What cream is recommended for treating hemorrhoids?

Recommended Cream for Hemorrhoids

For symptomatic hemorrhoids, topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks is the most effective cream option, achieving a 92% resolution rate compared to 45.8% with lidocaine alone. 1, 2

First-Line Topical Treatment Algorithm

For Thrombosed External Hemorrhoids (Most Painful)

• Topical 0.3% nifedipine with 1.5% lidocaine ointment is the superior choice 1, 2
  • Apply every 12 hours for two weeks 1, 2
  • Works by relaxing internal anal sphincter hypertonicity that contributes to pain 1
  • No systemic side effects observed 1
  • Lidocaine component provides immediate symptomatic relief of local pain and itching 1, 2

For Non-Thrombosed Hemorrhoids with Inflammation

• Short-term topical corticosteroid creams (e.g., hydrocortisone) 1, 3
  • Critical limitation: Use for NO MORE than 7 days to avoid thinning of perianal and anal mucosa 1, 3, 2
  • Effective for reducing local perianal inflammation 1, 3
  • Long-term use is potentially harmful and should be avoided 1

Alternative Topical Options (If First-Line Unavailable)

• Topical nitrates (e.g., nitroglycerin ointment) show good results for pain relief 1, 3

  • Work by decreasing anal tone 3
  • Major limitation: High incidence of headache may limit use 1, 3

• Topical heparin has shown promise in improving healing and resolution 1, 3

  • Evidence is limited due to small study sizes 1, 3

• Combination products with tribenoside + lidocaine (rectal cream: tribenoside 5%/lidocaine 2%) 4

  • Fast onset of symptom relief reported from 10 minutes after administration 4
  • Can be safely administered in postpartum women and pregnant women after first trimester 4

Essential Adjunctive Measures (Must Accompany Any Cream)

• Increased dietary fiber and water intake to soften stool 1, 3
• Avoid straining during defecation 1, 3, 2
• Regular sitz baths (warm water soaks) to reduce inflammation and discomfort 1, 2

Critical Pitfalls to Avoid

• Never use corticosteroid creams for more than 7 days due to risk of perianal tissue thinning 1, 3, 2
• Do not rely on suppositories as primary treatment - they lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion 1
• Over-the-counter topical agents are widely used but clinical data supporting their effectiveness are lacking 1
• If symptoms worsen or fail to improve within 1-2 weeks, reassessment is necessary 1, 2

When Creams Are Insufficient

• For persistent symptoms despite pharmacological treatment, procedural interventions like rubber band ligation should be considered 3
• Surgical excision is recommended for thrombosed external hemorrhoids presenting within 72 hours for faster pain relief and reduced recurrence 2