rapid strep tests had 80% positive and 96% negative predictive value
Who was studied
children, mostly boys 7 years old or younger
What they received
no treatment tested; review describes diagnosis and clinical features of perianal strep infection
Compared with
none - descriptive review, not a treatment comparison
Main outcome
clinical features, recurrence rate, and accuracy of rapid strep tests for perianal infection
Quality
this is a descriptive review of case reports and small studies without statistical pooling, so it describes patterns but cannot prove cause and effect strongly.
Limitations
findings come from pooled case literature on a specific childhood condition, not a general study of anal pain after bowel movements in all ages.
Taken word for word from the abstract
- population More than 80% of cases are boys ≤7.0 years of age with defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness.
- primaryOutcome The main purposes were to document the clinical features, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and the mechanism possibly underlying the acquisition of this infection.
- result The time to diagnosis is ≥3 weeks in 65% of cases. Recurrences occur within 3½ months in about 20% of cases.
- result As compared with perianal Streptococcus A culture, the rapid streptococcal tests have a positive predictive value of 80% and a negative predictive value of 96%.
- intervention Systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment.
- comparator Systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment.
Eur J Pediatr · PMID 33532889 · Read it on PubMed ↗
Crea et al. 2022
Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis
Laser hemorrhoid treatment reduced pain long-termCase seriesLow qualityRelated question
189 people42 months
Pain after surgery was absent in 94% of patients, with symptom improvement in about 90% over follow-up
Who was studied
Patients with second- to third-degree hemorrhoids with mild-to-moderate prolapse
What they received
Hemorrhoid laser procedure (HeLP)
Compared with
None (no comparison group)
Main outcome
Pain after surgery, hemorrhoid grade improvement, and recurrence of hemorrhoid disease
Quality
This was an uncontrolled case series without a comparison group, so it can't prove the laser caused the improvement.
Limitations
No control group, single intervention tracked, relies on patient-reported improvement scale
Taken word for word from the abstract
- n A total of 189 patients were treated between April 2012 and October 2017.
- population patients with second- to third-grade hemorrhoids with minimal or moderate mucosal prolapse
- intervention 5-year consecutive use of the hemorrhoidal laser procedure (HeLP)
- comparator We reported perioperative complications, postoperative pain, improvement of hemorrhoids grade, and relapse of hemorrhoidal disease (HD).
- primaryOutcome postoperative pain, improvement of hemorrhoids grade, and relapse of hemorrhoidal disease (HD)
- result Pain after surgery was absent in 94% of patients.
- result The individual level of improvement in symptoms was consistent (very much and much improved, according to PGI-I score) for about 90% of patients during the follow-up.
- followUp The median follow-up was 42 months (range 6-62 months).
Lasers Med Sci · PMID 33439376 · Read it on PubMed ↗
Giamundo et al. 2022
Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial
Laser hemorrhoid treatment reduced pain long-term.Case seriesLow qualityRelated question
284 people2-year follow-up
89.9% of patients had their symptoms resolve after 2 years, with significant improvement in quality of life, pain, and bleeding
Who was studied
Adults with hemorrhoids (183 men, 101 women, average age 47.5) having pain, bleeding, or other symptoms
What they received
Doppler-guided laser treatment to close the blood vessels feeding hemorrhoids (HeLP procedure)
Compared with
None – all patients received the same treatment, no control group
Main outcome
Whether hemorrhoid-related symptoms (bleeding, pain, frequency of flare-ups) went away
Quality
This was a single-arm study with no comparison group, so it can't prove the laser procedure itself caused the improvement.
Limitations
No control group for comparison; some patients lost to follow-up; failure rates were higher in patients with constipation or more severe hemorrhoids.
Taken word for word from the abstract
- n Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
- population Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
- intervention Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy.
- comparator Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up.
- primaryOutcome Primary endpoint was resolution of symptoms
- result Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients.
Surg Endosc · PMID 33415419 · Read it on PubMed ↗
Hatami et al. 2022
The Effect of Perianal Tramadol Infiltration on Postoperative Pain Following Hemorrhoidectomy
Less pain after hemorrhoid surgery with tramadol.Randomised trialLow qualityRelated question
90 people2022
tramadol group had significantly different (lower) pain scores at all times after surgery, including at first bowel movement, compared to the other groups
Who was studied
patients with grade 3 and 4 hemorrhoids undergoing surgery to remove them
What they received
local injection of tramadol around the anus before surgery
Compared with
local injection of bupivacaine or saline (placebo) before surgery
Main outcome
pain severity after hemorrhoid surgery, including pain during first bowel movement
Quality
small trial of surgical patients, not people with ordinary post-bowel-movement anal pain, so it doesn't directly answer why pooping hurts in general.
Limitations
Small sample size (90 patients across 3 groups); population is specifically post-hemorrhoidectomy surgical patients, not general anal pain after defecation.
Taken word for word from the abstract
- n 90 patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy
- population patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy
- intervention perianal infiltration of tramadol on postoperative pain in patients undergoing hemorrhoidectomy
- comparator Patients were randomly assigned into 3 groups of control or bupivacaine or tramadol.
- primaryOutcome Data on pain severity (based on the visual analog scale (VAS), the duration of surgery, sedation score, pain at the first defecation, first request time for additional analgesia, nausea and vomiting, and analgesic intakes) were evaluated and analyzed.
- result The results showed a significant difference in pain score between 3 groups (P ≤.05) at all times after the surgery. In addition, the means of sedation scores (P = .03), pain score at the first defecation (P = .001)
Am Surg · PMID 33371715 · Read it on PubMed ↗
Gallo et al. 2020
Mesoglycan for pain control after open excisional HAEMOrrhoidectomy (MeHAEMO): an observational multicentre study on behalf of the Italian Society of Colorectal Surgery (SICCR)
Less pain after hemorrhoid surgeryRetrospectiveLow qualityRelated question
398 people6 weeks
mesoglycan group had less pain, less clotting, and recovered independence faster
Who was studied
patients who had surgery to remove severe hemorrhoids
What they received
mesoglycan medication after hemorrhoid removal surgery
Compared with
no mesoglycan (standard post-surgical care)
Main outcome
pain levels after bowel movements and other times, plus clot formation and healing after surgery
Quality
this was a retrospective observational study without random assignment, so differences between groups could be due to other factors.
Limitations
retrospective design (not randomized), and it studies pain after hemorrhoid surgery specifically, not general pain after normal bowel movements
Taken word for word from the abstract
- n Three hundred ninety-eight patients from sixteen colorectal referral centres who underwent OEH for III and IV HD were enrolled.
- population patients who underwent open excisional diathermy haemorrhoidectomy (OEH)
- intervention The use of mesoglycan led to a significant reduction in post-operative thrombosis and pain
- comparator There were no significant differences between the two groups regarding the time to surgical wound healing or post-operative bleeding.
- primaryOutcome VAS at rest (VASs), after defecation (VASd), and after anorectal digital examination (VASe), bleeding and thrombosis, time to surgical wound healing and autonomy were evaluated.
- result all patients experienced less post-operative pain at each time point (p < 0.001 except for VASe T4 p = 0.003)
- design This was a retrospective multicentre observational study.
- followUp after 1 week (T2), 3 weeks (T3) and 6 weeks (T4)
BMC Surg · PMID 33092570 · Read it on PubMed ↗
Yano 2021
Is There a Relationship Between Stool Consistency and Pain at First Defecation After Limited Half Hemorrhoidectomy? A Pilot Study
Stool softness didn't affect pain.Prospective cohortLow qualityRelated question
61 people2021
no significant difference in pain across stool consistency groups
Who was studied
patients who had surgery for severe hemorrhoids (grade III or IV)
What they received
soft or hard stool consistency at first bowel movement after surgery
Compared with
normal stool consistency
Main outcome
pain intensity during first bowel movement after surgery
Quality
small pilot study with self-reported pain scores and no control for other factors affecting pain
Limitations
small pilot study, self-recorded measures, only examined first defecation after hemorrhoidectomy surgery
Taken word for word from the abstract
- n A total of 61 patients were eligible for this study and were classified into the hard stool (n=15), normal stool (n=21), and soft stool groups (n=25).
- population evaluated patients who underwent hemorrhoidectomy in combination with injection sclerotherapy for grade III or IV hemorrhoids
- intervention The patients were classified into 3 groups according to stool consistency
- comparator normal stool
- primaryOutcome The pain intensity and stool form during the first postoperative defecation were self-recorded by the patients using a visual analogue scale (score of 0-10)
- result No significant intergroup differences were identified in the intensity of pain at defecation (P=0.29).
Ann Coloproctol · PMID 32972107 · Read it on PubMed ↗
Wang et al. 2020
Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
154 people48 h
the treatment group had lower pain scores, needed less pain medicine, had less anxiety, and had their first bowel movement sooner than the sham group
Who was studied
patients receiving Milligan hemorrhoidectomy surgery
What they received
pestle needle therapy, a type of acupoint stimulation given after hemorrhoid surgery
Compared with
sham treatment with very light pressure at the same points
Main outcome
pain level measured with a visual analogue scale 12 hours after surgery
Quality
It was a single-center randomized trial with blinded assessors but only a sham-pressure control, so some bias and limited generalizability remain.
Limitations
Single-center design; patients (not just assessors) may have noticed which treatment felt different despite blinding attempts; no mention of long-term follow-up beyond 48 hours.
Taken word for word from the abstract
- population 154 patients receiving Milligan hemorrhoidectomy surgery
- intervention the pestle needle therapy, an acupoint stimulation method, for relief of post-hemorrhoidectomy pain
- comparator the control group received a sham treatment with very light pressure
- primaryOutcome The primary outcome was post-operative pain measured with the visual analogue scale (VAS) at 12 h after surgery
- result The mean pain score of the treatment group was significantly lower than that of the control group (3.10 ± 1.27 vs 4.82 ± 1.29; P < 0.001) at 12 h after surgery.
- n 154 patients receiving Milligan hemorrhoidectomy surgery
- followUp the VAS scores measured at 0.5, 2, 4, 6, 8, 24 and 48 h after surgery
J Integr Med · PMID 32798197 · Read it on PubMed ↗
Wilkie et al. 2021
Efficacy of postoperative oral metronidazole for haemorrhoidectomy pain: a randomized double-blind, placebo-controlled trial
No pain relief after hemorrhoid surgery.Randomised trialLow qualityRelated question
40 people21 days
no significant difference in pain scores between metronidazole and placebo groups
Who was studied
patients recovering from haemorrhoidectomy surgery
What they received
oral metronidazole plus standard care after haemorrhoid surgery
Compared with
placebo plus standard care
Main outcome
pain scores after surgery measured over 21 days
Quality
it was a small trial of only 40 patients and the small pain trend seen did not hold up after correcting for multiple comparisons
Limitations
small sample size of 40 patients; apparent trend toward benefit lost significance after Bonferroni correction
Taken word for word from the abstract
- n Forty patients were randomized to either metronidazole and standard care or placebo and standard care (21 metronidazole, 19 placebo)
- population posthaemorrhoidectomy pain
- intervention metronidazole and standard care
- comparator placebo and standard care
- primaryOutcome posthaemorrhoidectomy pain scores over 21 days, measured on a 10-point Likert scale
- result treatment allocation (placebo versus metronidazole) did not significantly affect the improvement in patients' reported pain (P = 0.8837)
- result Our data do not support the hypothesis that postoperative metronidazole has a clinically meaningful effect on posthaemorrhoidectomy pain.
Colorectal Dis · PMID 32750730 · Read it on PubMed ↗
Dantas et al. 2020
PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY
Constipation linked to painful, burning bowel movements.RetrospectiveLow qualityRelated question
195 people2020
pain and burning sensation during bowel movements, along with hemorrhoids and sexual dysfunction, were linked to constipation
Who was studied
premenopausal women in northeastern Brazil
What they received
having constipation (Rome III criteria)
Compared with
not having constipation
Main outcome
factors associated with constipation, including pain and burning sensation on bowel movement
Quality
This is a cross-sectional study that can show links but cannot prove constipation causes the pain, and it relies on self-reported symptoms.
Limitations
Cross-sectional design cannot establish cause and effect; based on self-report; specific population (premenopausal women, one region) may not generalize.
Taken word for word from the abstract
- n Participated 195 women, adult and middle age.
- population premenopausal women living in Northeastern Brazil
- intervention Constipation was diagnosed using the Rome III Criteria.
- comparator Constipation was diagnosed using the Rome III Criteria.
- primaryOutcome verify the prevalence and factors associated with intestinal constipation
- result hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation
Arq Gastroenterol · PMID 32609161 · Read it on PubMed ↗
Soltany et al. 2020
Therapeutic properties of botulinum toxin on chronic anal fissure treatment and the patient factors role
Most fissures healed with injection.Case seriesLow qualityRelated question
106 people8 weeks
84.9% of patients healed, with mean healing time of 4.68 weeks
Who was studied
patients with chronic anal fissure
What they received
botulinum toxin injection (30 units)
Compared with
none (single-arm, no control group)
Main outcome
healing of the anal fissure
Quality
This was a small study with no comparison group, so it can't prove the treatment caused the improvement.
Limitations
No control group; heterogeneity among prior studies noted; case-series design without randomization
Taken word for word from the abstract
- population 106 patients who suffer from chronic anal fissure
- intervention All patients received 30 units of botulinum toxin
- comparator prospective case series medical research
- primaryOutcome fissure healing rate
- result the healing rate was 84.9% (90 patients responded to injections)
- n 106 patients who suffer from chronic anal fissure were treated by botulinum toxin injections
- followUp At the end of the study (8 weeks)
J Family Med Prim Care · PMID 32509650 · Read it on PubMed ↗
Şişik et al. 2020
Recovery from hemorrhoids and anal fissure without surgery
Straining and hard stools linked to pain.Case-controlLow quality
180 people2020
hard stools, long toilet time, straining, and (for fissures) anxiety were more common in patients with these conditions than in healthy people
Who was studied
adults with hemorrhoids or anal fissure compared to healthy people
What they received
having hard stools, straining, spending more than 5 minutes on the toilet, spicy food, and anxiety
Compared with
healthy individuals without hemorrhoids or anal fissure
Main outcome
whether toilet habits, diet, and anxiety are linked to hemorrhoids and anal fissure
Quality
this is a small questionnaire-based study comparing groups after the fact, so it can show links but not prove what causes the pain.
Limitations
relies on patient-reported survey answers and compares groups after diagnosis rather than following people over time
Taken word for word from the abstract
- n patients with HD (n=60) and AF (n=60) were enrolled consecutively into the study group and compared with the control group (n=60) of healthy individuals
- population patients with HD (n=60) and AF (n=60) were enrolled consecutively into the study group and compared with the control group (n=60) of healthy individuals
- intervention Hard stools, spending more than 5 minutes in the toilet, frequent straining during defecation, and increased spice intake were more frequent in the patients with HD
- comparator compared with the control group (n=60) of healthy individuals
- primaryOutcome The survey was designed to assess the participants' toilet and dietary habits and anxiety risk.
- result hard fecal consistency, time elapsed in toilet greater than 5 min, straining during defecation, and high anxiety risk were more frequent in the patients with AF as compared to the control group (p<0.05)
Turk J Gastroenterol · PMID 32412899 · Read it on PubMed ↗
Acar et al. 2020
Comparative efficacy of medical treatment versus surgical sphincterotomy in the treatment of chronic anal fissure
Surgery relieves fissure pain best.Randomised trialModerate qualityRelated question
550 people2020
Surgery (lateral internal sphincterotomy) gave the best pain relief and healing, while many patients on topical ointments still had pain and no healing by two months and needed surgery
Who was studied
people with chronic anal fissure (a tear in the skin near the anus)
What they received
topical ointments (nitroglycerin or diltiazem) or surgical lateral internal sphincterotomy
Compared with
the four treatment groups were compared against each other
Main outcome
pain relief and healing of the fissure after treatment
Quality
It was a large randomized trial, but the abstract gives few details on how groups were assigned or blinded, so some bias is possible.
