What are effective topical treatments for non-bleeding hemorrhoids and anal skin tags?

From the Guidelines

For non-bleeding hemorrhoids and skin tags, the most effective topical treatment is a cream containing hydrocortisone (0.5-1%) applied up to 3-4 times daily for 1-2 weeks, as it reduces inflammation and itching, according to the most recent evidence 1.

Key Points to Consider

• Topical corticosteroids, such as hydrocortisone, are useful for managing perianal skin irritation due to poor hygiene, mucus discharge, or fecal seepage, as stated in 1.
• Prolonged use of potent corticosteroid preparations should be avoided, as it may be harmful, as warned in 1 and 1.
• For skin tags specifically, there are fewer effective topical options, as they typically don't respond well to creams alone, and keeping the area clean and dry is essential.
• Warm sitz baths for 10-15 minutes, 2-3 times daily, can soothe discomfort, and products with witch hazel, such as Tucks pads, provide cooling relief and mild astringent effects.

Treatment Options

• Over-the-counter hemorrhoid creams containing hydrocortisone (0.5-1%) can reduce inflammation and itching.
• Products with witch hazel, such as Tucks pads, provide cooling relief and mild astringent effects.
• Preparation H ointment contains phenylephrine, which shrinks swollen tissues by constricting blood vessels, and can be applied 3-4 times daily.

Important Considerations

• If symptoms persist beyond 1-2 weeks of home treatment, or if hemorrhoids are large or very painful, medical evaluation is recommended as more advanced treatments like rubber band ligation or surgical removal might be necessary, as suggested in 1 and 1.
• The use of topical muscle relaxants, such as topical nitrates, has been proposed for the treatment of thrombosed hemorrhoids, but the evidence is limited, as discussed in 1.

From the Research

Topical Treatments for Non-Bleeding Hemorrhoids and Skin Tags

• There are several topical treatments that can help reduce non-bleeding hemorrhoids and skin tags, including:
  • Topical over-the-counter preparations 2
  • Topical nitroglycerine 2
  • Topical lidocaine or lidocaine/diltiazem ointment 3
• These treatments can help reduce pain and discomfort associated with hemorrhoids, and may also help reduce the size of the hemorrhoids.

Effectiveness of Topical Treatments

• A study published in 2023 found that topical lidocaine or lidocaine/diltiazem ointment was effective in reducing pain and improving patient satisfaction after rubber band ligation of hemorrhoids 3
• The study found that patients who received topical lidocaine or lidocaine/diltiazem ointment had reduced pain scores and required less analgesia compared to those who received a placebo 3
• Another study published in 2018 found that medical management, including topical over-the-counter preparations and topical nitroglycerine, was a mainstay of initial therapy for hemorrhoids 2

Considerations for Treatment

• The choice of topical treatment will depend on the individual patient's needs and preferences, as well as the severity of their symptoms.
• It is essential to consult with a healthcare professional before starting any new treatment, especially if you have a history of bleeding or other complications.
• Patients should follow the recommended treatment plan and attend follow-up appointments to monitor their progress and adjust the treatment plan as needed.