Anusol works by forming a protective barrier over irritated hemorrhoid tissue while reducing swelling and moisture in the affected area. Its ingredients act as astringents, meaning they tighten and dry the surface of inflamed skin, which helps relieve itching, burning, and discomfort. The effect is more about protection and symptom relief than curing hemorrhoids themselves.
What Each Ingredient Does
Standard Anusol ointment contains four active ingredients, each playing a specific role in managing hemorrhoid symptoms.
Zinc oxide (10.75%) is the primary workhorse. It coagulates proteins on the surface of damaged skin and mucous membranes, creating a thin protective layer. This barrier reduces contact between the raw tissue and stool or moisture, which is what causes much of the stinging and irritation. Zinc oxide also helps reduce the secretion of mucus and fluid from damaged cells, calming local inflammation.
Bismuth subgallate (2.25%) and bismuth oxide (0.875%) work similarly to zinc oxide. These bismuth salts also act as astringents, tightening tissue and providing an additional mechanical barrier on the skin’s surface. Together with the zinc oxide, they reduce the weeping and oozing that often accompanies inflamed hemorrhoids.
Balsam Peru (1.875%) serves a different purpose. This plant-derived resin has mild antiseptic properties and has been used traditionally in Central and South America to stop bleeding and promote wound healing. In Anusol, it helps protect the area from bacterial contamination while supporting the natural healing process of damaged tissue. The German Commission E, which evaluates herbal medicines, recognizes balsam Peru for use on poorly healing wounds, burns, and hemorrhoids.
How Anusol HC Differs
Anusol HC adds hydrocortisone, a mild steroid that reduces inflammation more aggressively than the standard formula. Where regular Anusol relies on physical barrier protection and astringent action, the HC version actively suppresses the immune response that causes swelling, redness, and itching in the tissue around hemorrhoids.
The trade-off is that hydrocortisone thins the skin with prolonged use, so it should not be used for more than 7 days at a time. If your symptoms haven’t improved within that window, the issue likely needs a different approach. Using hydrocortisone repeatedly or for extended periods can, in rare cases, allow the steroid to enter your bloodstream, potentially causing fatigue, mood changes, or other systemic effects. It can also worsen any existing infection around the area.
Cream vs. Suppositories
Anusol comes in two main forms, and which one works better depends on where your symptoms are.
The cream is designed for external hemorrhoids, the ones you can feel around the outside of the anus. You clean and dry the area, then apply the cream morning and night, plus after each bowel movement. The cream sits on the surface and delivers its protective barrier directly to irritated external skin.
Suppositories are for internal hemorrhoids, which form inside the anal canal where cream can’t easily reach. You insert one suppository morning and night, and again after each bowel movement. The suppository melts at body temperature and coats the internal tissue with the same active ingredients. You can also use the cream as a lubricant when inserting a suppository.
What Anusol Can and Cannot Do
Anusol is effective at managing the symptoms of hemorrhoids: itching, burning, soreness, and minor irritation. The protective barrier it creates gives damaged tissue a chance to heal by shielding it from further irritation during bowel movements and throughout the day.
What it cannot do is shrink hemorrhoids permanently or address the underlying cause. Hemorrhoids develop from increased pressure in the veins around the anus, often due to straining during bowel movements, sitting for long periods, pregnancy, or chronic constipation. Anusol manages the discomfort while your body heals, but if the pressure source remains, symptoms tend to return.
For most flare-ups, the combination of Anusol with dietary changes (more fiber, more water) and avoiding straining resolves symptoms within a few days to a week. If you’re still dealing with pain, bleeding, or swelling beyond 7 days of treatment, the hemorrhoids may need a different intervention.
Side Effects
Standard Anusol rarely causes problems for most people. The most common issue is local irritation or a mild allergic reaction to one of the ingredients, particularly balsam Peru, which can cause contact sensitivity in some individuals. If applying the product makes your symptoms worse rather than better, stop using it.
For Anusol HC specifically, the hydrocortisone component carries additional risks. Prolonged use thins the delicate skin around the anus, making it more vulnerable to tearing and infection. Signs of a serious allergic reaction, though very rare, include sudden swelling of the lips, mouth, or throat, difficulty breathing, or a spreading rash. These require immediate medical attention.