Limitations
The abstract does not describe blinding, dropout rates, or long-term follow-up after surgery.
Taken word for word from the abstract
- population patients who were treated for chronic anal fissure
- intervention topical ointment with medical treatment and surgical lateral internal sphincterotomy
- comparator Patients were randomly divided into 4 groups according to the treatment type they received.
- primaryOutcome Both pain relief and healing of the fissure, which are the components of response to treatment
- result had not been observed in 56 (37.3%) patients of topical nitroglycerin ointment group until the second month
- result The best response to treatment was also obtained in lateral internal sphincterotomy group.
- n a randomized clinical trial of 550 patients who were treated for chronic anal fissure
Niger J Clin Pract · PMID 32246662 · Read it on PubMed ↗
Caetano et al. 2019
Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study
Less bleeding, no clear pain reliefProspective cohortLow qualityRelated question
44 people28 days
the combined treatment reduced bleeding and itching more than RBL alone, with only a non‑significant trend toward improvement in pain during defecation
Who was studied
patients with hemorrhoidal disease treated at a gastroenterology outpatient clinic
What they received
combination of rubber band ligation plus a micronized purified flavonoid fraction (MPFF)
Compared with
rubber band ligation (RBL) alone
Main outcome
severity of hemorrhoid symptoms including bleeding, itching, pain at rest, pain during defecation and prolapse
Quality
This was a small, non‑randomized comparison of two treatment groups, so differences could be due to chance or other factors rather than the treatment itself.
Limitations
Small sample size (19 vs 25 patients), non-randomized design, and only a 'trend' rather than significant difference for pain outcomes.
Taken word for word from the abstract
- n Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group).
- population Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated.
- intervention a combination of RBL with a micronized purified flavonoid fraction (MPFF)
- comparator Isolated rubber band ligation (RBL)
- primaryOutcome Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5).
- result significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).
Ann Coloproctol · PMID 31937070 · Read it on PubMed ↗
Lehmann et al. 2020
Long-term functional results after excisional haemorrhoidectomy
Less pain years after hemorrhoid surgery.Randomised trialModerate qualityRelated question
151 people10.7 years
Pain at defecation fell from 25% before surgery to 11% at long-term follow-up, and other symptoms like bleeding and soiling also dropped, though a sense of anal narrowing and perceived recurrence remained common
Who was studied
adults who had surgery for haemorrhoids in Sweden between 1999 and 2003
What they received
excisional haemorrhoidectomy using the Milligan technique
Compared with
excisional haemorrhoidectomy using the Ferguson technique
Main outcome
long-term bowel and anal symptoms such as pain, bleeding, soiling and a sense of narrowing
Quality
It was a long-term follow-up of a randomized surgical trial, but it relied on patient questionnaires years later with only 76% response and no non-surgery comparison group.
Limitations
Questionnaire-based follow-up with 24% non-participation, no untreated comparison group, and symptoms were self-reported long after surgery
Taken word for word from the abstract
- population patients operated on for haemorrhoids in Sweden between 1999 and 2003
- intervention randomized to Milligan's or Ferguson's operation
- comparator randomized to Milligan's or Ferguson's operation
- primaryOutcome a long-term evaluation of a randomized trial focusing on functional aspects after excisional haemorrhoidectomy
- result At baseline, 49% had spontaneous anal pain and 25% pain at defaecation. At follow-up, these figures were 17% and 11%.
- n 151 (76%) participated after a median follow-up of 10.7 years
Colorectal Dis · PMID 31912937 · Read it on PubMed ↗
Wu et al. 2019
Segmental resection combined with anoplasty for the treatment of circumferential mixed hemorrhoids
Less pain with newer hemorrhoid surgery.Randomised trialModerate qualityRelated question
300 people18 months
SPH group healed faster, recovered sooner, had better anal function, and less pain with defecation than the standard surgery group
Who was studied
patients with circumferential mixed hemorrhoids
What they received
segmented and plastic hemorrhoidectomy (SPH) surgery
Compared with
Milligan-Morgan hemorrhoidectomy surgery
Main outcome
healing time, recovery time, anal function, and pain after bowel movements
Quality
it was a randomized trial with a reasonable number of patients but this specific study is about a surgical technique for a specific condition (hemorrhoids), not a direct answer to general post-defecation anal pain.
Limitations
The abstract does not report blinding, dropout rates, or the exact statistical significance of all differences described.
Taken word for word from the abstract
- population 300 patients with circumferential mixed hemorrhoids
- intervention experimental group (n=150) undergoing SPH
- comparator control group (n=150) undergoing Milligan-Morgan hemorrhoidectomy
- primaryOutcome the rating in the visual analogue scale for defecation pain and edema
- result the rating in the visual analogue scale for defecation pain and edema in the experimental group was less than that in the control group
- n A total of 300 patients with circumferential mixed hemorrhoids were divided into experimental group (n=150) undergoing SPH and control group (n=150) undergoing Milligan-Morgan hemorrhoidectomy.
Braz J Med Biol Res · PMID 31116312 · Read it on PubMed ↗
Karatzi et al. 2019
Beware of anal fissures: pemphigus vulgaris of the anal canal
Rare disease mimicking fissures, treated successfullyCase seriesVery low qualityRelated question
1 people2019
treatment with rituximab plus corticosteroids achieved complete remission after the condition did not respond to earlier treatment
Who was studied
49-year-old woman with pemphigus vulgaris (an autoimmune blistering skin disease) affecting her mouth
What they received
combination of rituximab and corticosteroid medication
Compared with
no comparator (single case report)
Main outcome
anal pain, bleeding, and erosions from anal pemphigus vulgaris, and whether treatment led to remission
Quality
this is a single patient case report, which cannot show whether the treatment works in general.
Limitations
only one patient; no comparison group; the abstract does not describe how long remission lasted after treatment
Taken word for word from the abstract
- n A case of anal pemphigus vulgaris in a 49-year-old female
- population 49-year-old female suffering from pemphigus vulgaris of the oral cavity
- intervention complete remission was only achieved with the combination of rituximab and corticosteroids
- comparator The disease was refractory to treatment
- primaryOutcome episodes of anal pain and bleeding on defecation, initially mimicking anal fissures
- result complete remission was only achieved with the combination of rituximab and corticosteroids
Ann Gastroenterol · PMID 30872911 · Read it on PubMed ↗
Handaya et al. 2019
Bilateral Rotational S Flap Technique for Preventing Restenosis in Patients With Severe Circular Anal Stenosis: A Review of 2 Cases
Surgery relieved stenosis pain and straining.Case seriesVery low qualityRelated question
2 people1 year
at 1-year follow-up, no complaints of defecation problems or pain, and no longer needed laxatives
Who was studied
patients with severe circular anal stenosis after hemorrhoidectomy
What they received
bilateral rotational S flap surgery to rebuild the anal canal
Compared with
none
Main outcome
defecation problems and pain after surgery
Quality
Only two patients were studied, so it's hard to know if this works for most people.
Limitations
Extremely small sample size (2 cases), no comparison group, condition described is anal stenosis from scarring, not typical post-defecation pain in a general population.
Taken word for word from the abstract
- n We review 2 cases of severe circular anal stenosis.
- population 2 cases of severe circular anal stenosis
- intervention reconstruction using the bilateral rotational S flap procedure
- comparator no procedure is ideal for every patient
- primaryOutcome Their complaints included narrow caliber of the stool and feeling unsatisfied defecation.
- result At the 1-year follow-up, the patient had complaints about neither defecation nor pain, and no longer needed laxative agents.
Ann Coloproctol · PMID 30781931 · Read it on PubMed ↗
Carter et al. 2018
The Role of Botox in Colorectal Disorders
Botox rarely helps chronic anal pain.Narrative reviewLow qualityRelated question
size not given2018
Botox was less effective than surgery for healing anal fissures; for chronic anal pain, only a small number of patients improved
Who was studied
people with lower gastrointestinal and anorectal disorders, including anal fissures and chronic anal pain
What they received
botulinum toxin (Botox) injection
Compared with
surgical treatment (for anal fissures); no clear comparator for chronic anal pain
Main outcome
how well Botox treats anorectal conditions including anal fissures, chronic anal pain, and related disorders
Quality
this is a narrative overview of existing studies rather than new original research, and the authors say evidence on anal pain is limited and more research is needed.
Limitations
abstract states data on chronic anal pain treatment is limited and effects were seen in only a minority of patients; no study sizes or methods are given.
Taken word for word from the abstract
- population lower gastrointestinal disorders (GIT)
- intervention botulism toxin treatment (BTX-A)
- comparator Surgical treatment was found to be more effective than BTX-A for the healing of chronic anal fissures
- primaryOutcome the efficacy of botulism toxin treatment (BTX-A) for lower gastrointestinal disorders
- result Data regarding the effects of BTX-A injection for the treatment of chronic anal pain is limited. Beneficial effects were observed only in a minority of patients.
Curr Treat Options Gastroenterol · PMID 30397849 · Read it on PubMed ↗
Acar et al. 2019
Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?
Surgery cured fissure pain, rare leakage risk.RetrospectiveLow qualityRelated question
417 people2019
low rate of fissure returning and a small number developed gas or stool leakage, mostly temporary
Who was studied
adults with chronic anal fissure (a tear near the anus) having surgery
What they received
lateral internal sphincterotomy (a cut in the anal muscle to relieve fissure)
Compared with
no comparison group; outcomes tracked in the same patients
Main outcome
return of the fissure and bowel control problems after surgery
Quality
it only looked back at records of one treatment with no comparison group, so it can't prove the surgery is better than other options
Limitations
retrospective design, no control group, and this is about surgical treatment of an already-diagnosed fissure rather than explaining why pain happens after bowel movements in general
Taken word for word from the abstract
- n 417 patients included in the study
- population 417 patients who were treated for chronic anal fissure were included
- intervention lateral internal sphincterotomy (LIS)
- primaryOutcome Recurrence occurred in 15 patients (3.6%)
- result Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence
- comparator This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included.
Asian J Surg · PMID 30366766 · Read it on PubMed ↗
Ceulemans et al. 2019
High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study
Pain after pooping remains hard to treat.Prospective cohortLow quality
42 people21 days
despite multimodal pain treatment, patients having surgery for hemorrhoids or anal fissures still had high pain scores and used painkillers for longer; pain during defecation remained a persistent problem
Who was studied
patients who had outpatient surgery on the anus or rectum, including for hemorrhoids or anal fissures
What they received
multimodal pain treatment (local anesthetic injection, multiple oral painkillers, and written pain management information)
Compared with
different combinations of these pain treatments compared within the same group of patients
Main outcome
pain levels, including pain during pooping, over the two weeks after surgery
Quality
this was a small, uncontrolled observational study of only 42 patients without a true comparison group, so it can't reliably prove what works.
Limitations
small sample size (only 42 patients completed diaries), no control group without multimodal treatment, single-center design
Taken word for word from the abstract
- n Forty-two patients completed the pain diary.
- population patients undergoing surgery for hemorrhoids or anal fissures
- intervention multimodal analgesic approach consisting of local anesthetic infiltration, multiple oral analgesics and written information
- comparator The use of local anesthetic infiltration did not result in a significant difference in pain scores in this study.
- primaryOutcome Mean pain throughout the day and pain during defecation where recorded on day 0-14 and day 21 postoperatively using a numeric rating scale-11.
- result Despite receiving multimodal analgesic treatment, patients undergoing surgery for hemorrhoids or anal fissures reported pain scores ≥4 and used analgesics longer.
- result Pain during defecation is problematic and finding a solution for this problem remains challenging.
Acta Chir Belg · PMID 30189793 · Read it on PubMed ↗
Abramowitz et al. 2019
Psychometric properties of a questionnaire (HEMO-FISS-QoL) to evaluate the burden associated with haemorrhoidal disease and anal fissures
Validated symptom questionnaire, not pain cause.Case seriesVery low qualityRelated question
256 people2019
the questionnaire reliably measured the impact of haemorrhoidal disease and anal fissures on daily life and correlated with other quality-of-life scores
Who was studied
adults with haemorrhoids or anal fissures (mean age 46.2 years)
What they received
none (questionnaire administered, no treatment given)
Compared with
none
Main outcome
reliability and validity of a new symptom-burden questionnaire (HEMO-FISS-QoL)
Quality
this study only tests a symptom questionnaire and does not investigate why pain occurs after bowel movements or test any treatment
Limitations
abstract does not address causes of post-defecation pain; only reports development of a measurement tool
Taken word for word from the abstract
- n administered it to 256 patients (mean age 46.2 years; men 60.4%)
- population 256 patients (mean age 46.2 years; men 60.4%) with haemorrhoidal disease (67.2%), anal fissure (29.3%) or both (3.5%)
- intervention We developed a questionnaire (HEMO-FISS-QoL) to assess the symptom burden of anal disorders
- comparator External validity was evaluated against SF-12 and the Psychological Global Well-Being Index (PGWBI)
- primaryOutcome Psychometric properties were evaluated by testing the acceptability, construct validity and reliability of the questionnaire.
- result The HEMO-FISS-QoL questionnaire reliably evaluates the global impact of haemorrhoids and anal fissures on patients' daily lives.
Colorectal Dis · PMID 30171745 · Read it on PubMed ↗
Wu et al. 2018
Effect of acupuncture on post-hemorrhoidectomy pain: a randomized controlled trial
Less pain after hemorrhoid surgery.Randomised trialLow qualityRelated question
72 people48 h
Lower pain scores in the acupuncture group at several time points including 6 hours, 24 hours, and during defecation
Who was studied
patients with mixed hemorrhoids who had undergone hemorrhoidectomy surgery
What they received
electroacupuncture (surround needling) given right after surgery
Compared with
sham acupuncture
Main outcome
pain intensity measured by visual analog scale after surgery and during bowel movements
Quality
Small single-center trial with only 36 people per group, measuring pain after surgery rather than everyday post-bowel-movement pain.
Limitations
Small sample size, single-center, single-blind design, and population is post-surgical hemorrhoidectomy patients rather than people with ordinary anal pain after pooping.
Taken word for word from the abstract
- n Seventy-two patients with mixed hemorrhoids who had undergone hemorrhoidectomy were randomly assigned
- population Seventy-two patients with mixed hemorrhoids who had undergone hemorrhoidectomy
- intervention the EA treatment group (EA) received surround needling with EA (n=36)
- comparator the control group received sham acupuncture (SA) treatment (n=36)
- primaryOutcome The pain intensity was recorded by using the visual analog scale as the primary outcome.
- result The EA group had significantly lower visual analog scale scores at the 3 time points of 6, 24 h, and during the defecation (p<0.05).
J Pain Res · PMID 30122979 · Read it on PubMed ↗
Paudel et al. 2018
Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome
Hemorrhoids found incidentally in some patientsCase seriesLow qualityRelated question
140 people2018
27.85% had some other bowel finding, including hemorrhoids in 4.2% of patients
Who was studied
adults with irritable bowel syndrome diagnosed by ROME IV criteria
What they received
full colonoscopy with biopsy to look for other bowel diseases
Compared with
none
Main outcome
how often colonoscopy found other bowel diseases in IBS patients
Quality
this is a single-center survey of colonoscopy findings in IBS patients with no comparison group, and it was not designed to study anal pain after bowel movements specifically
Limitations
cross sectional design, single hospital, and hemorrhoids were only an incidental finding rather than the focus of the study
Taken word for word from the abstract
- population 140 consecutive patients of IBS fulfilling the ROME IV criteria
- intervention All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.
- comparator A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria.
- primaryOutcome Organic lesions were seen in 39 (27.85%) patients.
- result Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%).
- n A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria.
