Are Botulinum Toxin Injections an Effective Therapy for Hemorrhoids?

Albert B. Lowenfels, MD


January 05, 2009

Randomized clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external haemorrhoids

Patti R, Arcara M, Bonventre S, et al
Br J Surg. 2008;95:1339-1343


The aim of this study was to determine the effectiveness of botulinum toxin as a primary treatment for thrombosed external hemorrhoids. The authors conducted a randomized trial (15 treated, 15 control patients) among patients who refused conventional therapy (excision, incision and clot removal, anal dilatation). Pain was significantly less in the treated group after 24 hours (P ≤ .001), and anal pressure was significantly lower in the treated group 5 days after treatment (P = .004).


A thrombosed external hemorrhoid is a common, painful anorectal problem. If the patient seeks treatment promptly, incision and clot removal under local anesthesia usually affords dramatic relief. This report suggests that botulinum treatment can be effective for patients who refuse surgery. The authors did not discuss cost of this alternative form of therapy. It is likely that traditional surgical methods will continue to be popular for most patients.



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