From the Guidelines
For external hemorrhoids, the most effective treatment approach is non-operative management with dietary and lifestyle changes, including increased fiber and water intake, as well as adequate bathroom habits, as recommended by the most recent guidelines 1. This approach is supported by moderate quality evidence and is considered a strong recommendation. Some key points to consider in the management of external hemorrhoids include:
- Increasing fiber intake to 25-30g daily to help prevent worsening of hemorrhoids
- Drinking plenty of water to help soften stool and reduce straining during bowel movements
- Avoiding straining during bowel movements to reduce pressure on the veins in the anus
- Using over-the-counter treatments such as hydrocortisone creams or pads to reduce inflammation and itching, but only for short periods (1-2 weeks) and not exceeding 3-4 applications per day
- Applying cold compresses for 15 minutes several times daily to reduce swelling and numb pain
- Considering the use of flavonoids to relieve symptoms, as suggested by recent guidelines 1, although the evidence is moderate and the recommendation is weak. It is essential to note that if symptoms do not improve within 1-2 weeks or if bleeding occurs, medical evaluation is necessary, and prescription-strength medications or procedures might be needed. The use of topical muscle relaxants, such as topical nitrates or calcium channel antagonists, may also be considered for thrombosed or strangulated hemorrhoids, although the evidence is limited, and the recommendation is weak 1. Overall, the management of external hemorrhoids should prioritize non-operative approaches and lifestyle modifications, with a focus on preventing worsening of symptoms and promoting overall anal health.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - 77 g Bottle Carton TopCare® health COMPARE TO ICY HOT® ACTIVE INGREDIENTS* MAXIMUM STRENGTH LIDOCAINE Cold & Hot Pain Relieving Lidocaine Cream 4% Lidocaine • 1% Menthol LIDOCAINE 4% / TOPICAL ANALGESIC MENTHOL 1% / TOPICAL ANALGESIC Helps to Numb Away Pain Non-Greasy Maximum Strength External Analgesic with 4% Lidocaine NET WT 2.7 OZ (77 g)
The best medication for external hemorrhoids mentioned in the label is Lidocaine 4% cream, which is a topical analgesic that helps to numb away pain 2.
- Key benefits:
- Maximum strength external analgesic
- Non-greasy
- Contains 4% Lidocaine and 1% Menthol However, it is essential to note that the label does not explicitly state that this medication is specifically for external hemorrhoids, only that it is for external use as a pain reliever.
From the Research
Medications for External Hemorrhoids
- Topical nifedipine ointment has been shown to be effective in healing acute thrombosed external hemorrhoids, with a significant reduction in pain and symptoms compared to lidocaine ointment alone 3
- Local hydrocortisone creams can be used to manage external hemorrhoids, although excision of the entire hemorrhoidal mass and overlying skin may be necessary for acutely thrombosed external hemorrhoids 4
- The Rectal Rocket, a suppository containing lidocaine and hydrocortisone, can be used to treat internal and external hemorrhoids, as well as anal fissures 5
Treatment Options
- Conservative treatment, including dietary changes and stool softeners, is often the first line of treatment for external hemorrhoids 6, 7
- Topical ointments or suppositories, such as those containing nifedipine or hydrocortisone, can be used to manage symptoms 3, 7
- Interventional procedures, such as rubber band ligation, may be necessary for persistent or severe symptoms 7
- Surgery, including excisional hemorrhoidectomy or stapled hemorrhoidopexy, may be necessary for advanced or complicated cases 6, 7