From the Guidelines
For external hemorrhoids, I recommend starting with over-the-counter topical treatments containing witch hazel, hydrocortisone, or lidocaine, as these have been shown to provide relief and reduce symptoms 1. The most effective topical treatments for external hemorrhoids include:
- Preparation H cream or ointment applied 3-4 times daily for 1-2 weeks
- Tucks pads (witch hazel pads) for cooling relief
- Hydrocortisone creams (0.5-1%) applied thinly 2-3 times daily for up to 7 days to reduce inflammation
- Products with 5% lidocaine like RectiCare for pain relief, applied as needed These treatments should be combined with warm sitz baths for 10-15 minutes, 2-3 times daily, and a clean and dry area to prevent further irritation. Increasing fiber intake and drinking plenty of water is also essential to prevent constipation that can worsen hemorrhoids 1. It is essential to note that the use of topical corticosteroids should be limited to 7 days to avoid potential thinning of perianal and anal mucosa and increasing risk of injury 1. If symptoms do not improve within two weeks, or if bleeding occurs, medical evaluation is necessary as more severe cases may require prescription-strength treatments or procedures.
From the Research
Topical Treatments for External Hemorrhoids
- The use of micronized purified flavonoid fraction (MPFF) and sucralfate ointment has shown good results in reducing hemorrhoidal pain and itching 2
- A topical medical device in the form of rectal ointment, composed of sucralfate and herbal extracts (calendula, witch hazel leaf, chamomile), has been effective in controlling pain and itching and reducing edema 2
- Calcium dobesilate, dexamethasone acetate, and lidocaine, as well as prednisolone capronate with dibucaine clorohydrate, have been used as topical treatments for hemorrhoids, with both showing effectiveness and similar safety profiles 3
- A topical drug-free cream (Lenoid™) has been found to be safe and effective in improving clinical signs and symptoms in patients with grade I-II hemorrhoidal disease 4
- Local hydrocortisone creams are commonly used in the outpatient management of hemorrhoids 5
- A uniquely designed suppository (The Rectal Rocket) containing lidocaine and hydrocortisone has been used to treat internal and external hemorrhoids, as well as anal fissures 6