JNMA J Nepal Med Assoc · PMID 30058630 · Read it on PubMed ↗
Chiaretti et al. 2018
Comparison of Flavonoids and Centella asiatica for the treatment of chronic anal fissure. A randomized clinical trial
Faster healing, less pain, less bleeding.Randomised trialLow quality
98 people8 weeks
Flavonoids stopped bleeding fastest (1 week vs 3 vs 4 weeks); both Flavonoids and Centella asiatica reduced pain earlier than traditional treatment; all healed by 8 weeks
Who was studied
people with chronic anal fissure (tear near the anus)
What they received
Flavonoids or Centella asiatica added to standard treatment
Compared with
traditional treatment alone
Main outcome
time to stop bleeding and pain score
Quality
Small randomized trial with short follow-up and no mention of blinding, so results may be less reliable.
Limitations
No mention of blinding; small group sizes; only 8 weeks of observation
Taken word for word from the abstract
- n 98 outpatients were divided randomly into treated (either Fs or Ca) and control group.
- population treatment of chronic anal fissure
- intervention treated, additionally, with Fs (Group A, n=30) or Ca (Group B, n=36)
- comparator The control group (Group C, n=32) received the traditional treatment
- primaryOutcome healing time, bleeding and pain in the treatment of chronic Anal Fissure
- result The median time to stop bleeding in the group A was 1 week, in the Group B was 3 weeks and in the group C was 4 weeks.
- result All patients healed within 8th week.
- followUp Patients were observed once weekly over 8 consecutive weeks.
Ann Ital Chir · PMID 29844250 · Read it on PubMed ↗
Amorim et al. 2017
Botulinum toxin improves pain in chronic anal fissure
Less pain after botulinum toxin injection.RetrospectiveLow quality
81 people4 year period
pain scores at rest and after defecation significantly improved after botulinum toxin injection
Who was studied
patients with chronic anal fissure causing intense pain
What they received
botulinum toxin injection
Compared with
before vs after treatment (no control group)
Main outcome
pain intensity at rest and after pooping
Quality
This was a retrospective study without a comparison group, so it can't rule out other reasons pain improved over time.
Limitations
Retrospective cohort design without a control group; notable long-term treatment failure (23.5% needed surgery).
Taken word for word from the abstract
- n involving 81 consecutive patients
- population patients referred to a chronic pain management unit due to a chronic anal fissure
- intervention treatment with botulinum toxin
- comparator pre-treatment and post-treatment pain (numeric rating scale)
- primaryOutcome pain post-defecation score
- result Pain intensity rest score significantly improved after BoNT injection [variation: -4.2 ± 2.9 (p < 0.001)], as did pain post-defecation score [variation: -5.1 ± 3.0 (p < 0.001)]
Porto Biomed J · PMID 32258781 · Read it on PubMed ↗
Jacobs 2018
Hemorrhoids: what are the options in 2018?
No clear best hemorrhoid treatment yet.Narrative reviewLow qualityRelated question
size not given2018
no definitive best alternative identified; conservative measures and managing expectations emphasized as important
Who was studied
people with symptomatic hemorrhoids
What they received
various hemorrhoid treatments including newer surgical techniques
Compared with
traditional hemorrhoidectomy and conservative management
Main outcome
treatment efficiency, pain, blood loss, symptom control and recurrence
Quality
This is a general narrative review without original data, patient numbers, or controlled comparisons.
Limitations
Abstract notes heterogeneity in diagnosis, intervention, and outcome measures makes comparing therapies difficult, and long-term data are still being accumulated.
Taken word for word from the abstract
- population patients with symptomatic hemorrhoidal disease
- intervention new procedures or procedural refinements to existing techniques continue to be introduced with promising short-term outcomes
- comparator the best alternative to traditional hemorrhoidectomy remains controversial
- primaryOutcome reducing intraoperative and postoperative pain, decreasing operating times, minimizing blood loss and controlling symptoms and recurrence rates
- result a definitive, unequivocal answer to what is truly the best alternative to traditional hemorrhoidectomy remains controversial
- limitations heterogeneity as regards diagnosis, intervention and, especially, outcomes measures such that comparing therapies is too difficult
Curr Opin Gastroenterol · PMID 29076869 · Read it on PubMed ↗
Tsunoda et al. 2017
A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids
Less pain with one surgery type early onRandomised trialLow qualityRelated question
44 peoplemedian 33-month follow-up (range 12-46 months)
Pain was less in the DM group during the first week, but no difference after 2 weeks; quality of life was similar between groups
Who was studied
patients with grade III (third-degree) hemorrhoids
What they received
Doppler-guided hemorrhoidal dearterialization with mucopexy (DM)
Compared with
ultrasonic scalpel hemorrhoidectomy (US)
Main outcome
pain after surgery
Quality
Small trial of only 44 patients comparing two surgical techniques, not addressing typical post-bowel-movement pain in the general population.
Limitations
Small sample size; studies specific surgical procedures for hemorrhoids rather than general post-defecation anal pain.
Taken word for word from the abstract
- population third-degree hemorrhoids
- n Forty-four patients were randomly assigned
- intervention transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM)
- comparator hemorrhoidectomy using an ultrasonic scalpel (US)
- primaryOutcome The primary endpoint was postoperative pain with quality of life
- result Postoperative pain was less intense in the DM group than in the US group during week 1 (p < 0.05), but no difference was seen after 2 weeks.
- followUp median 33-month follow-up (range 12-46 months)
Tech Coloproctol · PMID 28871428 · Read it on PubMed ↗
Tessier et al. 2017
Immigrant with stomach pain, distension, nausea, and fever · Dx?
One unusual post-surgery complication case.Case seriesVery low qualityRelated question
1 people2017
Patient developed worsening abdominal pain, distention, inability to urinate, no bowel movement for 6 days, fevers, night sweats, chills, and weight loss; underlying cause not given in this excerpt
Who was studied
34-year-old man from Eritrea, recently emigrated, after hemorrhoid surgery
What they received
none (case report of symptoms after hemorrhoidectomy)
Main outcome
cause of abdominal pain, distention, nausea, fever after recent hemorrhoid surgery
Quality
This is a single patient case report, which cannot show whether any treatment works or what typically causes pain after bowel movements.
Limitations
Single case report; abstract does not give a final diagnosis or explain why the anus hurts after pooping in general; findings concern a rare, complex post-surgical case, not typical post-defecation anal pain.
Taken word for word from the abstract
- n A 34-year-old Eritrean man presented to the emergency department
- population A 34-year-old Eritrean man presented to the emergency department with complaints of diffuse abdominal pain and distention.
- intervention following a recent hemorrhoidectomy
- primaryOutcome complaints of diffuse abdominal pain and distention
- result he was unable to urinate and had not had a bowel movement in 6 days. He also described fevers, drenching night sweats, chills, and a 4-kg weight loss over 2 months.
J Fam Pract · PMID 28863202 · Read it on PubMed ↗
Mahboubi 2017
Effectiveness of Myrtus communis in the treatment of hemorrhoids
Less hemorrhoid pain and bleeding.Narrative reviewVery low quality
size not given2017
essential oil significantly improved bleeding, pain, pain during defecation, anal irritation, itching and heaviness, including in patients who had not responded to standard treatments
Who was studied
people with hemorrhoids (grades I and II)
What they received
Myrtus communis essential oil (as a lotion or ointment)
Compared with
current chemical anti-hemorrhoid ointment treatments (in patients who had not responded to them)
Main outcome
bleeding, ongoing pain, pain during defecation, anal irritation, itching and heaviness
Quality
this is a narrative review summarizing other studies without describing study design, sample sizes, or methods, so its claims can't be checked or weighed reliably.
Limitations
The abstract gives no details on the number or design of the clinical studies referenced, no statistics, and states further studies (e.g. suppository form) are still needed.
Taken word for word from the abstract
- population patients with hemorrhoids types I and II
- intervention M. communis essential oil (lotion or ointment)
- comparator patients who did not respond to current chemical treatments (anti-hemorrhoids ointment)
- primaryOutcome bleeding, permanent pain, pain during defecation, anal irritation, anal itching and anal heaviness
- result can significantly improve bleeding, permanent pain, pain during defecation, anal irritation, anal itching and anal heaviness in patients with hemorrhoids types I and II
J Integr Med · PMID 28844211 · Read it on PubMed ↗
Peng et al. 2017
[A multicenter, randomized controlled trial of wheat cellulose particles in the treatment of internal hemorrhoids]
No real improvement in pain itselfRandomised trialLow qualityRelated question
60 people7 days
the combined treatment group had a higher overall effective rate than the Diosmin-only group, but pain scores specifically did not differ significantly between the groups
Who was studied
adults aged 18 to 65 with grade 2 or 3 internal hemorrhoids
What they received
wheat cellulose particles (Fiberform) plus Diosmin tablets
Compared with
Diosmin tablets alone
Main outcome
improvement in hemorrhoid symptoms including bleeding, pain, prolapse, stool shape, defecation frequency and duration, scored and compared as an overall effective rate
Quality
it is a small, short (7-day) trial comparing an added fiber product to a drug alone, with no mention of blinding, so it offers only weak evidence.
Limitations
small sample size of 60 patients, short 7-day treatment course, and no significant improvement specifically in pain scores between groups
Taken word for word from the abstract
- n 60 patients with internal hemorrhoid were enrolled
- population Patients aging from 18 to 65 years old; being diagnosed with the second or third grade internal hemorrhoid
- intervention wheat cellulose particles 1 bag each time, 2 times per day; Diosmin tablet 2 pills, 2 times per day
- comparator Diosmin tablet 2 pills, 2 times per day
- primaryOutcome the efficacy evaluation would be made on six indicators, which were the degree of hematochezia or bleeding, the degree of pain, hemorrhoid prolapse, the shapes and properties of stool, the defecation frequency and the defecation duration
- result there was significant difference in effective rate between combination group and single group [96.7%(29/30) vs. 66.7%(20/30), Z=-4.376, P=0.000]
- result The scores of pain degree and hemorrhoid prolapse of two groups also decreased, but the difference was not statistically significant (P>0.05).
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 28722093 · Read it on PubMed ↗
Shekhawat et al. 2017
Management of internal bleeding piles by ligation and plication followed by Matra Basti - A case report
Symptoms resolved after combined procedure.Case seriesVery low qualityRelated question
1 people3 months
pile mass and bleeding resolved in 10 days, full symptom relief by 4 weeks, no recurrence seen at 3 months follow-up
Who was studied
a 45-year-old man with internal hemorrhoids causing pain, bleeding and prolapse during bowel movements
What they received
surgical tying and stitching of the piles followed by an Ayurvedic medicated oil enema (Matra Basti with Jatyadi oil)
Compared with
none - single patient treated, no comparison group
Main outcome
resolution of pile mass, bleeding, and symptoms; recurrence on follow-up
Quality
this is a single patient case report with no comparison group, so it cannot show whether the treatment caused the improvement.
Limitations
only one patient was treated and described, with no control group and no blinding mentioned.
Taken word for word from the abstract
- n A 45-year-old male patient came to the OPD
- population complaints of prolapsing pile mass during defecation, pain per anum with erosion and bleeding per anum while passing stool
- intervention Ligation of pile mass by surgical linen barbour thread number 20 on 11 O'clock positions and plication by absorbable chromic catgut on 3 O'clock positions of internal hemorrhoid were done under local anesthesia followed by Matra Basti (therapeutic oil enema) with Jatyadi oil.
- comparator A 45-year-old male patient came to the OPD
- primaryOutcome The pile mass and per rectal bleeding resolved in 10 days and the patient got relief from all the symptoms within 4 weeks.
- result The pile mass and per rectal bleeding resolved in 10 days and the patient got relief from all the symptoms within 4 weeks. No complications were reported after the procedure.
- followUp followed up regularly from the registered date onward till 3 months
Ayu · PMID 30254394 · Read it on PubMed ↗
Lin et al. 2017
A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspension clamp combined with harmonic scalpel
Less pain after hemorrhoid surgery, newer technique.RetrospectiveLow qualityRelated question
99 people20 days
ACS technique caused less pain during bowel movements and fewer complications than standard MMH surgery
Who was studied
patients hospitalized with severe (stage III-IV) hemorrhoids undergoing surgery
What they received
homemade anal cushion suspension clamp combined with harmonic scalpel (ACS)
Compared with
Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH)
Main outcome
postoperative pain and complications after hemorrhoid surgery
Quality
This was a retrospective (not randomized) study comparing two surgical techniques, so it can't rule out bias in how patients were selected for each treatment.
Limitations
Retrospective design, not randomized, specific to surgical patients with advanced (stage III-IV) hemorrhoids rather than general post-defecation anal pain.
Taken word for word from the abstract
- n We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013.
- population patients with stages III to IV hemorrhoids hospitalized from January to December in 2013
- intervention homemade anal cushion suspension clamp combined with harmonic scalpel (ACS)
- comparator Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH)
- primaryOutcome postoperative pain, and postoperative complications
- result The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05).
Medicine (Baltimore) · PMID 28658138 · Read it on PubMed ↗
Gaj et al. 2017
Anal self-massage in the treatment of acute anal fissure: a randomized prospective study
Finger massage healed fissures faster.Randomised trialLow quality
50 people6 months
80% of the finger-massage group had their fissure heal versus 60% of the dilator group, with greater pain reduction at 6 months in the massage group
Who was studied
adults with a newly diagnosed anal fissure
What they received
self-massage of the anal sphincter using a finger
Compared with
passive anal dilatation using dilators
Main outcome
healing of the anal fissure and reduction in anal pain and bleeding after bowel movements
Quality
It was a small randomized trial of only 50 patients with no mention of blinding, which limits confidence in the results.
Limitations
Small sample size; abstract does not mention blinding or long-term fissure recurrence data.
Taken word for word from the abstract
- n Fifty patients with a clinical diagnosis of AF were randomly assigned
- population Fifty patients with a clinical diagnosis of AF
- intervention self-massage of the anal sphincter (group A, 25 patients)
- comparator passive dilatation using dilators (group B, 25 patients)
- primaryOutcome reducing anal pressure and resolving anal fissures
- result 60% of patients treated with dilators and 80% of patients treated with anal self-massage using a finger showed disappearance of their anal fissures
- result a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02)
Ann Gastroenterol · PMID 28655981 · Read it on PubMed ↗
Lyons et al. 2017
Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief
Less pain after haemorrhoid surgeryMeta-analysisModerate qualityRelated question
437 people7 days
metronidazole significantly reduced pain on days 1, 2, and 7 after surgery and during the first bowel movement
Who was studied
patients who had surgery to remove haemorrhoids
What they received
metronidazole (an antibiotic) after haemorrhoidectomy surgery
Compared with
no metronidazole (placebo or standard care)
Main outcome
pain levels after surgery, including pain during the first bowel movement
Quality
this pools several randomized trials, but the studies varied in quality and in the severity of haemorrhoids treated, and this is about pain after surgical removal of haemorrhoids, not pain after a normal bowel movement.
Limitations
variation in the grade of haemorrhoids treated and variability in the quality of included studies
Taken word for word from the abstract
- population Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids.
- intervention metronidazole is often used to reduce postoperative pain
- comparator investigated the use of metronidazole for pain relief after haemorrhoidectomy
- primaryOutcome The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale.
- result The meta-analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of -1.42 (95% CI: -2.14 to -0.69, P = 0.0001), on day 2 of -1.43 (95% CI: -2.45 to -0.40, P = 0.006) and on day 7 of -2.40 (95% CI: -3.10 to -1.71, P < 0.00001).
- n a total population of 437 patients
Colorectal Dis · PMID 28589634 · Read it on PubMed ↗
Bildstein et al. 2017
Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders
Pain and fissures caused treatment dropout.RetrospectiveLow qualityRelated question
108 peopleone year
43% of patients were still using TAI after one year, and common reasons for stopping included pain during irrigation, anal fissure and anal bleeding
Who was studied
adults with constipation or fecal incontinence being trained in transanal irrigation
What they received
transanal irrigation (TAI) therapy
Compared with
no comparison group; patients compared by whether they continued or stopped TAI
Main outcome
whether patients kept using transanal irrigation one year after training
Quality
It is a retrospective, single-center study without a control group, so it only tracks compliance and side effects rather than proving benefit or harm.
