When is lidocaine (local anesthetic) used to treat hemorrhoids?

Lidocaine Use for Hemorrhoids

Topical lidocaine should be used for hemorrhoids primarily for short-term pain relief in thrombosed external hemorrhoids presenting more than 72 hours after onset, and as post-procedural pain management following hemorrhoid treatments. 1, 2

Indications for Lidocaine in Hemorrhoid Management

Thrombosed External Hemorrhoids

• For thrombosed external hemorrhoids presenting >72 hours after onset when surgical evacuation is no longer recommended
• Applied as part of medical management along with stool softeners and other oral analgesics 1

Post-Procedural Pain Management

• After rubber band ligation procedures
  • Topical lidocaine significantly reduces pain scores at 1 hour post-procedure (OR 4.15 [1.12-15.41]; p = 0.03) 2
  • Combination of lidocaine with diltiazem shows even better results for patient satisfaction (OR 3.82 [1.28-11.44]; p = 0.02) 2
• Following hemorrhoidectomy
  • EMLA cream (lidocaine 2.5% and prilocaine 2.5%) significantly reduces post-hemorrhoidectomy pain 3
  • Decreases need for opioid analgesics and reduces urinary retention complications 3

Special Populations

• Can be safely administered to postpartum women and pregnant women after the first trimester 4
• Provides fast onset of symptom relief (within 10 minutes) lasting up to 10-12 hours in pregnant women 4

Application Guidelines and Precautions

Application Method

• Apply only to external hemorrhoids or just inside the anal canal
• Use as directed on product labeling
• For external use only 5

Important Precautions

• Do not use on large areas of the body or on cut, irritated, or swollen skin 5
• Do not use on puncture wounds 5
• Do not use for more than one week without consulting a doctor 5
• Do not bandage or apply local heat to the area 5
• Avoid contact with eyes and mucous membranes 5

Potential Side Effects

• Transient burning sensation may occur upon application (generally disappears in several days) 5
• Rare cases of serious burns have been reported 5

When to Discontinue and Seek Medical Attention

• If condition worsens
• If redness is present
• If irritation develops
• If symptoms persist for more than 7 days or clear up and occur again within a few days
• If signs of skin injury occur (pain, swelling, or blistering) 5

Alternative and Complementary Treatments

• First-line treatment for hemorrhoids should be conservative management:

  • Increased dietary fiber (25-30g daily)
  • Adequate hydration
  • Sitz baths 2-3 times daily
  • Avoidance of straining during defecation 6

• For internal hemorrhoids, consider:

  • Mesalamine (5-ASA) suppositories (recommended by American Gastroenterological Association) 6
  • Hydrocortisone suppositories for short-term management 6

Clinical Pearls and Pitfalls

• Lidocaine alone provides short-term relief but combination products (like lidocaine with tribenoside) may offer more comprehensive symptom control 4
• The combination of lidocaine with diltiazem shows superior results for post-procedural pain management compared to lidocaine alone 2
• Remember that lidocaine is for symptomatic relief only and does not treat the underlying cause of hemorrhoids
• Always rule out more serious conditions that can mimic hemorrhoidal symptoms before recommending symptomatic treatment 6