What medications relieve hemorrhoid pain?

Medications for Hemorrhoid Pain Relief

For hemorrhoid pain relief, topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks is highly effective, with a 92% resolution rate for thrombosed hemorrhoids. 1

First-Line Pharmacological Options

• Topical muscle relaxants like nifedipine are recommended for thrombosed or strangulated hemorrhoids to relieve pain associated with anal sphincter hypertonicity 2
• Topical analgesics, particularly lidocaine, provide symptomatic relief of local pain and itching associated with hemorrhoids 1, 3
• Flavonoids (phlebotonics) are effective for controlling hemorrhoidal symptoms by improving venous tone, particularly for bleeding control 1, 4
• Short-term topical corticosteroids (≤7 days) can reduce local perianal inflammation but should be used briefly to avoid thinning of perianal and anal mucosa 1, 3

Second-Line Pharmacological Options

• Topical nitrates have shown good results in relieving pain due to thrombosed external hemorrhoids by decreasing anal tone, though headaches may limit their use 2, 1
• Topical heparin treatment has been found to significantly improve healing and resolution of acute hemorrhoids, although evidence is limited due to small study sizes 2, 3

Treatment Based on Hemorrhoid Type

For Internal Hemorrhoids

• Flavonoids and phlebotonics demonstrate statistically significant benefits for pruritus, bleeding, discharge, leakage, and overall symptom improvement 2, 4
• Suppositories may provide symptomatic relief but lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion 1

For External Hemorrhoids

• Topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks shows a 92% resolution rate compared to 45.8% with lidocaine alone 2, 1
• For thrombosed external hemorrhoids presenting within 72 hours, surgical excision provides faster pain relief and lower recurrence rates 1, 5
• For thrombosed hemorrhoids presenting after 72 hours, conservative management with stool softeners, oral and topical analgesics is preferred 1, 4

Adjunctive Measures

• Increased dietary fiber and water intake should always accompany pharmacological treatment to soften stool and reduce straining 1, 4
• Regular sitz baths (warm water soaks) can reduce inflammation and discomfort 1
• Bulk-forming agents like psyllium husk (5-6 teaspoonfuls with 600 mL water daily) help regulate bowel movements 1
• Avoid straining during defecation to prevent exacerbation of symptoms 1

Important Considerations and Pitfalls

• Long-term use of high-potency corticosteroid creams should be avoided as they can potentially thin anal tissue 1, 3
• Cryotherapy is rarely used due to prolonged pain, foul-smelling discharge, and greater need for additional therapy 1
• If symptoms worsen or fail to improve within 1-2 weeks, reassessment is necessary 1, 6
• For persistent symptoms despite pharmacological treatment, procedural interventions like rubber band ligation should be considered for grades I-III internal hemorrhoids 1, 4
• Excisional hemorrhoidectomy should be reserved for recurrent or higher-grade disease (grades III-IV) that does not respond to less invasive approaches 4, 5

Special Populations

• For pregnant patients, safe treatments include dietary fiber, adequate fluid intake, and bulk-forming agents like psyllium husk 1
• Hydrocortisone foam can be used safely for hemorrhoids in the third trimester 1
• Immunocompromised patients require closer monitoring due to increased risk for severe infection 6