What is the best prescribed medication for external hemorrhoids?

From the Guidelines

For external hemorrhoids, the best prescribed medication is typically a topical treatment containing hydrocortisone (0.5-1%) or witch hazel, which can be applied up to 3-4 times daily for 1-2 weeks to reduce inflammation, itching, and discomfort. Products like Preparation H, Tucks pads, or generic hydrocortisone creams can be used, applying a small amount (pea-sized) to the affected area after gentle cleaning, especially following bowel movements 1. These medications work by reducing inflammation and constricting blood vessels in the area, which helps shrink the hemorrhoids and relieve symptoms.

• Key points to consider when using these medications include:
  • Increasing fiber intake to prevent worsening of hemorrhoids
  • Staying hydrated to soften stool and reduce straining during bowel movements
  • Avoiding straining during bowel movements to prevent further irritation
• For more severe cases, prescription-strength hydrocortisone (2.5%) or combination products containing lidocaine for pain relief may be necessary, as suggested by the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1.
• It's essential to note that if symptoms don't improve within two weeks, or if there's significant pain or bleeding, medical evaluation is necessary as more intensive treatments may be required, such as surgical excision, which has been shown to be beneficial in selected patients with thrombosed hemorrhoids 1.

From the FDA Drug Label

Active ingredient Benzocaine 20.0% (w/w) The best prescribed medication for external hemorrhoids is Benzocaine (TOP), as it is a topical anesthetic that can help relieve pain and discomfort associated with external hemorrhoids 2.

• Key benefits: numbs the affected area, providing temporary pain relief
• Important consideration: follow the instructions for use and consult a doctor if symptoms persist or worsen Note that Lidocaine (TOP) is also a topical anesthetic, but the provided label text does not explicitly mention its use for external hemorrhoids 3.

From the Research

Medication Options for External Hemorrhoids

• Topical nifedipine ointment has been shown to be effective in treating acute thrombosed external hemorrhoids, providing complete relief of pain in 86% of patients after 7 days of therapy 4.
• Lidocaine and hydrocortisone suppositories, such as the Rectal Rocket, can be used to treat internal and external hemorrhoids, delivering medication directly to the site of inflammation 5.
• Local hydrocortisone creams can be used to manage hemorrhoids conservatively, along with dietary changes and stool softeners 6.
• Flavonoids, such as micronised purified flavonoid fraction (MPFF), can be used to relieve acute symptoms of hemorrhoids, including bleeding and pain 7.

Key Findings

• Topical nifedipine ointment has been shown to be more effective than lidocaine ointment alone in treating acute thrombosed external hemorrhoids, with a higher rate of complete relief of pain and resolution of symptoms 4.
• The use of lidocaine plus lauromacrogol has been shown to be effective in alleviating postoperative pain after endoscopic rubber band ligation combined with injection sclerotherapy for internal hemorrhoids 8.
• Drug treatment for hemorrhoids is aimed at controlling acute symptoms, such as bleeding and pain, rather than curing the condition 7.