Top OTC Medications for Hemorrhoid Relief

Hemorrhoids are one of the most common medical conditions, affecting millions of people worldwide. While the topic is often discussed with a degree of reluctance, the discomfort, itching, and pain can impact daily life. Most cases of hemorrhoids are mild to moderate and respond well to over-the-counter (OTC) treatments and lifestyle adjustments. We will discuss how OTC medications work, and know exactly when it’s time to consult a healthcare professional.

Hemorrhoids: A Quick Overview

Hemorrhoids are essentially swollen, inflamed veins located in the lower rectum and anus. They develop when increased pressure causes these blood vessels to stretch and bulge.

There are two primary types:

• Internal hemorrhoids: Located inside the rectum, these are typically painless but may cause bleeding during bowel movements. In some cases, they can prolapse—extend outside the anus—causing discomfort.
• External hemorrhoids: Found under the skin around the anus, these are often painful, especially when irritated. They can cause itching, swelling, and discomfort. If a blood clot forms inside an external hemorrhoid, it can lead to severe pain—a condition known as a thrombosed hemorrhoid.

Common Causes: The increased pressure that leads to hemorrhoids often results from:

• Straining during bowel movements (often due to chronic constipation)
• Chronic diarrhea
• Sitting for long periods, especially on the toilet
• Pregnancy, where the growing baby places pressure on pelvic veins
• Obesity and a low-fiber diet

When to Consider OTC Solutions

OTC treatments are best for mild to hemorrhoids, where symptoms are bothersome but not debilitating.

They're ideal if you've noticed symptoms for less than a week, there's no heavy bleeding, and home tweaks (like more fiber) haven't fully helped. Studies show that up to 80% of cases respond well to OTC therapies combined with lifestyle changes.

The 7-Day Rule: OTC medications are intended for short-term use, typically up to one week. If your symptoms—pain, swelling, or bleeding—persist or worsen after a week of consistent use of OTC and home care, call your doctor.

How OTC Medications Work

OTC hemorrhoid treatments come in forms like creams, ointments, suppositories, pads, and wipes. Each targets specific symptoms through active ingredients that reduce inflammation, shrink swelling, numb pain, or protect the skin.

Vasoconstrictors (To Shrink Swelling)

Key Ingredient: Phenylephrine (Preparation H products)

• How it works: Phenylephrine is a vasoconstrictor. When applied to the affected area, it causes the small blood vessels (veins) to narrow or constrict.
• Effect: This constricting action helps to shrink the swollen hemorrhoidal tissue, thereby reducing the pressure, bulging, and discomfort. It is effective for both internal and external use.

Protectants (To Soothe and Guard)

Key Ingredient: Petrolatum, Mineral Oil, Glycerin, Zinc Oxide, Cocoa Butter

• How they work: These ingredients form a physical barrier over the irritated skin and mucous membranes. They promote a healing environment.
• Effect:
  • Barrier protection: Prevent further irritation by protecting the swollen tissue from contact with stool and moisture. Especially helpful during and after a bowel movement.
  • Lubrication: Th5ey help make the passage of stool less abrasive, which is crucial for internal hemorrhoids and fissures.
  • Moisture control: Zinc Oxide can help dry out weeping or excessive moisture, while Glycerin helps draw moisture into the tissue, promoting overall comfort.
  • Usage Note: These are common in suppositories (like those made with cocoa butter) to treat internal hemorrhoids.

Local Anesthetics (For Immediate Pain Relief)

Key Ingredient: Pramoxine HCl, Lidocaine

• How they work: They are numbing agents. They temporarily block nerve signals in the applied area.
• Effect: Provide fast-acting, targeted relief from pain, burning, and intense itching. Ideal for significant discomfort, especially from highly irritated external hemorrhoids.
• Caution: Use these only as directed and not for prolonged periods, as they can sometimes mask symptoms that require medical attention.

Astringents (To Cleanse and Firm Tissue)

Key Ingredient: Witch Hazel

• How it works: Witch hazel is a natural extract with astringent properties. Astringents work by causing the skin cells and underlying tissue to contract and constrict.
• Effect: By decreasing inflammation, hydrocortisone reduces the swelling, redness, and severe itching (pruritus). Recommended for severe itching that is not relieved by other agents.
• Important Caution: Corticosteroids should only be used for a maximum of 7 days unless otherwise instructed by a doctor, as prolonged use can thin the skin and lead to other complications.

Corticosteroids (For Inflammation Control)

Key Ingredient: Hydrocortisone

• How it works: Hydrocortisone is a low-potency corticosteroid. It reduces the inflammatory response in the body.
• Effect: Effective at reducing swelling, relieving minor pain, and stopping minor bleeding. Witch hazel also cleanses the area and offers a cooling sensation. Used in medicated pads and wipes (like Tucks pads) for post-bathroom cleaning and immediate soothing.
• Caution: Corticosteroids should only be used for a maximum of 7 days unless otherwise instructed by a doctor, as prolonged use can thin the skin and lead to other complications.

Choosing the Right OTC Product

What to Stock in Your Bathroom

At Marley Drug, we carry trusted brands. Here are patient-favorites, with key benefits:

• Preparation H Ointment (1 oz): Phenylephrine + protectants for multi-symptom relief. Great for external lumps; users report 24-hour soothing.
• Preparation H Suppositories (24-count): Internal focus with cocoa butter for bleeding and prolapse. Easy insertion, minimal mess.
• Preparation H Cooling Gel (0.9 oz): Witch hazel + aloe for a refreshing tingle—ideal if creams feel too greasy.
• Preparation H Maximum Strength Cream (0.9 oz): Phenylephrine + pramoxine for severe itching/pain. Fast-acting anesthetic kicks in under 5 minutes.
• Tucks Medicated Cooling Pads (40-count): Witch hazel + aloe wipes for gentle cleansing. Hypoallergenic and flushable.

At-Home Strategies: Boosting OTC Effectiveness

OTC works best alongside simple habits. These tips reduce pressure on veins and speed healing:

• Sitz Baths: Soak in 3-4 inches of warm water (add Epsom salt for extra soothing) for 10-15 minutes, 2-3 times daily. It improves circulation, eases muscle spasms, and cleanses without harsh soaps.
• Cold Compresses: Wrap ice in a cloth and apply for 10 minutes to numb pain and shrink swelling—alternate with warm baths for contrast therapy.
• Diet and Hydration: Aim for 25-30g fiber daily (oats, berries, broccoli) and 8 glasses of water. This softens stools, preventing strain. Consider a fiber supplement like Metamucil if needed.
• Positioning and Movement: Use a donut cushion for sitting, avoid straining (don't linger on the toilet), and walk 30 minutes daily to promote gut motility.

Track symptoms in a journal: Note what worsens them (spicy foods? Stress?) to refine your routine.

Frequently Asked Questions