Alternative Hemorrhoid Creams to Hydrocortisone (Provost)
For hemorrhoid treatment when hydrocortisone cream (Provost) is not covered, several effective alternatives include over-the-counter preparations containing sucralfate, witch hazel, or combination products with bacterial culture suspensions, as well as prescription options if needed. 1
First-Line Alternatives
Non-Prescription Options:
- Witch hazel-based preparations: Provide astringent properties that can reduce swelling and inflammation
- Sucralfate-containing products: Form a protective barrier over irritated tissue to facilitate healing 2
- Pramoxine-containing products: Provide local anesthetic effects for pain relief
- Phenylephrine-containing products: Act as vasoconstrictors to reduce swelling
Lifestyle and Conservative Measures:
- Increased dietary fiber (25-30g daily): Recommended by the American Society of Colon and Rectal Surgeons as first-line management 1
- Adequate hydration: Helps soften stools and ease bowel movements
- Sitz baths 2-3 times daily: Provide symptomatic relief
- Avoid straining during defecation: Prevents worsening of hemorrhoids 3, 1
Second-Line Options
Prescription Alternatives:
- Escherichia coli bacterial culture suspension (BCS): Acts through immunomodulation with demonstrated efficacy in clinical trials 4
- BCS + hydrocortisone combination products: Shown to be more effective than either component alone, with 83% of patients achieving satisfactory results 4
For Constipation-Related Hemorrhoids:
- Osmotic laxatives: Polyethylene glycol (17g with 8oz water twice daily) 1
- Bulk-forming agents: Psyllium husk or methylcellulose (safe during pregnancy) 3
- Lactulose: Effective but may cause bloating 3, 1
Treatment Selection Based on Hemorrhoid Grade
| Grade | Description | Recommended Treatment |
|---|---|---|
| First degree | Bleed but don't protrude | Conservative measures + topical treatments |
| Second degree | Protrude with defecation but reduce spontaneously | Conservative measures + topical treatments |
| Third degree | Protrude and require manual reduction | Consider procedural treatments if topicals fail |
| Fourth degree | Permanently prolapsed | May require surgical evaluation if conservative measures fail [1] |
Special Considerations
- Pregnancy: Use caution with any medication; bulk-forming agents and osmotic laxatives are generally considered safe 3
- Avoid stimulant laxatives: Safety data is conflicting, especially during pregnancy 3
- Pain with hemorrhoids: Suggests complications like thrombosis, fissure, or abscess requiring further evaluation 1
Important Caveats
- Anal pain is not typical of uncomplicated hemorrhoids and suggests other pathology requiring evaluation 1
- Long-term use of corticosteroid-containing preparations should be limited due to potential side effects including skin thinning and local immunosuppression 5
- Herbal preparations containing ingredients like horse chestnut, fig leaves, and artichoke leaves have shown anti-inflammatory properties in experimental models but lack robust clinical evidence 6
If symptoms persist despite conservative measures and topical treatments, procedural interventions like rubber band ligation (effective in 89% of patients) may be considered for internal hemorrhoids 1.