Recommended Suppositories for Treating Hemorrhoids

For hemorrhoids, suppositories provide symptomatic relief but lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion. 1

First-Line Topical Treatment Options

Topical analgesics in suppository form (such as lidocaine) can provide symptomatic relief of local pain and itching associated with hemorrhoids, though data supporting their long-term efficacy are limited 1, 2
Short-term topical corticosteroid suppositories (≤7 days) can reduce local inflammation but should be used briefly to avoid thinning of perianal and anal mucosa 1, 3, 2
Flavonoid suppositories are recommended to relieve hemorrhoidal symptoms by improving venous tone, with evidence showing effectiveness for controlling acute bleeding in all grades of hemorrhoids 2
Topical nifedipine with lidocaine (0.3% nifedipine with 1.5% lidocaine) applied every 12 hours for two weeks has shown a highly effective 92% resolution rate for thrombosed external hemorrhoids 3

Topical muscle relaxants can be used for pain relief 3, 2
Topical nitrates can be considered if muscle relaxants are ineffective, though headaches may limit their use 3, 2
Topical heparin treatment has shown promise in improving healing, though evidence is limited 3

Long-term use of high-potency corticosteroid suppositories is potentially harmful and should be avoided 1, 3
Over-the-counter topical agents and suppositories are widely used in empirical treatment of hemorrhoidal symptoms, but clinical data supporting their effectiveness are lacking 1
If symptoms worsen or fail to improve within 1-2 weeks of using suppositories, reassessment is recommended 1, 3
Suppositories should be used as part of a comprehensive approach that includes increased dietary fiber, adequate water intake, and avoiding straining during defecation 1, 3, 2

Sitz baths (warm water soaks) can reduce inflammation and discomfort and should be recommended alongside pharmacological options 1, 2
For persistent symptoms despite suppository treatment, procedural interventions like rubber band ligation should be considered for grade I-III hemorrhoids 2, 4
Surgical excision under local anesthesia is recommended for thrombosed external hemorrhoids within 72 hours of onset for faster pain relief and reduced risk of recurrence 3

Witch hazel (Hamamelis virginiana), horse chestnut (Aesculus hippocastanum), and triphala have shown beneficial therapeutic effects on pain, bleeding, and swelling 5
Polyherbal formulations like Triphala Guggulu and Pilex offer potential synergistic benefits 5