Comparative Effectiveness of Lidocaine- Versus Nifedipine-Based Multimodal Conservative Regimens for Acute Hemorrhoidal Disease

Background: Hemorrhoidal disease (HD) significantly impairs quality of life, and existing conservative treatments often yield delayed or insufficient relief. This multicentre cohort study evaluated the comparative effectiveness of structured multimodal conservative regimens versus standard conservative care in patients with acute hemorrhoidal disease (AHD). Methods: This retrospective cohort study, conducted across 5 Italian proctology centres, included 266 patients with AHD (Goligher grades I to III or thrombosed external hemorrhoids) treated between November 2024 and June 2025. Patients were assigned to 3 groups: group A (n=90) received a multimodal approach with phlebotonics, bromelain, and topical lidocaine; group C (n=93) received the same oral regimen with topical nifedipine; and group B (n=83) received conventional conservative therapy. Primary outcomes were changes in the Hemorrhoidal Disease Symptom Score (HDSS) and the visual analog scale (VAS) for pain. Results: While all treatment strategies yielded significant symptom improvement over time, the lidocaine-based multimodal regimen (group A) was associated with earlier and more pronounced reductions in pain, symptom burden, and impairment in health-related quality of life (SHS-HD), particularly within the first 14 days of treatment ( P <0.001 for all comparisons). Patients treated with the lidocaine-based regimen required less rescue systemic analgesia (8.9% vs. 28.9% in group B and 26.9% in group C; P <0.001) and underwent fewer urgent procedural interventions than those receiving standard care. Early resolution of bleeding and perianal oedema was also more frequent in the multimodal arms. Conclusion: In this multicentre retrospective cohort study, structured multimodal conservative therapy, particularly the lidocaine-based regimen, was associated with faster symptom relief, improved patient-reported quality of life, and a reduced need for urgent procedures compared with standard conservative care for AHD. These findings suggest the need for further prospective evaluation of lidocaine-centred multimodal protocols in the conservative management of AHD.