Limitations
Retrospective design, single institution, no control group, and outcomes assessed by intention-to-treat with discontinuation reasons self-reported by patients.
Taken word for word from the abstract
- n one hundred eight patients
- population suffering from constipation or fecal incontinence (FI)
- intervention compliance with transanal irrigation (TAI) one year after a training session
- comparator classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped
- primaryOutcome To investigate compliance with transanal irrigation (TAI) one year after a training session and to identify predictive factors for compliance
- result Forty-six of the 108 (43%) trained patients continued to use TAI one year after their training session
- result technical problems (catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure)
World J Gastroenterol · PMID 28373769 · Read it on PubMed ↗
Jeong et al. 2017
Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III-IV Prolapsing Hemorrhoids
New hemorrhoid surgery had few complications.RetrospectiveLow qualityRelated question
58 people2017
low complication rates with no urge to defecate, tenesmus, abscess, fistula, stricture, incontinence, or recurrence
Who was studied
patients with grade III-IV prolapsing hemorrhoids
What they received
partial stapled hemorrhoidopexy surgery
Compared with
none (single group, compared to typical circular stapled hemorrhoidopexy complications from prior knowledge)
Main outcome
surgical complications and safety
Quality
This is a small retrospective case series without a comparison group, so it cannot reliably prove the technique is better or explain why pooping hurts.
Limitations
Retrospective design, no control group, small sample size, short follow-up implied by hospital stay data only.
Taken word for word from the abstract
- n 58 patients with hemorrhoids who were treated with a PSH
- population patients with grades III-IV hemorrhoids
- intervention partial stapled hemorrhoidopexy (PSH)
- comparator Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III-IV hemorrhoids
- primaryOutcome present our early experience with the PSH
- result Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur.
Ann Coloproctol · PMID 28289661 · Read it on PubMed ↗
Grapsi et al. 2017
Mucocele complicating stapled hemorrhoidopexy
Rare surgery complication caused pain.Case seriesVery low qualityRelated question
1 peopleone year
after surgical drainage of the mucocele, the patient became symptom-free with normal bowel movements after one year
Who was studied
a 57-year-old woman who had surgery for hemorrhoids (stapled hemorrhoidopexy)
What they received
surgical drainage of a mucus-filled pocket (mucocele) near the rectum
Compared with
no comparison group, just one patient's case
Main outcome
symptoms like perineal discomfort, anal spasm, and straining, and whether they resolved after treatment
Quality
this is a single patient case report, so it cannot show how common or typical this cause of pain is.
Limitations
only one patient described, no control group, and this applies specifically to people who previously had stapled hemorrhoid surgery rather than general post-defecation anal pain.
Taken word for word from the abstract
- population Female patient, 57 years was treated with stapled hemorrhoidopexy.
- intervention A surgical operation was performed and a great amount of mucus was drained.
- comparator PRESENTATION OF CASE: Female patient, 57 years was treated with stapled hemorrhoidopexy.
- primaryOutcome she reported to our center the occurrence of perineal discomfort, anal spasm and tenesmus
- result After one year the patient is completely asymptomatic with normal defecation.
- n Female patient, 57 years was treated with stapled hemorrhoidopexy.
- followUp After one year the patient is completely asymptomatic with normal defecation.
Int J Surg Case Rep · PMID 28273604 · Read it on PubMed ↗
Shen et al. 2017
Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study
Less pain after hemorrhoid surgery.Randomised trialLow qualityRelated question
315 people28 days
less pain and less need for pain medication at several points after surgery, including after pooping
Who was studied
patients who had surgery to remove hemorrhoids
What they received
sitz bath with Xiaozhi decoction (a herbal medicine) after surgery
Compared with
sitz bath with warm water after surgery
Main outcome
pain after surgery and pain during bowel movements
Quality
this studied pain after hemorrhoid surgery, not everyday pain after pooping without surgery, and does not describe blinding of patients or outcome assessors.
Limitations
abstract does not mention blinding; population is post-surgical hemorrhoidectomy patients, not general population with pain after defecation
Taken word for word from the abstract
- n 315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study
- population patients who underwent open hemorrhoidectomy in our hospital
- intervention 155 patients were randomly assigned to accept sitz bath with XZD
- comparator 160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy
- primaryOutcome Postoperative pain at 12 hours after surgery and on postoperative days (PODs) 1, 2, 7, 14 and 28 was evaluated by Visual Analog Scale (VAS). Pain on defecation on PODs 1, 2, 7, 14 and 28 was also recorded using the VAS.
- result patients in the XZD group experienced significantly less pain on defecation on POD 2 (5.02±1.34 vs 5.43±1.56, P=0.0130), POD 7 (3.08±1.17 vs 3.52±1.29, P=0.0017) and POD 14 (2.31±0.85 vs 2.68±0.99, P=0.0004)
J Pain Res · PMID 28176917 · Read it on PubMed ↗
Venturi et al. 2016
Stapled anopexy versus transanal hemorrhoidal dearterialization for hemorrhoidal disease: a three-year follow-up from a randomized study
Similar pain between two hemorrhoid surgeries.Randomised trialLow qualityRelated question
70 people36±6 months
pain levels were about the same with both surgeries
Who was studied
adults with third- or fourth-degree hemorrhoids needing surgery
What they received
stapled anopexy (a hemorrhoid surgery)
Compared with
transanal hemorrhoidal dearterialization with anopexy (another hemorrhoid surgery)
Main outcome
hemorrhoids coming back after surgery
Quality
small randomized study of a specific surgical population, so it says little about ordinary pain after a bowel movement in people without hemorrhoid surgery.
Limitations
Small groups (totaling 70 patients), specific to surgical hemorrhoid patients, and costs/complications differed by surgery type.
Taken word for word from the abstract
- population Forty patients with third-degree and 30 with fourth-degree hemorrhoids
- intervention stapled anopexy (SA)
- comparator transanal hemorrhoidal dearterialization with anopexy (THD)
- primaryOutcome incidence of recurrent hemorrhoids as primary outcome measure
- result Operative time, complications, pain, and time of return to normal activity were similar in the 4 groups.
- n Forty patients with third-degree and 30 with fourth-degree hemorrhoids were randomly submitted to SA (N.=20+15) and THD (N.=20+15)
- followUp 36±6 months follow-up
Minerva Chir · PMID 27813396 · Read it on PubMed ↗
Ala et al. 2017
Effects of Topical Atorvastatin (2 %) on Posthemorrhoidectomy Pain and Wound Healing: A Randomized Double-Blind Placebo-Controlled Clinical Trial
Less pain after hemorrhoid surgery.Randomised trialLow qualityRelated question
66 people14 days
no difference in pain in the first 48 hours, but less pain during defecation at week 1 and 2, and better wound healing at week 2, with atorvastatin
Who was studied
patients with third- and fourth-degree hemorrhoids who had surgery to remove them
What they received
atorvastatin gel applied to the wound after hemorrhoid surgery
Compared with
placebo gel applied after hemorrhoid surgery
Main outcome
pain at rest and during bowel movements, pain medicine use, and wound healing
Quality
small trial of only 66 patients studying a specific post-surgery condition, not ordinary pain after a normal bowel movement
Limitations
small sample size; studies pain after surgical hemorrhoid removal, not general anal pain after defecation
Taken word for word from the abstract
- population A total of 66 patients with third- and fourth-degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial.
- intervention The patients were randomly assigned to either atorvastatin emulgel or placebo immediately after surgery and then every 12 h for 14 days.
- comparator The patients were randomly assigned to either atorvastatin emulgel or placebo immediately after surgery and then every 12 h for 14 days.
- primaryOutcome The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of pethidine and acetaminophen consumption, and percent of wound healing.
- result There was no significant difference in the average postoperative pain scores in the first 48 h (P 12h = 1, P 24h = 0.128 and P 48h = 0.079) after the surgery between the two groups, but at the week 1 the pain scores during defecation were considerably lower in the atorvastatin group than in placebo group (P = 0.004), which also was the same at the week 2 (P = 0.03).
- n A total of 66 patients with third- and fourth-degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial.
World J Surg · PMID 27738832 · Read it on PubMed ↗
Bharucha et al. 2016
Anorectal and Pelvic Pain
General overview, no specific treatment result.Narrative reviewLow qualityRelated question
size not given2016
the review describes management as tailored to symptoms and only partly supported by clinical trials, without giving a specific outcome result
Who was studied
people with anorectal and pelvic pain from functional disorders such as levator ani syndrome, unspecified anorectal pain, proctalgia fugax, bladder pain syndrome, or chronic prostatitis
What they received
multidisciplinary management including lifestyle changes, medications, behavioral therapy, and physical therapy
Compared with
opioids or surgery, which the review says should mostly be avoided or have limited use
Main outcome
pelvic and anorectal pain symptoms
Quality
This is a general review article summarizing conditions and treatments rather than a study testing whether a specific treatment works.
Limitations
The review focuses on functional pelvic pain conditions like levator ani syndrome and bladder/prostate pain syndromes, and explicitly excludes structural causes like anal fissure, which may be more relevant to pain right after a bowel movement.
Taken word for word from the abstract
- population this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome
- intervention includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy
- comparator Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
- primaryOutcome pelvic pain is a symptom of several structural anorectal and pelvic disorders
- result The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy.
Mayo Clin Proc · PMID 27712641 · Read it on PubMed ↗
van Meegdenburg et al. 2016
Increased anal basal pressure in chronic anal fissures may be caused by overreaction of the anal-external sphincter continence reflex
Pain may come from sphincter muscle spasm.Narrative reviewVery low qualityRelated question
1 people2016
pressure dropped right after surgery while anesthetic was active, but rose again after the anesthetic wore off even though the internal sphincter had been cut, suggesting the external sphincter, not the internal one, is driving the high pressure
Who was studied
people with chronic anal fissures (painful tears in the anal lining)
What they received
surgical cutting of the internal anal sphincter (lateral sphincterotomy)
Compared with
anal pressure measured while anesthetic was still active versus after it had worn off
Main outcome
anal basal (resting) pressure after surgery
Quality
this is a theoretical hypothesis paper based mainly on one patient's case and reasoning from other studies, not a controlled trial.
Limitations
based on a single patient case and indirect reasoning, no formal study testing the hypothesis in a group of patients
Taken word for word from the abstract
- population patients suffering from chronic anal fissure
- intervention lateral sphincterotomy
- comparator Directly after the operation, while the submucosal anesthetic was still active, basal anal pressure decreased to 80mmHg. Seven hours after the operation, when the anesthetic had completely worn off, basal anal pressure increased again to 125mmHg
- primaryOutcome basal anal pressure decreased to 80mmHg
- result Directly after the operation, while the submucosal anesthetic was still active, basal anal pressure decreased to 80mmHg. Seven hours after the operation, when the anesthetic had completely worn off, basal anal pressure increased again to 125mmHg, even though the internal anal sphincter could no longer be responsible for the increase.
- n a chronic anal fissure patient with increased anal basal pressure (170mmHg) who had undergone lateral sphincterotomy
Med Hypotheses · PMID 27515194 · Read it on PubMed ↗
Asteria et al. 2016
Tailored therapy for different presentations of chronic pain after stapled hemorrhoidopexy
Post-surgery anal pain often improved with targeted treatment.RetrospectiveLow qualityRelated question
31 people2016
pain scores dropped significantly after treatment and stayed low at follow-up, with response rates varying by specific treatment (13-94% depending on method)
Who was studied
people with ongoing anal pain after stapled hemorrhoidopexy (a staple-based surgery for hemorrhoids)
What they received
tailored treatments chosen by pain type and cause (topical nifedipine, anal dilation, anesthetic/steroid injection, staple removal, scar excision)
Compared with
pain levels before treatment (baseline), not a separate control group
Main outcome
change in pain score (VAS) from before to after treatment
Quality
This was a small retrospective study without a comparison group, so improvement could be due to other factors besides the treatments themselves.
Limitations
Retrospective design, no control group, referred from other hospitals, and the abstract doesn't specify how long follow-up lasted.
Taken word for word from the abstract
- n We retrospectively analyzed 31 consecutive patients with chronic anal pain who had undergone SH
- population patients with chronic anal pain who had undergone SH in other hospitals and were referred to our institutions
- intervention Treatments included: topical nifedipine, local anesthetic and steroid infiltration, removal of retained staples, anal dilation, and scar excision with mucosal suturing.
- comparator A visual analog scale (VAS) was used to compare pain at baseline, postoperatively, and in the follow-up.
- primaryOutcome This mean difference of the VAS score between stages was always used as the main outcome measure
- result The mean VAS score at baseline was 6.100, ± 1.953 SD, which dropped significantly after treatment to 1.733, ± 1.658 SD (p < 0.001) and remained low at follow-up
- result Success for topical nifedipine was between 13 and 25 % of patients depending on the clinical presentation.
- result scar excision with mucosal suturing in 94 % of patients
Tech Coloproctol · PMID 27037709 · Read it on PubMed ↗
Bhatti et al. 2016
Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials
Surgery type didn't change pain when pooping.Meta-analysisModerate qualityRelated question
1,326 people2016
Closed surgery caused less overall post-op pain, less bleeding, and faster healing, but pain specifically during bowel movements was not significantly different between the two methods
Who was studied
patients having surgery to remove hemorrhoids
What they received
closed (Ferguson) hemorrhoid removal surgery
Compared with
open (Milligan-Morgan) hemorrhoid removal surgery
Main outcome
pain after surgery, including pain with bowel movements, bleeding, and wound healing
Quality
It pools several randomized trials but the studies differed a lot from each other, which makes the combined results less certain.
Limitations
Significant heterogeneity among included trials was noted by the authors.
Taken word for word from the abstract
- n Eleven CRTs encompassing 1326 patients were analysed systematically.
- population the management of haemorrhoidal disease (HD)
- intervention Ferguson or closed haemorrhoidectomy (CH)
- comparator open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy
- primaryOutcome pain on defecation
- result pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups
- limitations There was significant heterogeneity among included trials.
World J Surg · PMID 26813541 · Read it on PubMed ↗
He et al. 2015
[Meta-analysis of randomized controlled trials comparing procedure for prolapse and hemorrhoids with Milligan-Morgan hemorrhoidectomy in the treatment of prolapsed hemorrhoids]
Less pain short-term, but more recurrence.Meta-analysisModerate qualityRelated question
1,411 people1 year
PPH caused less pain after surgery and during the first bowel movement, faster recovery, but higher chance of hemorrhoids coming back after a year
Who was studied
patients with prolapsed hemorrhoids undergoing surgery
What they received
stapled hemorrhoidopexy (procedure for prolapse and hemorrhoids, PPH)
Compared with
traditional hemorrhoid removal surgery (Milligan-Morgan hemorrhoidectomy, MMH)
Main outcome
pain, recovery time, complications and recurrence after surgery
Quality
it combines many randomized trials which strengthens the findings, but the individual trials may vary in quality and this is about surgical patients, not general post-bowel-movement pain.
Limitations
The abstract does not describe the quality of individual trials in detail or discuss publication bias.
Taken word for word from the abstract
- n Sixteen RCTs recruiting 1411 patients were identified.
- population the treatment of prolapsed hemorrhoids
- intervention procedure for prolapse and hemorrhoids (PPH)
- comparator Milligan-Morgan hemorrhoidectomy (MMH)
- primaryOutcome To compare the safety and efficacy of procedure for prolapse and hemorrhoids (PPH) with Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of prolapsed hemorrhoids.
- result Patients in PPH group experienced less pain at postoperative 24 h, postoperative 1 week and the first postoperative bowel movement (all P<0.01).
