Topical Application of GTN 0.4% in the Treatment of Anismus Following Stapled Haemorrhoidopexy (TAGASH)

• Postoperative pain related to upper anal canal pressure increasing (yes or no) [ Time Frame: from the intervention to 1 month ]
  To evaluate if the pain post stapled haemorrhoidopexy is related to an increased anal resting pressure or not. The presence of anorectal spasm was assessed by clinical examination and anorectal manometry
• Postoperative pain remission [ Time Frame: from 1 to 90 days after intervention ]
  To assess postoperative pain remission
• Postoperative anal resting pressure at pain remission [ Time Frame: from 1 to 90 days after intervention ]
  We evaluate with anorectal manometry the anal resting pressure at the time of pain remission

• Duration of therapy [ Time Frame: from 1 to 90 days after intervention ]
  To evaluate how many days of therapy are needed to obtain pain remission
• Use of additional analgesic [ Time Frame: from 1 to 90 days to intervention ]
  To evaluate the use of additional drugs respect to standard therapy
• Postoperative pain intensity [ Time Frame: from 1 to 90 days after intervention ]
  To evaluate the intensity of postoperative pain assessed by VAS (visual analogue scale)
• Patients satisfaction [ Time Frame: 45 days after intervention ]
  To evaluate the satisfaction of the patients, assessed by a questionnaire (scale from 1 to 5)

• Duration of therapy [ Time Frame: from 1 to 90 days after intervention ]
  To evaluate how many days of therapy are needed to obtain pain remission
• Use of additional analgesic [ Time Frame: from 1 to 90 days to intervention ]
  To evaluate the use of additional drugs respect to standard therapy
• Postoperative pain intensity [ Time Frame: from 1 to 90 days after intervention ]
  To evaluate the intensity of postoperative pain assessed by VAS (visual analogue scale)
• Patients satisfaction [ Time Frame: 45 days after intervention ]
  To evaluate the satisfaction of the patiens, assessed by a questionarie (scale from 1 to 5)

• Drug: 0.4% nitroglycerin ointment
  Local endoanal application 2 times a day
  Other Name: Rectogesic
• Drug: lidocaine cloridrato 2.5% ointment
  Local endoanal application of lidocaine cloridrato 2.5% ointment 2 times a day
  Other Name: Luan

• Experimental: GTN
  In this arm the investigators administer local application of 0.4% nitroglycerin ointment and ketorolac tromethamine 10 mg
  Intervention: Drug: 0.4% nitroglycerin ointment
• Active Comparator: Control
  In this arm the investigators administer local application of lidocaine cloridrato 2.5% and ketorolac tromethamine 10 mg.
  Intervention: Drug: lidocaine cloridrato 2.5% ointment

Inclusion Criteria:

• Patients with symptomatic II-III grade haemorrhoids and rectal mucosal prolapse
• Adults aged ≤ 75, male or female

Exclusion Criteria:

• Concomitant ano-rectal disease (fissure, fistula, abscess, inflammatory bowel disease, rectal cancer)