Best Prescription and Over-the-Counter Hemorrhoid Treatment

Approximately 4.4% of the world’s population has hemorrhoids, including about 10 million people In the United States. Approximately one-third of this population seeks hemorrhoid treatments each year, so that is roughly 1.5 million hemorrhoid-related prescriptions annually. Finding the best hemorrhoid creams is probably not on your everyday to-do list; however, the above statistics show how common hemorrhoids are. There are many prescriptions and over-the-counter products providing effective symptom relief for this condition. Please continue reading to learn what causes hemorrhoids and what are the best hemorrhoid treatments. Though not very common, there are medical procedures for people with severe hemorrhoids or those who do not achieve hemorrhoid relief after a few weeks of being on topical treatments.

What are hemorrhoids?

Hemorrhoids (piles) are enlarged veins in the anus and lower rectum, similar to varicose veins in the legs. They can be internal hemorrhoids that develop inside the rectum or external hemorrhoids that develop under the skin around the anus.

What causes hemorrhoids?

A low-fiber diet leading to constipation and straining during bowel movements can cause pressure in the lower rectum resulting in hemorrhoids. Prolonged sitting on the toilet, for example, a habit of reading on the toilet, can lead to enlarged hemorrhoids due to a poor return of a hemorrhoid’s blood supply. Pregnancy can cause painful hemorrhoids due to increased pressure in the anal region.

Other risk factors for hemorrhoids include poor posture, obesity, chronic diarrhea, anal intercourse, heavy weightlifting, inflammatory bowel disease, cancers of the digestive system, and rectal surgery. The risk of hemorrhoids also increases with age due to the weakening of tissues in the anal region.

What are hemorrhoid symptoms?

Symptoms of external hemorrhoids

Itching or irritation in the anal region.
Swelling.
Pain or discomfort.
Rectal bleeding.

Symptoms of internal hemorrhoids

Painless bleeding (small amounts of bright red blood in the toilet or on the toilet paper).
Pain and irritation if an internal hemorrhoid prolapses (protrudes through the anal opening).

Symptoms of thrombosed hemorrhoids

A thrombosed hemorrhoid is an external hemorrhoid in which blood has pooled and formed a thrombus (clot). Symptoms include:

A hard knot felt near the anus.
Severe pain and itching.
Inflammation.
Swelling.

What are home treatments for hemorrhoids?

The best treatment for hemorrhoids is to keep your stools soft. You can accomplish this by eating a high-fiber diet and staying well-hydrated by drinking 6 to 8 glasses of water or other fluids, excluding alcohol. Fiber helps to add bulk to your stool and drinking plenty of fluids keeps your stool soft. The goal is to prevent straining during bowel movements. Besides this, home remedies for treating hemorrhoids include:

Sitz bath. This involves soaking your anal area in a bowl of warm water placed under the toilet seat. Taking a sitz bath for 10-15 minutes 2-3 times a day can reduce swelling and help you get relief from mild pain. Alternatively, you can sit in a warm bath.
Aloe vera can soothe sensitive skin or damaged skin in the affected area.
Epsom salts and glycerin or vitamin E oil applied with a gauze pad can give relief from external hemorrhoids.
Cool gel pads may relieve pain and swelling and can be used during postpartum care for hemorrhoids.
OTC stool softeners (Colace, psyllium husk) or fiber supplements (Metamucil, Citrucel, FiberCon) can make stool softer and easier to pass.
Over-the-counter hemorrhoid treatments (see below).
Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain relief.

Note: Organic herbs, apple cider vinegar, and tea tree oil are best avoided as their efficacy and safety in treating hemorrhoid symptoms have not been well studied.

You should let your doctor know if your hemorrhoid symptoms do not go away within a week or if you have severe pain or bleeding.

What OTC shrinks hemorrhoids fast?

There are various over-the-counter topical treatments for symptom relief from irritated hemorrhoids. These are available as creams, ointments, pads, suppositories, and medicated wipes.

The key ingredients in OTC hemorrhoid products include soothing ingredients like witch hazel, anti-inflammatory medications like hydrocortisone, vasoconstrictors like phenylephrine to shrink swollen veins, and local numbing agents like lidocaine for pain and itch relief. These products can provide relief from mild discomfort, swelling, and itching but will not shrink hemorrhoids. Examples of over-the-counter products for treating hemorrhoids include:

Preparation H hemorrhoidal cream
Anusol suppositories
Tucks multi-care relief kit
Doctor Butler’s hemorrhoid and fissure ointment

Note: Do not use over-the-counter creams that contain a steroid medicine to treat hemorrhoids for more than one week without talking to your doctor first because these medicines can cause undesirable adverse effects.

Is there a stronger prescription for hemorrhoids?

For people who do not respond to over-the-counter products like Preparation H, doctors sometimes prescribe topical nitroglycerine ointment and nifedipine ointment. More potent hydrocortisone products are also available with a doctor’s prescription; these products are available as topical creams or suppositories. Your doctor might also recommend surgical removal of hemorrhoids. The following medical procedures can be done by a colon and rectal surgeon:

Rubber band ligation: This procedure cuts off blood flow to internal hemorrhoids, which then fall off in about a week.
Sclerotherapy: This involves injecting a chemical solution into the blood vessels in a hemorrhoid to shrink it.
Infrared light or heat: These hemorrhoid treatments cause hardening and shriveling of bleeding internal hemorrhoids.
Hemorrhoid stapling: This procedure interrupts the blood supply of hemorrhoids and reduces swelling.

How to prevent hemorrhoids?

The best way to prevent hemorrhoids is to:

Eat high-fiber foods (more fruits and vegetables).
Avoid spicy and fatty foods which can worsen symptoms.
Stay well hydrated.
Take OTC fiber supplements like Metamucil or Citrucel, if needed (you need 20-30 grams of fiber a day - if you don’t have enough fiber in your diet, take a fiber supplement).
Avoid straining during bowel movements.
Go to the bathroom to defecate as soon as you feel the urge. Waiting can build pressure in the anal region and make stool drier and harder to pass.
Get regular exercise to prevent constipation.
Avoid sitting or standing for long periods to prevent pressure on the anal veins, especially sitting for long periods on the toilet.

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