Key Takeaways

Over-the-counter medication like Preparation H cream is used to provide temporary relief from hemorrhoids, which are swollen veins in the rectum that cause anal pain, itching, bleeding, and discomfort.
Preparation H cream is generally well-tolerated and safe to use externally on the affected area as directed.
You should check with your healthcare provider before using Preparation H for hemorrhoids if you have certain health problems.

Hemorrhoids (also called piles) are swollen veins in the rectum that cause anal pain, itching, bleeding, and discomfort. Incorporating fiber-rich food into your daily diet can help maintain normal bowel function and prevent hemorrhoids. An over-the-counter medication such as Preparation H cream (generic: phenylephrine and pramoxine combination medicine) can provide relief from hemorrhoid symptoms. Please continue reading to learn more about the appropriate use and side effects of Preparation H cream.

What is Preparation H?

Preparation H is an over-the-counter medication for external use. It can provide temporary relief from hemorrhoids. The active ingredients in Preparation H include:

Phenylephrine hydrochloride: This is a vasoconstrictor that narrows blood vessels in the rectal area. This helps to temporarily relieve swelling and discomfort. Being a vasoconstrictor, phenylephrine can cause high blood pressure. However, as Preparation H is a topical medication, the risk of raising blood pressure is very minimal.
Pramoxine hydrochloride: This is a local anesthetic that helps to relieve pain and itching.
Protectants: Glycerin and white petrolatum form a protective barrier and prevent too much irritating contact with stool. This helps prevent skin damage.
Additional ingredients: Witch hazel, aloe vera, chamomile, cocoa butter, shark oil, vitamin E, and other ingredients in various Preparation H products help to soothe and cool the skin in the anal area.

Preparation H comes in the form of an ointment, gel, cream, spray, wipes, and suppositories. You can choose a Preparation H product based on your personal preference or the one that has the most pain relieving effect, decreases swelling, burning, and itching, temporarily shrinks hemorrhoidal tissue, and makes bowel movements less painful.

How to use Preparation H?

Read the product package for the proper way to use Preparation H. For example, it is recommended that you use the medicated wipes to clean the affected area before using the ointment, cream, gel, or suppositories. You can also wash the area with mild soap and pat it dry.

The ointment, gel, or cream preparation should be applied externally in the lower part of the anal canal only. Some products come with a dispensing cap or applicator to help you do this. The dispensing cap should be gently inserted partway into the anus to apply the medicine. You can use Preparation H up to 4 times a day. It is especially helpful to use the product in the morning, at night, and after each bowel movement.

Missed dose

Preparation H is used as needed. If you are on a regular dosing schedule, in case of a missed application, use the product as soon as you remember. If it is almost time for the next dose, skip the missed application and go back to your regular schedule. Do not use more than the recommended amount of Preparation H with each application, and do not use it more frequently than recommended on the package.

Storage

Store Preparation H at room temperature. Keep all medications out of reach of children and pets. Do not throw unneeded or expired medications in the trash or down the toilet. Contact your local waste disposal company to find out how to properly discard medications.

Overdose

Call your local poison control center, provincial poison control center, or national poison control center at 1-800-222-1222 in case of accidental ingestion of Preparation H products. Call 911 and seek emergency medical care if someone develops a serious medical problem such as seizures, has trouble breathing, or loses consciousness.

What are the side effects of hemorrhoid ointment?

Preparation H is generally well tolerated with few if any, side effects. Allergic reactions to Preparation H are rare. Call your doctor immediately or seek emergency medical attention if you develop a skin rash, itching, swelling of the face, eyes, lips, or throat, or difficulty breathing after using Preparation H.

Does Preparation H affect blood pressure?

A possible side effect of Preparation H is an increase in blood pressure. One of the active ingredients in Preparation H is phenylephrine, which is a vasoconstrictor. It works by temporarily narrowing blood vessels in the rectal area. While some of the topically applied phenylephrine can be absorbed into the bloodstream and can potentially raise blood pressure, this risk is very minimal compared to systemic therapy of phenylephrine.

Phenylephrine is also present in some cough and cold remedies (oral medications and nasal sprays), where it works as a nasal decongestant.

Does Preparation H have any drug interactions?

Preparation H may interact with other drugs used to treat a medical condition, such as hypertension (elevated blood pressure) or depression. Check with your healthcare provider before using Preparation H if you are on antihypertensives or antidepressants. Also, let your doctor know if you are using other topical products on the affected areas.

Who should not use hemorrhoid cream?

You should check with your healthcare provider before using Preparation H for hemorrhoids if you have health problems such as high blood pressure, heart disease, diabetes, thyroid problems, or difficulties with urination due to an enlarged prostate gland. Also, check with your doctor before use if you are pregnant or breast feeding (it is not known if the drug passes into breast milk). Do not use Preparation H in children below 12 years of age without consulting a healthcare provider.

Note: This medication guide is for information only and should not be used as a substitute for a medical consultation. Call your doctor promptly if you have rectal bleeding that does not stop, continuing hemorrhoid flare-up symptoms after 7 days of using Preparation H, worsening redness, irritation, swelling, or pain, or signs and symptoms of an allergic reaction.

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