Abstract
Background: Hemorrhoid is very common ano rectal disease causing painless bleeding after defecation. Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain in post operative period.
Aim of this study is to evaluate to break the “vicious circle” of “pain–sphincteric spasm–pain” with the postoperative use of self-mechanical anal dilation.
Methods: 30 patients undergoing hemorrhoidectomy as suffering from hemorroids were divided randomly in two groups by odd & even method, one group was assigned as dilator group where self mechanical 33 mm Anal Dilator for 15 mins was used for a period of 02 weeks and in another group no anal dilator used although both had fibre diet amd laxative with sitz bath in post operative period. Pain, oedema, discharge, bleeding and incontinence was observed on Ist, 3rd, 7th and 15th day.
Result: 15 Patients who had undergone self mechanical anal dilator showed less pain compaired to no dilator group (P<0.05).Bleeding, discharge and oedema was significantly low in both group, faecal incontinence was present in dilator group for 7 days but disappeared on 15th day(P=050).
Conclusions: This prospective study confirms that self mechanical anal dilatation reduce pain after haemorrhoidectomy. No faecal incontinence noticed.
Keywords: Hemorrhoids. Hemorrhoidectomy, Self Mechanical Anal Dilatation, Pain.
References
- Chierici A, Frontali A. Post-hemorrhoidectomy pain management: the latest news. Rev Recent Clin Trials. 2021;16(1):32–8.
- Al-Mulhim AS, Ali AM, Al-Masuod N, Alwahidi A. Post hemorrhoidectomy pain: a randomized controlled trial. Saudi Med J. 2006;27(10):1538–41.
- Lu PW, Fields AC, Andriotti T, Welten VM, Rojas-Alexandre M, Koehlmoos TP, Schoenfeld AJ, Melnitchouk N. Opioid prescriptions after hemorrhoid- ectomy. Dis Colon Rectum. 2020;63(8):1118–26.
- Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, Del Genio G, Docimo L. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoi- doplasty, a minimal invasive treatment of symptomatic haemorrhoids. Updates Surg. 2020;72(3):851–7.
- Lord PH. A day-case procedure for the cure of third-degree haemorrhoids. Brit J Surg. 1969;166:747.
- Skandalakis LJ, Skandalakis JE, editors. Surgical anatomy and technique. New York: Springer; 2014.
- Konsten J, Baeten CG. Hemorrhoidectomy versus Lord’s method: 17-year follow-up of a prospective, randomized trial. Dis Colon Rectum. 2000;43(4):503–6.
- Li KK, Harris K, Hadi S, Chow E. What should be the optimal cut points for mild, moderate, and severe pain? J Palliat Med. 2007;10(6):1338–46.
- Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ (Clin Res ed). 2010;340:c332.
- Cristea C, Lewis CR. Hemorrhoidectomy. 2020 Jul 10. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.
- Chiarelli M, Guttadauro A, Maternini M, et al. The clinical and therapeutic approach to anal stenosis. Ann Ital Chir. 2018;89:237–41.
- Rabelo FEF, Lacerda-Filho A, Mansur ES, de Oliveira FH, de Queiroz FL, França-Neto PR, Misson N. Benefits of flavonoid and metronidazole use after excisional haemorrhoidectomy: a randomized double-blind clinical trial. Tech Coloproctol. 2021;25(8):949–55.
- Eberspacher C, Mascagni P, Zeri KP, Fralleone L, Naldini G, Mascagni D. Self-mechanical anal dilatation: a simple trick to minimize postoperative pain and stenosis following hemorrhoidectomy with radiofrequency. Front Surg. 2021;30(8):711958.
- Selvarajan R. Efficacy of haemorrhoidectomy versus haemorrhoidectomy with internal sphincterotomy in treatment of haemorrhoids: a retrospective randomized controlled trial study. Int Surg J. 2021;8(3):839.
- Sohn N, Eisenberg MM, Weinstein MA, Lugo RN, Ader J. Precise anorectal sphincter dilatation–its role in the therapy of anal fissures. Dis Colon Rectum. 1992;35(4):322–7.
- Carter D. Conservative treatment for anal incontinence. Gastroenterol Rep (Oxf). 2014;2(2):85
Corresponding Author
Dr Dewat Ram Nakipuria
Assistant Professor, Department of General Surgery, North DMC Medical College & Hindu Rao Hospital, Delhi
DOI: https://dx.doi.org/10.18535/jmscr/v11i6.13
