What is a recommended topical ointment for hemorrhoids?

Recommended Topical Ointments for Hemorrhoids

For hemorrhoids, topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks is highly effective with a 92% resolution rate and should be considered first-line topical therapy. 1, 2

First-Line Topical Treatment Options

• Topical 0.3% nifedipine with 1.5% lidocaine ointment works by relaxing internal anal sphincter hypertonicity which contributes to pain, with no reported systemic side effects 1, 2
• Lidocaine-containing preparations provide symptomatic relief of local pain and itching associated with hemorrhoids 1, 2
• Short-term topical corticosteroids (≤7 days) can reduce local perianal inflammation but should be limited to avoid thinning of perianal and anal mucosa 1, 2
• Flavonoid-containing preparations can be used to relieve hemorrhoidal symptoms with moderate quality evidence supporting their use 3

Treatment Considerations by Hemorrhoid Type

For Internal Hemorrhoids

• Topical analgesics and corticosteroids can provide symptomatic relief but lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion 1
• Suppositories may provide symptomatic relief but clinical data supporting their long-term effectiveness are limited 1

For Thrombosed External Hemorrhoids

• For thrombosed external hemorrhoids present for >72 hours, topical 0.3% nifedipine with 1.5% lidocaine ointment is preferred as the natural resolution process has begun 1, 2
• Topical nitrates can be considered for pain relief if other options are ineffective, though headaches may limit their use 1, 2
• Topical heparin treatment has shown promise in improving healing, though evidence is limited 1

Important Considerations and Pitfalls

• Corticosteroid creams should be applied for no more than 7 days to avoid thinning of perianal and anal mucosa 1, 2
• Long-term use of high-potency corticosteroid preparations is potentially harmful and should be avoided 1
• If symptoms worsen or fail to improve within 1-2 weeks of topical treatment, reassessment is recommended 1, 2
• Topical treatments should be used as part of a comprehensive approach that includes increased fiber and water intake to soften stool and reduce straining 1, 3
• Sitz baths (warm water soaks) can reduce inflammation and discomfort and should be used alongside topical treatments 1, 2

Special Populations

• In pregnant women, topical treatments containing tribenoside and lidocaine can be safely administered after the first trimester 4
• Hydrocortisone foam can be used safely for hemorrhoids in the third trimester with no adverse events compared to placebo 1