From the Guidelines
For external hemorrhoids, topical creams or ointments containing hydrocortisone (0.5-1%) or witch hazel are recommended for reducing inflammation and relieving symptoms, as they have shown to be effective in reducing symptoms with minimal side effects 1. When considering treatment options for external hemorrhoids, it's essential to prioritize morbidity, mortality, and quality of life. The goal is to alleviate symptoms, reduce inflammation, and prevent complications.
- Topical hydrocortisone creams or ointments (0.5-1%) can help reduce inflammation and relieve symptoms, with a recommended application of up to four times daily, especially after bowel movements, for 1-2 weeks 1.
- Witch hazel-based products provide cooling relief and reduce swelling, making them a suitable alternative or adjunct to hydrocortisone creams 1.
- Cold compresses can supplement topical treatments by reducing swelling and numbing discomfort, further enhancing symptom relief. It's crucial to note that long-term use of high-potency corticosteroid creams should be avoided due to potential deleterious effects, such as thinning of perianal and anal mucosa and increasing risk of injury 1. In cases where symptoms persist or worsen, it's essential to consult a healthcare provider for further evaluation and potential prescription-strength treatments, as they may indicate a more severe condition requiring medical attention 1.
From the FDA Drug Label
Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily Warnings For external use only 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
The best topical cream or ointment for external hemorrhoids, as per the given drug labels, is Lidocaine 4% cream, which can be applied to the affected area not more than 3 to 4 times daily 2. However, it is crucial to follow the warnings and directions for use, including avoiding application on large areas, cut, irritated, or swollen skin, and not using for more than one week without consulting a doctor 2.
From the Research
Topical Creams and Ointments 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 3.
- Hemoheal cream, an anti-hemorrhoid herbal preparation, has also been found to be effective in improving clinical signs and symptoms in patients with hemorrhoids, with a significant difference in overall subjective improvement compared to a placebo group 4.
- Local hydrocortisone creams can be used to manage hemorrhoids conservatively, in addition to dietary changes and stool softeners 5.
- Topical preparations, such as lidocaine ointment, can be used to relieve swelling and symptoms of external hemorrhoids 6.
Treatment Options for External Hemorrhoids
- Conservative treatment with topical ointments or suppositories, and/or flavonoids, can be used to manage symptoms of external hemorrhoids 7.
- Rubber band ligation is the interventional treatment of choice for grade I-II hemorrhoids, while surgery may be necessary for grade III-IV hemorrhoids 7.
- Excisional hemorrhoidectomy and stapled hemorrhoidopexy are surgical options for treating external hemorrhoids, with stapled hemorrhoidopexy associated with reduced postoperative pain and faster recovery, but a higher recurrence rate 7.