TOPLINE:

A multimodal regimen of oral flavonoids and bromelain with topical lidocaine was associated with earlier and more pronounced symptom improvement in patients with acute hemorrhoidal disease than standard conservative care or nifedipine-based therapy. Patients receiving the lidocaine regimen underwent urgent procedural interventions less frequently and had reduced odds of needing additional analgesia.

METHODOLOGY:

• Hemorrhoidal disease imposes a significant burden on health systems and negatively affects health-related quality of life (HRQOL). Conservative measures frequently offer delayed or incomplete relief, highlighting the need for faster, more effective treatments.
• Researchers conducted a retrospective cohort study across five proctology centers in Italy, reviewing medical records of patients diagnosed with acute hemorrhoidal disease and treated between November 2024 and June 2025.
• They included 266 adult patients with acute hemorrhoidal disease (Goligher grades I-III or thrombosed external hemorrhoids) and allocated them to three treatment groups:
  • The lidocaine group (n = 90; mean age, 45.01 years) received 900 mg oral micronized diosmin and 100 mg hesperidin three times a day for 10 days, followed by twice daily for 14 days; 40 mg oral bromelain four times daily for 4 days, then three times daily for 3 days; and 50 mg topical lidocaine ointment three times daily for 4 days, then twice daily for 3 days.
  • The nifedipine group (n = 93; mean age, 42.40 years) received the same oral regimen with topical nifedipine ointment (0.3%) applied twice daily for 14 days.
  • The standard therapy group (n = 83; mean age, 44.22 years) received standard conservative therapy including increased dietary fiber (psyllium, 3.6 g/d), fluid intake (≥ 2 L per day), stool softeners, and warm sitz baths (three or more times per day for at least 10 minutes each)
• The primary outcomes were mean changes in the Hemorrhoidal Disease Symptom Score (HDSS), a validated five-item patient-reported measure on a 0-4 Likert scale, and the visual analog scale (VAS) pain score from baseline to day 21; patients were evaluated at baseline and on days 7, 14, and 21.
• Secondary endpoints included HRQOL measured using the Short Health Scale for Hemorrhoidal Disease, the need for procedural interventions, and the incidence of adverse events.

TAKEAWAY:

• Pain intensity decreased significantly across all groups. By day 7, patients who received the lidocaine-based multimodal regimen had significantly lower pain scores than those who received standard care and those who received nifedipine-based therapy, with mean VAS scores of 1.5 vs 3.4 and 2.5, respectively (P for group × time interaction < .001).
• By day 7, mean HDSS declined by 48% in the lidocaine group (from 13.89 to 7.20) compared with 27% in the nifedipine group (from 14.76 to 10.80) and 22% in the standard care group (from 14.33 to 11.20).
• HRQOL improved most substantially in the lidocaine group among the three groups at day 7 and day 14 (P < .001 for both). Patients in the lidocaine-based group had lower odds of requiring additional analgesia than those in the standard care group (odds ratio [OR], 0.21; 95% CI, 0.10-0.56) and nifedipine group (OR, 0.26; 95% CI, 0.11-0.62).
• Urgent procedural interventions, mainly thrombectomy, were significantly less frequent in the lidocaine-based (10%) and nifedipine-based (11%) multimodal groups than in the standard care group (31%). Adverse events were infrequent and mostly mild across all treatment groups; they included mild gastrointestinal discomfort and temporary local skin irritation, with the latter occurring only in the multimodal groups.

IN PRACTICE:

“Our findings suggest a strong trend toward earlier symptom relief with the lidocaine-based multimodal approach,” the authors of the study wrote.

SOURCE:

The study was led by Michele Schiano di Visconte, MD, Department of General Surgery, Colorectal and Pelvic Floor Diseases Centre, Local Health Authority 2 - Marca Trevigiana in Treviso, Italy. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The retrospective, nonrandomized design restricted causal inference, and the possibility of residual confounding from unmeasured or inadequately measured variables could not be ruled out. The lack of blinding raised the potential for reporting bias. The dropout rate varied among the groups, with greater retention observed in the multimodal treatment arms.

DISCLOSURES:

No specific funding source was reported. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.