From the Guidelines
Topical medications are not typically prescribed for internal hemorrhoids due to their location inside the rectum, making them difficult to reach with topical treatments. Instead, internal hemorrhoids are usually treated with oral medications, suppositories, or procedures performed by healthcare providers. For symptomatic relief, doctors may recommend suppositories containing hydrocortisone (such as Preparation H suppositories, typically used twice daily for up to 7 days) or witch hazel pads for gentle cleaning after bowel movements 1. Stool softeners like docusate sodium (100-300 mg daily) may be recommended to reduce straining.
Key Points to Consider
- For more severe cases, prescription-strength hydrocortisone suppositories or foam (1-2%) might be prescribed for short-term use (usually 1-2 weeks) to reduce inflammation.
- Patients should also increase fiber intake (25-30g daily), drink plenty of water, and avoid straining during bowel movements to prevent worsening of hemorrhoids.
- If symptoms persist beyond two weeks or are severe, medical procedures such as rubber band ligation or surgical removal may be necessary.
Treatment Options
- Flavonoids may be suggested to relieve symptoms, as they have been shown to have a beneficial effect on hemorrhoidal symptoms 1.
- Topical muscle relaxants, such as nifedipine or lidocaine, may be used to relieve pain and spasms associated with thrombosed or strangulated hemorrhoids 1.
Important Considerations
- Long-term use of high-potency corticosteroid creams should be avoided due to the risk of thinning of perianal and anal mucosa and increasing risk of injury 1.
- There is limited evidence to support the use of NSAIDs, topical steroids, or injection of local anesthetics for the treatment of complicated hemorrhoids 1.
From the Research
Topical Medications for Internal Hemorrhoids
Topical medications are often prescribed to relieve symptoms of internal hemorrhoids, such as pain, itching, and bleeding. Some of the commonly used topical medications include:
- Hydrocortisone creams, which can help reduce inflammation and itching 2
- Lidocaine, a local anesthetic that can help relieve pain 3, 4, 5
- Tribenoside, which can help reduce bleeding and inflammation 5
- Diltiazem, a calcium channel blocker that can help relax the anal sphincter and reduce pain 4
- Preparation-H, a topical cream that can help reduce swelling and itching 6
Mechanism of Action
These topical medications work by:
- Reducing inflammation and itching (hydrocortisone)
- Numbing the area to relieve pain (lidocaine)
- Reducing bleeding and inflammation (tribenoside)
- Relaxing the anal sphincter to reduce pain (diltiazem)
- Reducing swelling and itching (Preparation-H)
Efficacy and Safety
Studies have shown that these topical medications can be effective in relieving symptoms of internal hemorrhoids. For example, a study found that PP110 Gel, a topical medication containing a film-forming agent, was significantly better than Preparation-H in reducing bleeding, pain, and itching 6. Another study found that topical lidocaine and lidocaine/diltiazem were effective in reducing pain and improving patient satisfaction after hemorrhoid banding 4. The combination of tribenoside and lidocaine has also been shown to be effective and safe in relieving symptoms of hemorrhoids 5.