- result higher ratio of recurrent disease after 1 year (RR=2.54, 95% CI: 1.21 to 5.31, P=0.010)
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 26704004 · Read it on PubMed ↗
Ala et al. 2016
Comparison of captopril (0.5%) cream with diltiazem (2%) cream for chronic anal fissure: a prospective randomized double-blind two-centre clinical trial
Similar pain relief, but captopril caused more itching.Randomised trialLow quality
50 people8 weeks
diltiazem gave lower pain scores early on (days 20-30), but by day 40 both creams gave similar pain relief; captopril caused much more itching
Who was studied
patients aged 15-75 with chronic anal fissure
What they received
topical captopril cream (0.5%) applied twice daily
Compared with
topical diltiazem cream (2%) applied twice daily
Main outcome
pain intensity during bowel movements, measured over 8 weeks
Quality
small trial of only 50 patients, so results may not be reliable or generalizable.
Limitations
small sample size
Taken word for word from the abstract
- n Fifty patients aged between 15 and 75 years with CAF were included
- population patients aged between 15 and 75 years with CAF
- intervention They were randomly allocated to either captopril (0.5%) cream or diltiazem (2%) cream in a dose of 2 cm of cream on the perianal skin every 12 h for 8 weeks.
- comparator They were randomly allocated to either captopril (0.5%) cream or diltiazem (2%) cream in a dose of 2 cm of cream on the perianal skin every 12 h for 8 weeks.
- primaryOutcome The intensity of pain upon defaecation was evaluated every 10 days using a visual analogue scale.
- result The average pain scores were lower in the diltiazem group on the 20th and 30th days. From day 40 to the end of the trial the average pain scores of the two groups did not differ significantly.
- result the incidence of pruritus was considerably higher in the captopril group, and at the end of the trial 45.8% of the patients in this group still suffered from pruritus
Colorectal Dis · PMID 26456162 · Read it on PubMed ↗
Simillis et al. 2015
Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids
Surgery type trades less pain for more recurrence.Meta-analysisModerate qualityRelated question
7,827 people2015
newer techniques like THD, stapled, LigaSure and Harmonic caused less pain and faster recovery but more haemorrhoids came back, while open and closed surgery caused more pain and complications but fewer recurrences
Who was studied
adults with grade III and IV haemorrhoids having surgery
What they received
different surgical techniques for removing haemorrhoids (open, closed, stapled, THD, LigaSure, Harmonic, radiofrequency)
Compared with
the other surgical techniques compared against each other
Main outcome
pain, complications, recovery time and haemorrhoid recurrence after surgery
Quality
it pooled many randomized trials with thousands of patients, but combining 11 different surgeries indirectly makes the comparisons less certain.
Limitations
Network meta-analysis combines indirect comparisons across many different trials and surgical techniques, which can introduce uncertainty; findings apply only to surgical patients with grade III/IV haemorrhoids, not general anal pain after bowel movements.
Taken word for word from the abstract
- n Ninety-eight trials were included with 7827 participants
- population 11 surgical treatments for grade III and IV haemorrhoids
- intervention Open, closed and radiofrequency haemorrhoidectomies resulted in significantly more postoperative complications than transanal haemorrhoidal dearterialization (THD), LigaSure™ and Harmonic® haemorrhoidectomies
- comparator THD had significantly less postoperative bleeding than open and stapled procedures
- primaryOutcome compare the clinical outcomes and effectiveness of surgical treatments for haemorrhoids
- result Open and closed haemorrhoidectomies resulted in more postoperative complications and slower recovery, but fewer haemorrhoid recurrences. THD and stapled haemorrhoidectomies were associated with decreased postoperative pain and faster recovery, but higher recurrence rates.
Br J Surg · PMID 26420725 · Read it on PubMed ↗
Khaledifar et al. 2015
A Double-Blind Randomized Trial Comparing the Effectiveness and Safety of Nifedipine and Isosorbide Dinitrate in Chronic Anal Fissure
Nifedipine healed fissures better, less painRandomised trialLow quality
70 people21 days
more patients healed and less pain with nifedipine than ISDN
Who was studied
adults aged 20-60 with chronic anal fissure
What they received
nifedipine 0.3% cream applied three times daily
Compared with
isosorbide dinitrate 0.2% cream applied three times daily
Main outcome
healing of fissure and pain levels after 21 days
Quality
Small trial with borderline statistical significance for the main healing outcome and no mention of blinding success or loss to follow-up.
Limitations
small sample size; healing difference only borderline significant (P = 0.05)
Taken word for word from the abstract
- n nifedipine 0.3% (n = 35) or ISDN 0.2% (n = 35)
- population patients aged 20 to 60 years old
- population a primary diagnosis of chronic anal fissure
- intervention nifedipine 0.3% (n = 35)
- comparator ISDN 0.2% (n = 35)
- primaryOutcome symptoms including bleeding, pain, and healing status
- result complete healing was achieved in 77.1% (n = 27) of patients in the nifedipine group and 51.4% (n = 18) in the ISDN group (P = 0.05)
- result The mean VAS of the pain on day 21 was 0.91 (SD 0.01) in the ISDN group and 0.45±0.78 in the nifedipine group, with a statistically significant difference (P = 0.038)
Malays J Med Sci · PMID 28239267 · Read it on PubMed ↗
Lohsiriwat 2015
Treatment of hemorrhoids: A coloproctologist's view
Review of hemorrhoid treatments, not pain causeNarrative reviewVery low qualityRelated question
size not given2015
not a study result; this is an overview of treatment approaches for hemorrhoids
Who was studied
people with hemorrhoids
What they received
various hemorrhoid treatments (medication, rubber band ligation, injection, surgery)
Compared with
different treatment options compared to each other
Main outcome
management and outcomes of hemorrhoids
Quality
This is an editorial/review summarizing general knowledge and opinion, not a study with data on this specific question.
Limitations
This is a general review article, not a study testing a specific treatment or measuring post-defecation pain; it does not address why pain occurs after pooping specifically.
Taken word for word from the abstract
- population Hemorrhoids is recognized as one of the most common medical conditions in general population.
- intervention several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain
- comparator low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy)
- primaryOutcome This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist
- result Future perspectives in the treatment of hemorrhoids are also discussed.
World J Gastroenterol · PMID 26309351 · Read it on PubMed ↗
Lu et al. 2015
Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation
Less pain after hemorrhoid-prolapse surgery with PPH.Randomised trialLow qualityRelated question
108 people2015
Pain scores were lower with PPH surgery than with traditional surgery at 24 hours, at first defecation, and one week after surgery, and complications like perianal swelling and reduced anal sensation were also less common
Who was studied
patients having surgery for constipation caused by internal rectal prolapse with circumferential hemorrhoids
What they received
procedure for prolapse and hemorrhoids (PPH) surgery
Compared with
conventional (traditional) surgery
Main outcome
pain after surgery, measured at 24 hours, at first bowel movement, and one week later
Quality
it is a randomized trial but from a single hospital with a small, specific surgical population, so it may not apply to general anal pain after pooping
Limitations
Single-center study in patients with a specific surgical condition (rectal prolapse with hemorrhoids), not general anal pain after bowel movements; short study period (2012-2013).
Taken word for word from the abstract
- n One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids
- population patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation
- intervention procedure for prolapse and hemorrhoids (PPH) (n = 54)
- comparator conventional surgery (n = 54; control group)
- primaryOutcome The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery
- result The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01)
World J Gastroenterol · PMID 26185392 · Read it on PubMed ↗
Dessily et al. 2014
Injection of a sclerosing agent as first line treatment in anal fissure
High healing rates after fissure injection.Case seriesLow quality
109 people2014
53 of 58 acute fissures (91.4%) and 40 of 51 chronic fissures (78.4%) healed after injection
Who was studied
patients with anal fissure (tear near the anus)
What they received
injection of a sclerosing agent (phenol, menthol and peanut oil) under the fissure
Compared with
none (single-group study, no comparison treatment)
Main outcome
whether the fissure healed
Quality
This was a retrospective study of one treatment with no comparison group, so it can't show if the injection worked better than other options.
Limitations
Retrospective design, no control group, and some complications (necrosis, abscess) and continence problems occurred.
Taken word for word from the abstract
- n 109 patients benefited from a sclerosis in our outpatient clinic.
- population 129 patients with an anal fissure were treated between January 2010 and June 2011.
- intervention the injection of a sclerosing agent consisting of phenol, menthol and peanut oil (Phenomen®, Sterop laboratory, Belgium) under the fissure after a local anaesthesia
- comparator Of the 109 patients treated by a sclerosis, 58 had an AAF and 51 had a CAF.
- primaryOutcome evaluates its efficacy
- result 53/58 AAF (91.4%) healed and 40/51 CAF (78.4%).
Acta Chir Belg · PMID 26021422 · Read it on PubMed ↗
Amouzeshi et al. 2015
The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery
Less pain with bisacodyl prep.Randomised trialLow qualityRelated question
79 people1 mo
bisacodyl group had less pain after the first postoperative defecation and fewer complications than the enema group
Who was studied
patients hospitalized for anorectal surgery (hemorrhoids, fissure, fistula)
What they received
bowel preparation with bisacodyl tablets before surgery
Compared with
bowel preparation with saline rectal enema before surgery
Main outcome
pain after the first bowel movement following surgery
Quality
Small randomized trial with only 79 patients and unclear blinding of patients, so the pain difference may not be reliable.
Limitations
Abstract does not mention blinding of patients or surgeons, and sample size is small; this studies post-surgical anorectal pain, not pain after normal bowel movements without surgery.
Taken word for word from the abstract
- n A total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets.
- population Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula)
- intervention six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel
- comparator receive 500 cc Saline by rectal enema
- primaryOutcome the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0-10 scores
- result the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema
J Surg Res · PMID 25979561 · Read it on PubMed ↗
Szyca et al. 2015
Assessment of patients' quality of life after haemorrhoidectomy using the LigaSure device
Less pain after hemorrhoid surgery.Case seriesLow qualityRelated question
50 people1 year
pain was significantly lower by 3 months after surgery and remained lower at 1 year
Who was studied
adults with hemorrhoids who had surgery to remove them
What they received
hemorrhoidectomy surgery using the LigaSure device (Ferguson method)
Compared with
same patients' pain and quality of life before surgery
Main outcome
pain level and quality of life before and after surgery
Quality
Small group of 50 patients with no comparison group, just checking the same people before and after surgery.
Limitations
No control group, small sample, self-reported pain and quality of life measures
Taken word for word from the abstract
- n among 50 patients treated due to haemorrhoids
- population 50 patients treated due to haemorrhoids and operated on in the period 2007-2008
- intervention quality of patients' life after haemorrhoidectomy by Ferguson's method using a LigaSure appliance
- comparator whether patients perceived a difference before and after surgery
- primaryOutcome describe and classify the pain before and 1 year after the haemorrhoidectomy
- result which was statistically significantly lower already 3 months after the operation
Wideochir Inne Tech Maloinwazyjne · PMID 25960796 · Read it on PubMed ↗
Grekova et al. 2015
The effects of topical application of metronidazole for treatment of chronic anal fissure: A randomized, controlled pilot study
Faster fissure healing with antibacterial cream.Randomised trialLow quality
47 people28 days
more fissures healed with metronidazole (95.6%) than with conventional treatment (70.8%)
Who was studied
patients with chronic anal fissures and anaerobic bacteria found in fissure swabs
What they received
topical metronidazole (antibacterial cream) applied to the fissure
Compared with
conventional treatment for anal fissure
Main outcome
fissure healing confirmed by anoscopy
Quality
this was a small pilot study of only 47 patients with a result just barely reaching statistical significance.
Limitations
small pilot study; only included patients whose fissures tested positive for anaerobic bacteria, so may not apply to all anal fissures.
Taken word for word from the abstract
- n Patients in whose samples anaerobic bacteria were identified (47 patients) were then invited to participate
- population Patients with anaerobic bacteria in their swabs
- intervention topical metronidazole
- comparator comparing topical metronidazole with conventional treatment
- primaryOutcome The primary endpoint was fissure healing confirmed on anoscopy.
- result enhanced fissure healing (95.6 % healing rate compared with 70.8 % in the control group, p = 0.048)
Indian J Gastroenterol · PMID 25925729 · Read it on PubMed ↗
Raahave 2015
Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy
Treating constipation reduced anal pain.Case seriesLow qualityRelated question
size not given5 years
After the bowel-stimulation treatment, pain and bloating were significantly reduced and proctalgia and flu-like episodes were significantly reduced; after stapled haemorrhoid surgery, post-operative pain was described as low
Who was studied
people with long-term bowel problems such as constipation, irritable bowel symptoms and haemorrhoids
What they received
a bowel-stimulation program (high-fibre diet, fluids, exercise and a bowel-stimulant drug), and in some patients surgery for haemorrhoids (stapled haemorrhoidopexy)
Main outcome
anal pain after bowel movements (proctalgia) and related bowel symptoms such as bloating and difficult defecation
Quality
this is a mix of uncontrolled before-and-after studies and surgical case series without randomization or blinding, so the improvement could be due to other factors.
Limitations
No randomization or control group for the bowel-stimulation intervention; surgical series without comparison group; multiple different patient groups combined (constipation, appendicitis, haemorrhoids) making it hard to isolate the cause of anal pain after defecation.
Taken word for word from the abstract
- population Patients with functional bowel disorders, predominantly women, had a significantly increased CTT and faecal load compared to controls.
- intervention Intervention with a bowel stimulation regimen combining a fibre-rich diet, fluid, physical activity, and a prokinetic drug was essential to proving that abdominal symptoms and defecation disorders are caused by faecal retention, with or without a prolonged CTT.
- intervention a novel operation to cure this disease, stapled haemorrhoidopexy (n = 40 and 258 patients)
- primaryOutcome Proctalgia and flue-like episodes were significantly reduced.
- result Bloating and pain were reduced significantly.
- result The operation time was short, post-operative pain was low, and recovery was rapid.
- followUp the durability of procedure was confirmed with a follow-up of up to 5 years
Dan Med J · PMID 25748875 · Read it on PubMed ↗
Wang et al. 2015
Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy
Less pain after bowel movements with TST surgery.Randomised trialModerate qualityRelated question
480 peopleone year after the operation
TST patients had less pain at 12 hours, at first dressing change, and at first bowel movement than M-M patients, plus fewer complications
Who was studied
adults with severe hemorrhoids that bulge out (prolapsing hemorrhoids) having surgery
What they received
tissue selecting therapy (TST) stapler hemorrhoid surgery
Compared with
Milligan-Morgan hemorrhoidectomy (traditional surgical removal)
Main outcome
pain levels and complications after hemorrhoid surgery, including pain with first bowel movement
Quality
it was a randomized trial with a large number of patients, but it only looked at people having surgery for severe hemorrhoids, not general pain after pooping, and it was done at one hospital.
Limitations
Single-center study limited to patients undergoing surgery for severe prolapsing hemorrhoids; doesn't address non-surgical causes of pain after defecation.
Taken word for word from the abstract
- n Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n=240) and control (n=240) groups.
- population Four hundred and eighty patients with severe prolapsing hemorrhoids
- intervention Hemorrhoidectomies were performed with TST in the observation group
- comparator with the M-M technique in the control group
- primaryOutcome Pain was assessed on a visual analogue scale.
- result first defecation: 3.91±1.47 vs 5.63±1.98, P=0.001
World J Gastroenterol · PMID 25741159 · Read it on PubMed ↗
Balta et al. 2015
The effect of early warm plastic bag application on postoperative pain after hemorrhoidectomy: a prospective randomized controlled trial
Warm compress eased post-surgery painRandomised trialLow qualityRelated question
size not given2015
lower pain scores at rest on days 1 and 3, and lower pain during defecation on day 3, with less need for extra pain medicine
Who was studied
people who had surgery to remove hemorrhoids
What they received
warm plastic bag applied after surgery
Compared with
no warm bag treatment
Main outcome
pain levels after surgery, including pain during bowel movements
Quality
this is a small single trial about a specific surgical pain-relief method, not about everyday pain after a normal bowel movement
Limitations
abstract does not report number of participants, blinding, or how pain was measured beyond VAS scores
Taken word for word from the abstract
- population All patients were randomly divided into warm plastic bag and control groups
- intervention the study group received the warm bag application
- comparator the control group did not receive such a treatment
- primaryOutcome Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement.
