PROSPECTIVE NON-RANDOMIZED COMPARATIVE STUDY OF LOCAL CRYOTHERAPY APPLICATION VERSUS MAGNESIUM SULFATE DRESSING IN THE EMERGENCY CONSERVATIVE MANAGEMENT OF ACUTELY PROLAPSED HEMORRHOIDS

Abstract

Background: Acutely prolapsed hemorrhoids can present with severe pain, edema, and difficulty in manual reduction. Conservative treatment may provide symptomatic relief and facilitate reduction in selected patients without necrosis or other indications for urgent surgery. Local Cryotherapy application and magnesium sulfate (MgSO₄) dressing are inexpensive local measures, but direct comparative evidence is limited. This study prospectively compared their short term clinical effects in patients with acutely prolapsed irreducible Grade IV internal hemorrhoids. Methods: This prospective non-randomized comparative study included 30 consecutive adults presenting to a tertiary care emergency department. Fifteen patients received intermittent local Cryotherapy application and 15 received topical MgSO₄ dressing. No a priori sample-size calculation or single prespecified primary endpoint was documented; therefore, this analysis is considered exploratory, with 1-hour VAS treated as the principal efficacy endpoint for interpretation. Pain, edema, manual reduction, time to meaningful pain relief, recurrence, complications, and emergency surgery were assessed. Categorical variables were rechecked using Fisher's exact test where small expected cell counts were present; continuous between-group comparisons were checked using independent-samples methods. Effect estimates and 95% confidence intervals were added where calculable from the reported summary data. Results: Baseline age, sex distribution, and symptom duration were similar between groups. At 1 hour, mean VAS was lower with local Cryotherapy than with MgSO₄ (4.1 ± 0.9 vs 5.9 ± 1.0; mean difference −1.8 points, 95% CI −2.51 to −1.09; p<0.001). At 24 hours, mean VAS was lower with MgSO₄ (2.3 ± 0.8 vs 3.2 ± 0.9; mean difference −0.9 points, MgSO₄ minus ice, 95% CI −1.54 to −0.26; p≈0.01). Time to meaningful pain relief was shorter with local Cryotherapy (24.8 ± 7.6 vs 51.4 ± 11.2 minutes; mean difference −26.6 minutes, 95% CI −33.80 to −19.40; p<0.001). Successful manual reduction occurred in 86.7% and 93.3% of the local Cryotherapy and MgSO₄ groups, respectively; Fisher's exact p=1.00. Marked edema reduction at 1 hour occurred in 73.3% versus 40.0% (Fisher's exact p=0.139), and at 24 hours in 60.0% versus 86.7% (Fisher's exact p=0.215). Recurrence within 24 hours occurred in 40.0% versus 13.3% (Fisher's exact p=0.215). The reported mean times to recurrence suggested a longer interval with MgSO₄, but individual time-to-event data were unavailable for independent survival analysis; therefore, this finding is considered exploratory. Conclusion:  In this small prospective non-randomized study, local Cryotherapy application was associated with more rapid early pain relief, whereas MgSO₄ was associated with lower pain scores at 24 hours. Differences in edema and early recurrence were not statistically significant using Fisher's exact test.The findings are hypothesis-generating and should not be interpreted as evidence that MgSO₄ prevents recurrence or that sequential local Cryotherapy followed by MgSO₄ is superior. Larger randomized studies with standardized interventions, prespecified outcomes, and appropriate longitudinal and time-to-event analyses are warranted.