From the Research
Preparation H containing phenylephrine is applied directly to the affected anal area to temporarily relieve hemorrhoid symptoms, but its effectiveness is limited compared to other treatments, as shown in a study comparing recombinant streptokinase and phenylephrine-based suppositories 1. To use Preparation H, apply a small amount of the ointment or cream to the affected area up to four times daily, especially after bowel movements, using the applicator if provided for internal hemorrhoids or clean fingers for external application. Thoroughly wash your hands before and after application. Phenylephrine works as a vasoconstrictor that shrinks swollen hemorrhoidal tissue by narrowing blood vessels, reducing pain, itching, and discomfort. Most people experience relief within a few days, but discontinue use and consult a doctor if symptoms persist beyond 7 days or worsen. Avoid using the product if you have heart disease, high blood pressure, thyroid problems, diabetes, or difficulty urinating due to an enlarged prostate, as phenylephrine can be absorbed systemically. For better hemorrhoid prevention, maintain regular bowel movements through adequate fiber and water intake, avoid straining during bowel movements, and don't sit on the toilet for extended periods. Some key points to consider when treating hemorrhoids include:
- The etiology of hemorrhoids is speculative, but a low-fiber diet and constipation have historically been thought to increase the risk for hemorrhoids 2.
- Symptoms commonly attributed to hemorrhoids include bleeding, pain, pruritus, fecal seepage, prolapse, and mucus discharge, but research has found that these symptoms were equally reported by patients with and without hemorrhoids 2.
- Medical therapies for hemorrhoids have not been formally studied except for fiber where the results have been inconsistent 2.
- Office-based interventions such as rubber band ligation and infrared coagulation are widely used and economically favorable for practitioners 3, 4.
- Surgical procedures are effective at eliminating hemorrhoids but may be painful 3, 4. Given the burden of disease and numerous gaps in our understanding, the time has come for targeted research to understand the cause, symptoms, and best treatment for patients with symptomatic hemorrhoids 2. Recently introduced novel haemorrhoid management techniques, such as stapled haemorrhoidopexy, Ligasure™ excision and haemorrhoidal artery ligation, aim to reduce harm whilst maintaining or improving on outcome, but available good quality data suggest the additional cost does not necessarily equate to universally better outcomes compared with traditional older interventions 4. Whatever the intervention selected for treatment, it is clear that this should be tailored to the individual based on patient choice, convenience and degree of haemorrhoids 4.