- result Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation.
Am Surg · PMID 25642882 · Read it on PubMed ↗
Theodoropoulos et al. 2015
Dermal flap advancement combined with conservative sphincterotomy in the treatment of chronic anal fissure
Faster healing, less post-surgery painRetrospectiveLow qualityRelated question
62 people2015
the flap technique caused less pain, needed fewer painkillers, and healed faster with less soiling
Who was studied
adults with chronic anal fissure needing surgery
What they received
lateral internal sphincterotomy plus dermal flap advancement after fissure removal
Compared with
conventional lateral internal sphincterotomy alone
Main outcome
pain after surgery and during bowel movements, and how fast the wound healed
Quality
this compared two surgical groups from different time periods rather than randomly assigning patients, so other differences between the groups could explain the results
Limitations
not randomized, compared a new group to a previously treated group, no mention of blinding, long-term outcomes unclear
Taken word for word from the abstract
- population chronic anal fissure
- intervention "tailoring" the LIS to the apex of the CAF, but never greater than 1 cm, and by advancing a dermal flap for coverage of the CAF (LIS + flap) after fissurectomy
- comparator 32 patients who had been previously treated by CLIS
- primaryOutcome Pain at the first postoperative day, pain at defecation during the first week, postoperative use of analgesics, and time for patients' pain relief
- result Pain at the first postoperative day, pain at defecation during the first week, postoperative use of analgesics, and time for patients' pain relief were significantly less at the "LIS + flap" group (P < 0.01).
- n Thirty consecutive patients who underwent "LIS + flap" were compared with 32 patients who had been previously treated by CLIS.
Am Surg · PMID 25642874 · Read it on PubMed ↗
Dehghani et al. 2015
Clinical Manifestations among Children with Chronic Functional Constipation
Painful pooping tied to hard stool, fissures in kids.Case seriesVery low qualityRelated question
222 people2015
anal fissures and fresh rectal bleeding were the least common symptoms, while painful defecation occurred in most children
Who was studied
children under 18 with long-term constipation seen at a pediatric gastroenterology clinic
What they received
no treatment was tested; researchers just recorded symptoms
Compared with
not applicable - no treatment comparison was made
Main outcome
how often different constipation-related symptoms occurred, including painful pooping and anal fissures
Quality
this was just a descriptive look at symptoms in kids with constipation, with no comparison group and no test of any treatment, so it can't tell us what causes anal pain after pooping in general.
Limitations
cross-sectional design with no control group, limited to children with chronic functional constipation, based on history and physical exam rather than objective testing
Taken word for word from the abstract
- n Of 222 children with functional constipation
- population children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences
- intervention This cross-sectional study was carried out on children
- comparator Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and peri-anal erythema were recorded for each case based on history and physical examination.
- primaryOutcome We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children.
- result Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group.
Middle East J Dig Dis · PMID 25628851 · Read it on PubMed ↗
Elshazly et al. 2015
Ligation anopexy versus hemorrhoidectomy in the treatment of second- and third-degree hemorrhoids
Less pain after newer hemorrhoid surgeryRandomised trialModerate qualityRelated question
200 people14 days
LA had shorter operative times, earlier bowel movement, earlier return to work, and lower pain scores on days 1,3,7,14 after surgery, with no difference in complications
Who was studied
patients with grade II and III hemorrhoids undergoing surgery
What they received
ligation anopexy (LA) surgery for hemorrhoids
Compared with
conventional hemorrhoidectomy (CH)
Main outcome
pain, complications, recovery time after hemorrhoid surgery
Quality
It was a randomized trial comparing two surgeries with 200 patients, but it doesn't address general causes of pain after bowel movements, only post-surgical recovery.
Limitations
Abstract does not mention blinding, long-term follow-up beyond 14 days, or how pain was measured in detail.
Taken word for word from the abstract
- n 100 patients who underwent CH (CH group) and 100 patients who underwent LA (LA group)
- population treatment of second- and third-degree hemorrhoids
- intervention ligation anopexy (LA)
- comparator conventional hemorrhoidectomy (CH)
- primaryOutcome effectiveness, safety, postoperative complications, operative time, length of hospital stay, time until first bowel movement, time until return to work, and postoperative pain score were assessed
- result The LA group had significantly shorter operative times, earlier first bowel movement, and an earlier return to work/activities. The postoperative pain score in the LA group was significantly lower than that in the CH group on days 1, 3, 7, and 14 after surgery.
Tech Coloproctol · PMID 25421703 · Read it on PubMed ↗
Zanella et al. 2014
Long-term outcome of stapled transanal rectal resection (STARR) versus stapled hemorrhoidopexys (STH) for grade III-IV hemorrhoids: preliminary results
No difference in pain after surgery.RetrospectiveLow qualityRelated question
320 peoplethree years
STARR had less bleeding and lower recurrence, but pain, soiling, incontinence and urgency were the same between groups
Who was studied
patients with grade III or IV hemorrhoids
What they received
stapled transanal rectal resection (STARR) surgery
Compared with
stapled hemorrhoidopexy (STH) surgery
Main outcome
postoperative bleeding, pain, recurrence and complications after hemorrhoid surgery
Quality
This was a non-randomized comparison of two surgeries with small numbers in one group, described by the authors themselves as preliminary.
Limitations
Not randomized, unequal group sizes (281 vs 39), authors call results preliminary.
Taken word for word from the abstract
- n A group of 320 consecutive patients (median age=51 years; range=16-85) underwent STH (n=281) or STARR (n=39) procedure.
- population patients with grade III (n=218, 68.1%) and IV (n=102, 31.9%) hemorrhoids
- intervention stapled transanal rectal resection (STARR)
- comparator Circular stapled transanal hemorrhoidopexy (STH)
- primaryOutcome The rate of postoperative bleeding (53.8% vs. 74.4%, p<0.01) was significantly reduced in patients who underwent STARR procedure
- result There were no differences between groups with regard to use of painkillers, postoperative pain intensity, short- (three months) and long-term (one and three years) residual pain, soiling, incontinence and urgency.
In Vivo · PMID 25398818 · Read it on PubMed ↗
Nelson 2014
Anal fissure (chronic)
Anal fissures cause pain; surgery options reviewed.Systematic reviewLow quality
size not given2014
The abstract lists the interventions reviewed but does not state which worked better or by how much
Who was studied
people with chronic anal fissures causing anal pain after pooping
What they received
surgical treatments (anal advancement flap, anal stretch/dilation, internal anal sphincterotomy)
Compared with
different surgical options compared with each other
Main outcome
effectiveness and safety of surgical treatments for chronic anal fissure
Quality
The abstract doesn't report actual results, numbers, or effect sizes, just which treatments were reviewed.
Limitations
No outcome data, effect sizes, or comparative results are given in this abstract; only the topics covered are listed.
Taken word for word from the abstract
- population Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation.
- intervention anal advancement flap, anal stretch/dilation, and internal anal sphincterotomy
- primaryOutcome we present information relating to the effectiveness and safety of the following interventions
- result In this systematic review, we present information relating to the effectiveness and safety of the following interventions: anal advancement flap, anal stretch/dilation, and internal anal sphincterotomy.
- comparator What are the effects of surgical treatments for chronic anal fissure?
BMJ Clin Evid · PMID 25391392 · Read it on PubMed ↗
Caglayan et al. 2015
Evaluation of the incidence of haemorrhoidal disease in patients with ankylosing spondylitis
More haemorrhoids with ankylosing spondylitis.Case-controlLow qualityRelated question
221 people2015
haemorrhoids were much more common in ankylosing spondylitis patients than in the other two groups
Who was studied
people with ankylosing spondylitis, compared to those with chronic low back pain and healthy people
What they received
having ankylosing spondylitis
Compared with
chronic low back pain patients and healthy control subjects
Main outcome
presence of haemorrhoidal disease
Quality
this is a small observational comparison that cannot prove ankylosing spondylitis causes haemorrhoids, only that they occur together more often.
Limitations
The abstract does not report controlling for other factors like diet, or the study design details beyond a three-group comparison.
Taken word for word from the abstract
- n A total of 221 individuals were included in this study in three groups
- population 72 patients with ankylosing spondylitis (AS), 75 patients with chronic low back pain (LBP) and 74 healthy control subjects
- intervention Patients with ankylosing spondylitis (AS) frequently use the Valsalva manoeuvre in their daily lives, which may increase the abdominal pressure, leading to formation of haemorrhoids.
- comparator 75 patients with chronic low back pain (LBP) and 74 healthy control subjects
- primaryOutcome The purpose of this study was to evaluate the incidence of haemorrhoidal disease in patients with AS.
- result The incidence of HD was significantly higher in patients with AS compared to the other groups.
Clin Rheumatol · PMID 24985040 · Read it on PubMed ↗
He et al. 2014
[Clinical study of tissue-selecting therapy in the treatment of mixed hemorrhoids: a single-blind randomized controlled trail]
Similar post-poop pain, fewer surgery complicationsRandomised trialLow qualityRelated question
120 people2014
TST had a shorter operation time, lower rectal urgency scores, shorter hospital stay, and no anastomotic stricture (vs 18.3% with PPH); there was no significant difference between the two surgeries in effective rate or pain score at first bowel movement
Who was studied
adults with mixed hemorrhoids undergoing surgery
What they received
tissue-selecting therapy (TST) hemorrhoid surgery
Compared with
procedure for prolapse and hemorrhoids (PPH) surgery
Main outcome
surgical outcomes and complications after hemorrhoid surgery, including pain with first bowel movement
Quality
It is a small, single-blind surgical trial comparing two hemorrhoid operations, not a study of the general cause of pain after a bowel movement.
Limitations
Single-blind design, small sample of only surgical hemorrhoid patients, and no mention of blinding for pain assessment or long-term follow-up.
Taken word for word from the abstract
- n A total of 120 patients with mixed hemorrhoids from January to December 2012 were prospectively enrolled in the study and equally divided into two groups
- population patients with mixed hemorrhoids
- intervention tissue-selecting therapy (TST)
- comparator procedure for prolapse and hemorrhoids(PPH)
- primaryOutcome Surgical data, efficacy and postoperative complications were compared between the two groups.
- result There were no significant differences in effective rate and pain score of first defecation between the two groups.
- result No anastomotic stricture case was found in TST group, while 11 cases(18.3%) developed anastomotic stricture in PPH group.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 24953368 · Read it on PubMed ↗
Lin et al. 2014
The tissue selecting technique (TST) versus the Milligan-Morgan hemorrhoidectomy for prolapsing hemorrhoids: a retrospective case-control study
Less pain with TST surgery.RetrospectiveLow qualityRelated question
195 people1-year
TST caused less pain than MMH after surgery and at first bowel movement, with similar 1-year recurrence rates
Who was studied
patients with advanced (grade III-IV) prolapsing hemorrhoids needing surgery
What they received
tissue selecting technique (TST), a stapled hemorrhoid surgery
Compared with
Milligan-Morgan hemorrhoidectomy (traditional hemorrhoid removal surgery)
Main outcome
pain after bowel movements and recurrence of hemorrhoids after surgery
Quality
This was a retrospective study comparing two surgery groups without randomization, so other differences between patients could affect the results.
Limitations
Retrospective design, not randomized, so groups may differ in ways that affect pain and outcomes.
Taken word for word from the abstract
- n One hundred and ninety-five eligible patients underwent either TST (n = 121) or MMH (n = 74).
- population patients with grade III-IV hemorrhoids
- intervention Tissue selecting technique (TST) is a segmental stapled hemorrhoidopexy
- comparator Milligan-Morgan hemorrhoidectomy (MMH) is the procedure of choice in the management of hemorrhoidal disease
- primaryOutcome The pain score was significantly less in the TST group than that in the MMH group at the first defecation and at 12 h, day 3 and day 7 postoperatively
- result The pain score was significantly less in the TST group than that in the MMH group at the first defecation and at 12 h, day 3 and day 7 postoperatively (P = 0.001).
- result The 1-year recurrence rate was 3.3 % (4/121) and 2.7 % (2/74), respectively, in TST and MMH groups (P = 1.0).
Tech Coloproctol · PMID 24952734 · Read it on PubMed ↗
Froehner Junior et al. 2014
Postoperative topical analgesia of hemorrhoidectomy with policresulen and cinchocaine: a prospective and controlled study
No benefit over placeboRandomised trialLow qualityRelated question
43 peopleday 15
no difference in pain between groups at any time point, including at first bowel movement
Who was studied
patients who had hemorrhoid surgery (hemorrhoidectomy)
What they received
topical ointment with policresulen and cinchocaine applied after surgery
Compared with
placebo ointment or usual care with oral medications alone
Main outcome
pain intensity after surgery, measured on a pain scale
Quality
very small number of patients split into small groups makes it hard to trust the result.
Limitations
small sample size split across three groups, studied pain after surgical hemorrhoid removal rather than ordinary pain after a bowel movement
Taken word for word from the abstract
- n 43 patients were operated on: control group - n = 13, one excluded; placebo - n = 15; and policresulen + cinchocaine - n = 15.
- population postoperative pain behavior of open hemorrhoidectomy
- intervention topical policresulen and cinchocaine
- comparator The topical treatment group received, in addition, the application of the ointment and was comprised of two subgroups (policresulen + cinchocaine, and placebo).
- primaryOutcome Pain intensity was recorded with the visual analogue scale.
- result with no difference between groups in all periods
- result This study showed no reduction in pain after hemorrhoidectomy with the use of topical policresulen and cinchocaine.
Rev Col Bras Cir · PMID 24918721 · Read it on PubMed ↗
Tsang et al. 2014
Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review
Less pain with one hemorrhoid surgery techniqueRetrospectiveLow qualityRelated question
77 people2014
THD patients had much lower pain scores than PPH patients and returned to normal activity sooner, with similar complication and recurrence rates
Who was studied
adults with symptomatic hemorrhoids who had surgery
What they received
transanal hemorrhoidal dearterialisation (THD) surgery
Compared with
stapled hemorrhoidopexy (PPH) surgery
Main outcome
pain level after surgery, plus bleeding, prolapse, complications and recurrence
Quality
it compared one group of patients to historical records from a different time period rather than randomly assigning treatments, and the groups were small.
Limitations
Retrospective comparison with a historical control group, excluded thrombosed or external-only hemorrhoids, small sample size.
Taken word for word from the abstract
- n Forty consecutive patients underwent THD from February 2012 to July 2013 and were compared to 37 patients who underwent PPH
- population Patients presenting with symptomatic haemorrhoids were treated with THD.
- intervention transanal haemorrhoidal dearterialisation (THD)
- comparator stapled haemorrhoidopexy [also called procedure for prolapsed haemorrhoids (PPH)]
- primaryOutcome post-operative pain scores, complications, recurrence, and patient satisfaction scores were evaluated and recorded
- result The median pain score after THD and PPH was 1.71 and 5.00, respectively, on a scale of 0-10 (10 = worst possible pain) (p = 0.000).
- result THD patients had an earlier return to normal daily activities (3.13 vs. 6.78 days, p = 0.001) when compared with the PPH group.
Tech Coloproctol · PMID 24906978 · Read it on PubMed ↗
Kammacher Guerreiro et al. 2014
Fecal overflow often affects children with chronic constipation that appears after the age of 2 years
Pain not linked to soiling.RetrospectiveLow qualityRelated question
270 people2014
pain at defecation or anal fissure was not linked to soiling; stool retention, scybala, later onset, longer disease duration, and male gender were linked to it
Who was studied
children seen at a pediatric gastroenterology clinic with chronic constipation
What they received
not applicable (observational study of risk factors, no treatment tested)
Compared with
children with chronic constipation without overflow incontinence (encopresis)
Main outcome
whether the child developed overflow incontinence (soiling) and related risk factors
Quality
this is a retrospective chart review without a control intervention, so it can show associations but not prove what causes pain after pooping.
