From the Guidelines
For bleeding hemorrhoids, the most effective over-the-counter treatment is to increase fiber intake to 25-30g daily and drink 6-8 glasses of water to soften stool, as this has been shown to reduce hemorrhoidal bleeding and painful defecation 1.
Key Recommendations
- Increase fiber intake to 25-30g daily to reduce hemorrhoidal bleeding and painful defecation 1
- Drink 6-8 glasses of water daily to soften stool and ease bowel movements
- Apply witch hazel pads (like Tucks), hydrocortisone creams (0.5-1%), and medicated wipes to reduce inflammation and soothe irritation after gentle cleaning with warm water up to 4 times daily
- Use oral pain relievers like acetaminophen or ibuprofen to manage discomfort
- Use stool softeners such as docusate sodium (Colace) to prevent straining during bowel movements, which can worsen bleeding
- Take sitz baths (warm water soaks) for 10-15 minutes, 2-3 times daily, to promote healing and comfort
Important Considerations
- If bleeding persists beyond one week, worsens, or is accompanied by severe pain, seek medical attention as this may indicate a more serious condition requiring prescription treatment or procedures
- Topical corticosteroids and analgesics may be useful for managing perianal skin irritation, but prolonged use of potent corticosteroid preparations should be avoided 1
- Flavonoids may be suggested to relieve symptoms, but the evidence is moderate and the recommendation is weak 1
From the FDA Drug Label
Purpose Stool softener Active Ingredient Hydrocortisone 1%
The treatment of bleeding hemorrhoids with over-the-counter (OTC) medications is not directly supported by the provided drug labels.
- Docusate sodium (PO) is a stool softener, which may help reduce straining during bowel movements, but it does not directly address bleeding hemorrhoids.
- Hydrocortisone (TOP) is used for skin irritation and inflammation, but its use for bleeding hemorrhoids is not explicitly stated in the provided label. The FDA drug label does not answer the question.
From the Research
Over-the-Counter (OTC) Treatment Options for Bleeding Hemorrhoids
- Medical management, including stool softeners and topical over-the-counter preparations, is a mainstay of initial therapy for hemorrhoids 2
- Topical nitroglycerine is also an option for medical management of hemorrhoids 2
- Dietary modifications, such as increased fiber and water intake, can help alleviate symptoms of hemorrhoids 2
- Behavioral therapies, including sitz baths, can also be used to manage hemorrhoid symptoms 2
When to Seek Medical Attention
- If OTC treatments are unsuccessful, office-based treatment of grades I to III internal hemorrhoids with rubber band ligation may be the next step 2
- In cases of severe active bleeding, emergency hemorrhoidectomy may be necessary 3
- Patients with anemia and active bleeding may require urgent surgery, with hemorrhoidectomy being the treatment of choice 3
Important Considerations
- The degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued 2
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, as patients may experience less pain and recover more quickly 2
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 2