Limitations
retrospective design, relies on clinic records from 1997-2012, no information on general population, does not directly address anal pain mechanism
Taken word for word from the abstract
- n A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted
- population patients with chronic constipation seen at a pediatric gastroenterology consultation
- primaryOutcome assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation
- result A history of stool retention and the presence of scybala at examination, but not of pain at defecation or anal fissure, were associated with encopresis.
- comparator 41 (35%) girls and 76 (65%) boys
- intervention The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation.
Clin Pediatr (Phila) · PMID 24860106 · Read it on PubMed ↗
Rahmani et al. 2014
Effects of Aloe vera cream on chronic anal fissure pain, wound healing and hemorrhaging upon defection: a prospective double blind clinical trial
Less pain, faster healing with aloe cream.Randomised trialLow quality
size not given6 weeks
significant improvement in pain, bleeding, and healing from the first week onward compared to control group
Who was studied
people with chronic anal fissures (small tears/cracks in the anus causing pain)
What they received
Aloe vera cream applied to the wound 3 times a day for 6 weeks
Compared with
control group (not specified what they received)
Main outcome
pain, bleeding after pooping, and wound healing
Quality
the abstract does not report how many patients were studied or what the control group received, making it hard to judge how reliable the results are.
Limitations
number of participants not reported; details of control treatment not described; abstract does not specify randomization or blinding methods in detail despite being called double-blind
Taken word for word from the abstract
- population topical cream containing 0.5% Aloe vera juice powder in the treatment of chronic anal fissures
- intervention The aloe cream was applied by the patients to the wound site 3 times per day for 6 weeks
- comparator in comparison with control group
- primaryOutcome Pain was assessed with a visual analog scale before treatment and at the end of each week of treatment. Wound healing and the amount and severity of bleeding were examined and evaluated
- result There were statistically significant differences in chronic anal fissure pain, hemorrhaging upon defection and wound healing before and at the end of the first week of treatment also in comparison with control group (p < 0.0001).
Eur Rev Med Pharmacol Sci · PMID 24763890 · Read it on PubMed ↗
Chen et al. 2014
Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials
No difference in pain between surgery types.Meta-analysisModerate qualityRelated question
397 people2014
Ligasure had shorter operative time and lower recurrence than stapling, but no significant difference in postoperative pain or other complications
Who was studied
patients with prolapsed hemorrhoids undergoing surgery
What they received
Ligasure hemorrhoidectomy (a sealing device used to remove hemorrhoids)
Compared with
stapled hemorrhoidectomy
Main outcome
surgical outcomes including operative time, recurrence, and postoperative pain
Quality
It pools five randomized trials with a reasonable total number of patients, but it only covers people having hemorrhoid surgery, not general pain after bowel movements.
Limitations
Abstract does not mention blinding, heterogeneity between trials, or quality assessment of included studies.
Taken word for word from the abstract
- population to compare the outcomes of Ligasure hemorrhoidectomy and stapled hemorrhoidectomy for prolapsed hemorrhoids
- intervention Ligasure hemorrhoidectomy
- comparator stapled hemorrhoidectomy
- primaryOutcome No statistically significant differences were observed in postoperative bleeding, urinary retention, difficult defecating, anal fissure, anal stenosis, incontinence, postoperative pain, return to normal activities, and hospital stay.
- result Patients treated with Ligasure had a significantly shorter operative time compared with patients who underwent stapler techniques. The recurrence rate was higher in patients who underwent stapled hemorrhoidectomy. No statistically significant differences were observed in postoperative bleeding, urinary retention, difficult defecating, anal fissure, anal stenosis, incontinence, postoperative pain, return to normal activities, and hospital stay.
- n Five trials including 397 patients met the inclusion criteria.
Surg Laparosc Endosc Percutan Tech · PMID 24732739 · Read it on PubMed ↗
Tsunoda et al. 2015
Comparison of the early results of transanal hemorrhoidal dearterialization and hemorrhoidectomy using an ultrasonic scalpel
Less pain than other hemorrhoid surgeryRetrospectiveLow qualityRelated question
66 peoplefirst postoperative week
THD patients had significantly lower pain scores on days 6 and 7 and used fewer analgesic tablets, though blood loss was greater; complications were similar between groups
Who was studied
patients with grade III or IV hemorrhoids undergoing surgery
What they received
Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (THD surgery)
Compared with
hemorrhoidectomy using an ultrasonic scalpel (US surgery)
Main outcome
postoperative pain scores and analgesic use
Quality
This compared one group of patients to a separate group from a past study rather than randomizing everyone together, which makes the comparison less reliable.
Limitations
Compared a new cohort of THD patients against a historical cohort from a previous randomized trial rather than a concurrent randomized comparison; small sample size.
Taken word for word from the abstract
- n Thirty-six patients with grade III hemorrhoids underwent the THD surgery and were compared with a cohort of 30 patients with grade III or IV hemorrhoids who were assigned to US surgery in a previous randomized trial.
- population Thirty-six patients with grade III hemorrhoids underwent the THD surgery and were compared with a cohort of 30 patients with grade III or IV hemorrhoids who were assigned to US surgery in a previous randomized trial.
- intervention Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (THD surgery) is a new approach for treating hemorrhoids.
- comparator hemorrhoidectomy using an ultrasonic scalpel (US surgery)
- primaryOutcome The pain scores were significantly lower in the THD patients on days 6 and 7 after the operation.
- result The pain scores were significantly lower in the THD patients on days 6 and 7 after the operation. The number of analgesic tablets consumed during the first postoperative week in the THD patients was significantly lower than that in the US patients. The blood loss was significantly greater in the THD patients.
Surg Today · PMID 24682584 · Read it on PubMed ↗
Gupta et al. 2014
Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: a prospective randomized study
Closed surgery less painful than open.Randomised trialLow qualityRelated question
136 peoplemore than 1 year
closed technique had lower pain scores, shorter hospital stay, and fewer complications than open technique
Who was studied
patients with chronic anal fissure
What they received
closed lateral internal anal sphincterotomy
Compared with
open lateral sphincterotomy
Main outcome
postoperative pain, healing, and complications after surgery
Quality
this is a surgical treatment study for an already-diagnosed fissure, not evidence about why pain happens after normal bowel movements.
Limitations
abstract does not report randomization method, blinding, or detailed statistics beyond pain score and complication rate
Taken word for word from the abstract
- n A total of 136 patients were randomly assigned to each of two groups.
- population Chronic anal fissure is a benign disorder that is associated with considerable discomfort.
- intervention Closed lateral internal sphincterotomy is the treatment of choice for chronic fissures
- comparator group of patients undergoing open lateral sphincterotomy
- primaryOutcome This study compared the open and closed techniques of lateral sphincterotomy in terms of their postoperative outcomes.
- result The mean pain score and duration of hospital stay were lower with the closed technique.
Asian J Surg · PMID 24637183 · Read it on PubMed ↗
Naldini et al. 2014
Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus
New stapler surgery mostly safe.Case seriesLow qualityRelated question
160 people30 days
short operative time, low complication rate, no major complications, bleeding in 5% of patients
Who was studied
patients with advanced hemorrhoids or obstructed defecation with rectal prolapse
What they received
stapled transanal surgery using a new device (TST STARR Plus)
Main outcome
safety, effectiveness and feasibility of the surgery, including complications
Quality
This was a case series of one surgery type with no comparison group, so it can't show whether the surgery is better than other options.
Limitations
No control group, short follow-up, and focuses on surgical complications rather than everyday post-bowel-movement pain.
Taken word for word from the abstract
- n 160 consecutive patients (96 females) were enrolled in the study
- population All the consecutive patients admitted to eight referral centres affected by prolapses with III-IV degrees haemorrhoids or obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception
- intervention underwent stapled transanal resection with TST STARR plus
- primaryOutcome The aim of the study was to assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, for tailored transanal stapled surgery.
- result The mean duration of the procedure was 25 min.
- result Bleeding was reported in seven patients (5%).
- result Urgency after 30 days was reported in one patient.
- result No major complication occurred.
Int J Colorectal Dis · PMID 24569943 · Read it on PubMed ↗
Crea et al. 2014
Hemorrhoidal laser procedure: short- and long-term results from a prospective study
Laser hemorrhoid treatment reduced symptoms, little pain.Case seriesLow qualityRelated question
97 people15 months
symptoms (bleeding, pain, itching, hemorrhoidal acute syndrome) decreased by 76% to 79%, hemorrhoid grade was significantly reduced, and disease recurred in 5% of patients at 2 years
Who was studied
adults with symptomatic grade 2-3 hemorrhoids with mild to moderate internal prolapse
What they received
hemorrhoidal laser procedure (HeLP)
Compared with
none (single-arm study, no comparison group)
Main outcome
pain, bleeding, itching and hemorrhoid grade after laser treatment
Quality
this was a single-arm study with no comparison group, so it can't show whether the laser worked better than no treatment or another method.
Limitations
no control or comparator group was used, and the study only reports outcomes in people already diagnosed with hemorrhoids undergoing a specific laser procedure.
Taken word for word from the abstract
- population 97 patients with symptomatic second- to third-grade hemorrhoids with minimal or moderate internal mucosal prolapse
- intervention hemorrhoidal laser procedure (HeLP)
- comparator Data on duration of the procedure, perioperative complications, postoperative pain, downgrading of hemorrhoids, resolution or persistency, and recurrence of hemorrhoidal disease (HD) were prospectively collected.
- primaryOutcome postoperative pain, downgrading of hemorrhoids, resolution or persistency, and recurrence of hemorrhoidal disease
- result frequency of bleeding, pain, itching, and hemorrhoidal acute syndrome decreased by 76% to 79%. HD grade showed a significant reduction. HD recurrence rate was 5% at 2 years.
- n 97 patients with symptomatic second- to third-grade hemorrhoids
- followUp The median follow-up was 15 months.
Am J Surg · PMID 24507943 · Read it on PubMed ↗
Faleiros-Castro et al. 2013
[Constipation in patients with quadriplegic cerebral palsy: intestinal reeducation using massage and a laxative diet]
Diet and massage eased painful constipationProspective cohortVery low qualityRelated question
50 people2013
90% of patients had full or partial relief of constipation, with fewer anal fissures, less rectal bleeding, and less pain on defecation
Who was studied
Patients with severe cerebral palsy (quadriplegic) who had constipation
What they received
Daily laxative foods, vegetable oils, increased fluids, and intestinal massage
Compared with
No separate control group; symptoms compared before and after the intervention
Main outcome
Relief of constipation and related symptoms including pain during bowel movements
Quality
This was a small, uncontrolled study in a very specific population of children with cerebral palsy, so it says little about anal pain after pooping in general.
Limitations
No control group, specific and unusual patient population, and no mention of blinding or randomization
Taken word for word from the abstract
- population 50 patients with quadriplegic cerebral palsy and constipation
- intervention daily consumption of laxative foods and vegetable oils, increase in fluid intake, and daily intestinal massage
- comparator quantitative, prospective, comparative study
- primaryOutcome evaluate the results of nursing interventions for treating intestinal constipation associated with cerebral palsy
- result Total or partial constipation relief was observed in 90% of the patients, with improvement in quality-of-life aspects such as sleep, appetite, and irritability, and a significant decrease in rectal bleeding, anal fissure, voluntary retention of stools, crying, and pain on defecation.
- n included 50 patients with quadriplegic cerebral palsy and constipation
Rev Esc Enferm USP · PMID 24310680 · Read it on PubMed ↗
Bulus et al. 2013
Comparison of topical isosorbide mononitrate, topical diltiazem, and their combination in the treatment of chronic anal fissure
All three creams eased fissure pain equally.Randomised trialLow quality
55 people2013
pain and straining both decreased significantly in all three groups after treatment, but none of the creams worked significantly better than the others
Who was studied
people with chronic anal fissure (a tear in the anus causing pain, often with pooping)
What they received
topical isosorbide mononitrate, topical diltiazem, or a combination cream applied to the anus
Compared with
the three creams compared against each other
Main outcome
pain level (on a visual pain scale) and straining during bowel movements, before and after treatment
Quality
it was a randomized trial but very small, had no placebo group to compare against, and did not describe blinding.
Limitations
small sample size (55 patients total split into three groups), no placebo comparison group, and the abstract does not describe blinding or length of follow-up
Taken word for word from the abstract
- population Patients with chronic anal fissure were enrolled in the study.
- intervention Group A (0.2% isosorbide 5 mononitrate users), Group B (2% diltiazem users), and Group C (2%diltiazem + 0.2% isosorbide 5 mononitrate users)
- comparator They were randomized into three groups
- primaryOutcome Pain was evaluated using a visual analog scale (VAS). Level of strain during defecation was graded on a 4-point scale.
- result The decreases in average VAS values prior to and after treatment in Groups A, B, and C were statistically significant (p values 0.0001, 0.001, and 0.0001, respectively).
- result the agents are not significantly superior each other.
- n A total of 55 patients were enrolled in the study.
Asian J Surg · PMID 24054756 · Read it on PubMed ↗
Drug Ther Bull 2013
Non-surgical treatments for anal fissure in adults
Explains fissure pain, no results given.Narrative reviewLow quality
size not given2013
the abstract does not state a specific result, only that it reviews the evidence
Who was studied
adults with anal fissure (a tear in the anal lining causing pain after pooping)
What they received
non-surgical treatments for anal fissure
Main outcome
how well treatments work and their safety
Quality
this is a narrative review summarizing background information without presenting specific trial results or data in the abstract.
Limitations
the abstract gives background information on anal fissure but does not report the actual findings or data comparing treatments
Taken word for word from the abstract
- population Fissures are most common in young to middle-aged adults and are also commonly seen in pregnant and postpartum women.
- intervention Here, we review the evidence on the efficacy and safety of non-surgical treatments for anal fissure.
- primaryOutcome Here, we review the evidence on the efficacy and safety of non-surgical treatments for anal fissure.
- result Here, we review the evidence on the efficacy and safety of non-surgical treatments for anal fissure.
Drug Ther Bull · PMID 24030967 · Read it on PubMed ↗
Huang et al. 2013
[Influence of acupuncture and moxibustion on defecation in postoperative patients of anal fissure: a randomized controlled trial]
Less pain with acupuncture after fissure surgeryRandomised trialLow qualityRelated question
200 people2013
From day 3, acupuncture group had less pain and more willingness to defecate than medication group; no difference in defecation difficulty or stool texture
Who was studied
patients who had surgery for anal fissure
What they received
acupuncture and moxibustion plus standard post-surgery care
Compared with
laxative medication (forlax) plus standard post-surgery care
Main outcome
pain, willingness to defecate, difficulty, and stool texture after bowel movements following surgery
Quality
This was a small single trial in a very specific post-surgical population, with unclear blinding, so it may not generalize to typical anal pain after pooping.
Limitations
Abstract does not describe blinding, randomization method, or dropout rates; population is specifically post-surgical anal fissure patients, not general anal pain sufferers.
Taken word for word from the abstract
- n Two hundred cases of postoperation of anal fissure were randomly divided into an acupuncture-moxibustion group and a medication group, 100 cases in each one.
- population postoperative patient of anal fissure
- intervention acupuncture was applied at Zhongliao (BL 33) and Xialiao (BL 34) in the morning of first 5 days of postoperative 24 h in the acupuncture-moxibustion group, and suspended moxibusiton was applied at Changqiang (GV 1) within 5 to 10 min after defecation
- comparator two bags of forlax was orally administrated in the morning of first 5 days of postoperative 24 h in the medication group
- primaryOutcome The pain intensity, defecation willingness, defecation difficulty and stool texture during postoperative defecation were observed.
- result From the third day of treatment, the improvements of defecation pain in acupuncture-moxibustion group were more obvious than those in the medication group (all P < 0.05). The patients in the acupuncture-moxibustion group had more positive defecation willingness than those in the medication group (all P < 0.05). The differences of defecation difficulty and stool properties in two groups had no statistical significance (both P > 0.05).
Zhongguo Zhen Jiu · PMID 23967636 · Read it on PubMed ↗
Izzo et al. 2014
Role of 0.4 % glyceryl trinitrate ointment after stapled trans-anal rectal resection for obstructed defecation syndrome: a prospective, randomized trial
Less pain and fissures after surgery.Randomised trialLow qualityRelated question
104 people1, 6, and 12 months
GTN group had less anal spasm (0% vs 14.6%), less anal fissure (0% vs 9.7%), and lower pain scores at 1 week and 1 month
Who was studied
patients who had surgery (STARR) for obstructed defecation syndrome
What they received
topical glyceryl trinitrate (GTN) ointment 0.4% applied every 12 hours for four weeks after surgery
Compared with
no GTN ointment after surgery
Main outcome
anal spasm, anal fissure, and pain after the surgery
Quality
This was a small randomized trial in a specific post-surgical population, so it may not apply to general after-pooping anal pain.
Limitations
Small sample size; studies a specific surgical population (after STARR for obstructed defecation syndrome), not general post-defecation anal pain.
Taken word for word from the abstract
- n 104 (42.7 %) underwent STARR and were randomized
- population patients that have undergone stapled trans-anal rectal resection (STARR)
- intervention topical 0.4 % GTN ointment
- comparator 104 (42.7 %) underwent STARR and were randomized to receive (Group 1) or not (Group 2) topical 0.4 % GTN ointment every 12 h for four postoperative weeks.
- primaryOutcome evaluate the effectiveness of topical glyceryl trinitrate (GTN) 0.4 % in determining decrease of incidence of postoperative anal spams and fissure and reduction of early postoperative pain
- result the incidence of anal spasm in Groups 1 and 2 was, respectively, 0 and 14.6 % (6/41) (p = 0.010; Fisher's exact test)
- result The incidence of anal fissure was 4/41 (9.7 %) in Group 2 and 0/44 (0 %) in Group 1 (p = 0.05; Fisher's exact test)
- result Significant differences in median visual analogue scale score between groups were found at 1 week and 1 month follow-up (1; 0-5 vs. 2; 0-7: p = 0.0104; Mann-Whitney U test).
- followUp Postoperative evaluation was made at 1, 6, and 12 months.
Int J Colorectal Dis · PMID 23943282 · Read it on PubMed ↗
Talha et al. 2013
Early quality of life outcomes following Doppler guided transanal haemorrhoidal dearterialisation: a prospective observational study
Less pain after hemorrhoid surgery.Prospective cohortLow quality
13 people1-month
pain with bowel movements and other symptoms significantly reduced one month after surgery
Who was studied
patients with hemorrhoid disease
What they received
Doppler guided transanal hemorrhoidal dearterialisation (THD) surgery
Compared with
same patients before surgery
Main outcome
symptoms (including pain with pooping) and quality of life one month after surgery
Quality
Very small study of only 13 people with no comparison group and short follow-up, so it can't rule out other explanations for improvement.
Limitations
Small sample size, no control group, short follow-up of only one month.
Taken word for word from the abstract
- n Thirteen patients undergoing THD were evaluated.
- population There are few studies examining the quality of life (QOL) of patients with haemorrhoidal disease.
- intervention Transanal heamorrhoidal dearterialization (THD) is a treatment modality for heamorrhoidal disease in which a Doppler transducer is used to locate the supplying arteries that are subsequently ligated.
- comparator Patient symptoms, demographics and QOL were recorded preoperatively and 1-month post-operatively following THD using the medical outcomes study short-form-36 (SF-36).
- primaryOutcome The aim of this study was to assess symptoms and QOL changes following THD.
- result One month following THD symptoms of haemorrhoid protrusion, bleeding, anal pain, painful defaecation, constipation and tenesmus, had all significantly reduced (P <0.05).
- followUp 1-month post-operatively following THD
Acta Gastroenterol Belg · PMID 23898561 · Read it on PubMed ↗
Sugimoto et al. 2013
A randomized, prospective, double-blind, placebo-controlled trial of the effect of diltiazem gel on pain after hemorrhoidectomy
No clear pain benefit after hemorrhoid surgeryRandomised trialLow qualityRelated question
62 people14 days
Pain during defecation and pain medication use were lower with diltiazem but the difference was not statistically significant
Who was studied
Adults who had surgery to remove hemorrhoids
What they received
Diltiazem gel applied to the anal area after hemorrhoid surgery
Compared with
Placebo gel
Main outcome
Pain level during bowel movements and amount of pain medication used
Quality
It was a well-designed blinded trial but small, and its main pain results did not reach statistical significance.
Limitations
Small sample size (62 patients), results for pain and medication use did not reach statistical significance, and total complications were higher in the treatment group.
Taken word for word from the abstract
- population Sixty-two patients were randomly assigned to receive a 2 % diltiazem gel (n = 32) or a placebo gel (n = 30) after hemorrhoidectomy.
- intervention a 2 % diltiazem gel
- comparator a placebo gel
- primaryOutcome Pain both in the resting state and on defecation ranged from 0 to 10 on a numerical rating scale, and the number of prescribed loxoprofen tablets (Loxonin) were recorded
- result Both pain scores during defecation and the number of analgesic tablets consumed tended to be lower in the diltiazem group, although they did not reach statistical significance (P = 0.09, P = 0.12, respectively).
- n Sixty-two patients were randomly assigned to receive a 2 % diltiazem gel (n = 32) or a placebo gel (n = 30)
World J Surg · PMID 23775515 · Read it on PubMed ↗
Denoya et al. 2013
Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial
Less pain after hemorrhoid surgeryRandomised trialModerate qualityRelated question
40 people3 months
dearterialization caused less pain, shorter operative time, earlier first bowel movement, and less need for pain medication than hemorrhoidectomy, though symptom relief was similar by 3 months
Who was studied
adults with grade III or IV hemorrhoids (enlarged, prolapsing hemorrhoidal tissue)
What they received
a procedure called dearterialization with mucopexy (using Doppler guidance to tie off hemorrhoid blood vessels and lift tissue back into place)
Compared with
standard hemorrhoidectomy (surgical removal of hemorrhoids)
Main outcome
pain after the procedure, measured with a pain inventory score
Quality
this was a well-designed double-blind randomized trial, but it was small (40 patients) and from a single hospital, so results may not generalize widely.
Limitations
small sample size, single-center study, only short-term follow-up reported, and it compares two specific surgical techniques rather than addressing general post-bowel-movement anal pain
Taken word for word from the abstract
- n Twenty dearterialization patients were comparable to 20 haemorrhoidectomy patients
- population Included haemorrhoids were grade III, prolapsing but reducible; and grade IV, chronic non-incarcerated.
- intervention dearterialization (with Doppler guidance and mucopexy)
- comparator haemorrhoidectomy
- primaryOutcome The primary end-point was pain.
- result Dearterialization patients had shorter operative time (36 vs 54 min, P = 0.043) with less pain (P = 0.011) and urinary retention (P = 0.012).
- result At 3 months, symptomatic relief was the same with no differences in BPI, FIQOL or SF-12.
Colorectal Dis · PMID 23711288 · Read it on PubMed ↗
Ala et al. 2013
Efficacy of cholestyramine ointment in reduction of postoperative pain and pain during defecation after open hemorrhoidectomy: results of a prospective, single-center, randomized, double-blind, placebo-controlled trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
91 people14 days
cholestyramine reduced pain and pain during defecation, and reduced need for pain medication compared to placebo
Who was studied
patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy
What they received
cholestyramine ointment (15%) applied after surgery
Compared with
placebo ointment given the same way after surgery
Main outcome
pain at rest and pain during pooping, and need for pain medication
Quality
this was a randomized, double-blind, placebo-controlled trial but with a modest number of patients from a single center.
Limitations
small single-center trial; applies specifically to pain after hemorrhoid surgery, not general pain after bowel movements in people without hemorrhoid surgery.
Taken word for word from the abstract
- population A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial.
- intervention The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days.
- comparator The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days.
- primaryOutcome The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of tramadol consumption.
- result The cholestyramine group had less postoperative pain than the placebo group at the 24th hour (1.84 ± 2.54 vs. 4.07 ± 3.35; P = 0.001) and 48th hour (0.18 ± 0.88 vs. 3.57 ± 3.45; P < 0.001) and less pain during defecation starting at the 48th hour (2.28 ± 2.96 vs. 4.77 ± 4.09; P = 0.001)
- n A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial.
World J Surg · PMID 23229850 · Read it on PubMed ↗
Zampieri et al. 2012
Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: Ligasure versus transanal hemorrhoidal dearterialization
Faster pain relief with one surgery type.Randomised trialLow qualityRelated question
114 people1 year
THD patients had faster pain resolution, while Ligasure patients had more constipation after surgery
Who was studied
adults having surgery to remove hemorrhoids
What they received
hemorrhoid removal surgery using a sealing device called Ligasure
Compared with
hemorrhoid removal surgery using a technique called transanal hemorrhoidal dearterialization (THD)
Main outcome
quality of life, quality of bowel movements, and symptom improvement after surgery
Quality
This was a small randomized study comparing two surgical techniques, not addressing typical post-bowel-movement anal pain in the general population.
Limitations
Small number of patients, and findings apply only to people who had surgical hemorrhoid removal, not to general anal pain after defecation.
Taken word for word from the abstract
- n Forty-six patients treated with THD and 68 patients treated with Ligasure were enrolled in the study.
- population Patients who underwent hemorrhoidectomy between January 2008 and June 2010 were considered and analyzed.
- intervention LigaSure-vessel sealing system (Valleylab, Boulder, CO)
- comparator transanal hemorrhoidal dearterialization (THD) hemorrhoidectomy
- primaryOutcome The primary objectives were quality of life, quality of defecation, and regression of symptoms.
- result THD patients had a higher rate of pain resolution compared with Ligasure patients (P < .05).
- result Functionally, all patients treated with Ligasure showed more postoperative constipation despite administration of laxatives than patients treated with THD.
- followUp at 1 year after surgery
Am J Surg · PMID 23140829 · Read it on PubMed ↗
Gee et al. 2013
Ano-coccygeal support in the treatment of idiopathic chronic posterior anal fissure: a prospective non-randomised controlled pilot trial
Comparable relief to surgeryProspective cohortLow quality
53 people6 months
both treatments healed all fissures with no significant difference in bleeding resolution, pain scores or time to healing
Who was studied
adults with long-lasting (chronic) anal fissures
What they received
a cushioned ano-coccygeal support device attached to the toilet seat
Compared with
standard surgery (lateral internal sphincterotomy)
Main outcome
fissure healing, bleeding resolution and pain scores after treatment
Quality
this was a small pilot study where patients chose their own treatment group rather than being randomly assigned, so the comparison is weak.
Limitations
non-randomised design with patient self-selection into groups, small sample size, described by the authors as a pilot trial needing larger randomised trials
Taken word for word from the abstract
- n Fifty-three patients with confirmed chronic anal fissures were enrolled
- population Fifty-three patients with confirmed chronic anal fissures were enrolled
- intervention a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec)
- comparator the standard procedure of lateral internal sphincterotomy (LIS)
- primaryOutcome resolution of rectal bleeding at defaecation after 4 weeks
- primaryOutcome pain scores at 4, 6 and 8 weeks
- result The fissure healing rate was 100% in both groups.
- result There was no statistically significant difference between the test group and the control group with regards to pain scores at 4, 6 and 8 weeks
- followUp follow-up was scheduled at 4, 6 and 8 weeks and at 6 months
Tech Coloproctol · PMID 22983551 · Read it on PubMed ↗
Tauro et al. 2011
Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure
Both GTN and surgery relieve pain.Prospective cohortLow quality
90 people12 weeks
Both GTN ointment and surgical sphincterotomy relieved pain and healed fissures, but surgery was recommended for patients who did not respond to GTN, suggesting surgery may be more reliably effective while GTN serves as a good alternative for those avoiding surgery
Who was studied
adults with chronic anal fissure causing pain and bleeding during bowel movements
What they received
0.2% glyceryl trinitrate (GTN) ointment applied to the anus
Compared with
surgical treatment (fissurectomy with lateral or posterior internal sphincterotomy)
Main outcome
relief of pain and bleeding during defecation and healing of the fissure
Quality
small groups of only 30 patients each, not clearly randomized, and no statistical comparison data given between groups.
Limitations
No randomization described, no statistical significance reported between treatment arms, and short follow-up of only 12 weeks.
Taken word for word from the abstract
- n Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy
- population Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity.
- intervention A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm.
- comparator fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS)
- primaryOutcome regarding symptoms like pain and bleeding during defecation, healing of CAF
- result Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment.
Indian J Surg · PMID 22851840 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Fissure in Ano"[Mesh] OR "Hemorrhoids"[Mesh] OR anal fissure OR hemorrhoid*) AND ("Defecation"[Mesh] OR defecation OR bowel movement) AND (pain[Title/Abstract] OR "Pain"[Mesh]); PubMed expanded that to: ("Fissure in Ano"[MeSH Terms] OR "Hemorrhoids"[MeSH Terms] OR ("Fissure in Ano"[MeSH Terms] OR ("fissure"[All Fields] AND "ano"[All Fields]) OR "Fissure in Ano"[All Fields] OR ("anal"[All Fields] AND "fissure"[All Fields]) OR "anal fissure"[All Fields]) OR "hemorrhoid*"[All Fields]) AND ("Defecation"[MeSH Terms] OR ("defaecate"[All Fields] OR "defaecated"[All Fields] OR "defaecating"[All Fields] OR "defaecation"[All Fields] OR "Defecation"[MeSH Terms] OR "Defecation"[All Fields] OR "defaecations"[All Fields] OR "defecate"[All Fields] OR "defecated"[All Fields] OR "defecates"[All Fields] OR "defecating"[All Fields] OR "defecations"[All Fields] OR "defecational"[All Fields]) OR ("Defecation"[MeSH Terms] OR "Defecation"[All Fields] OR ("bowel"[All Fields] AND "movement"[All Fields]) OR "bowel movement"[All Fields])) AND ("Pain"[Title/Abstract] OR "Pain"[MeSH Terms])
What came back: 402 records found · 198 read · 185 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

402records came back from the search
198were read
185actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

Hemorrhoids are the condition most people have heard of, so many assume that's the cause without ever being examined.
Anal pain feels embarrassing to talk about, so people often reach for an over-the-counter cream before seeing a doctor.
The pain often eases between bowel movements, which makes it tempting to assume it will simply go away on its own.

Common questionsShort answers, drawn from the same studies.

Why does it hurt to sit on my butt after pooping?: In these studies, sharp pain that lingers after a bowel movement was most often linked to an anal fissure, a small tear in the lining of the anus. Trials found that creams like diltiazem or nifedipine healed most of these within weeks.
Why does anal hurt but pooping doesn't?: One guideline in this review notes that hemorrhoids usually don't cause pain unless a clot has formed inside them, so ongoing pain not tied to the act of passing stool may point to something other than typical hemorrhoids. This wasn't tested in a formal trial, so it's not a sure answer.
What to do when your anus hurts while pooping?: Trials found that more fiber and fluids, warm water (sitz) baths, and over-the-counter or prescription creams eased pain and healed most fissures within weeks. See a doctor if the pain lasts more than a couple of weeks, or if there's a lump or bleeding, since rare but serious causes have been reported behind what looked like ordinary hemorrhoids.
Is it hemorrhoids or an anal fissure?: A guideline included here says fissures usually cause sharp pain during or right after passing stool, while hemorrhoids mostly cause pain only if a clot has formed. But a separate study found that symptoms often don't match what's actually found on examination, so this can't be reliably self-diagnosed.
Should I just treat it myself, or should I see a doctor instead?: Most cases in these trials improved with simple conservative care — fiber, sitz baths, and topical creams — so trying those first is reasonable. But see a doctor rather than continuing to self-treat if pain lasts more than a couple of weeks, there's a lump, or you notice bleeding, because case reports found rare but serious causes, including a cancer, mistaken for ordinary hemorrhoids.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.