Preparation H can be applied internally using the applicator tip that comes with the ointment tube or by using the suppository form of the product. The process is straightforward, but getting the positioning and technique right makes a real difference in both comfort and effectiveness. Here’s how to do it properly with each form.
Ointment vs. Suppositories for Internal Use
Preparation H comes in several forms, but for internal hemorrhoids, two matter most: the ointment (used with an applicator or dispensing cap) and suppositories. They work differently and each has advantages worth knowing about.
Suppositories are generally better suited for internal hemorrhoids. They dissolve slowly inside the rectum, releasing medication over a longer period. Ointment applied with the tube’s applicator works well for hemorrhoids in the lower anal canal, but the relief tends to be shorter-lived since the product doesn’t break down gradually the way a suppository does.
Both contain phenylephrine at 0.25%, a vasoconstrictor that narrows swollen blood vessels in hemorrhoidal tissue. This temporarily shrinks the swollen area and reduces pain, itching, and discomfort. If you’re dealing with hemorrhoids higher up in the rectum, suppositories are the better choice. For hemorrhoids just inside the anal opening, the ointment applicator works fine.
How to Apply the Ointment Internally
The ointment tube comes with a separate applicator or dispensing cap specifically designed for internal use. Here’s the step-by-step process:
- Prepare the applicator. Remove the protective cover from the dispensing cap, then screw or attach the cap firmly onto the end of the ointment tube.
- Lubricate. Apply a generous amount of the ointment itself to the outside of the applicator tip. This is essential for comfortable insertion.
- Position yourself. Lie on your side with your bottom leg straight and your top leg pulled toward your stomach. You can also stand beside a chair with one foot propped up on the seat. Either position relaxes the muscles around the anus and makes insertion easier.
- Insert gently. Slide the lubricated applicator partway into the anus. You don’t need to push it deep. Squeeze the tube to dispense the ointment, then slowly withdraw the applicator.
- Clean immediately. Thoroughly wash the dispensing cap with warm water and soap after every single use, then replace the protective cover. Skipping this step risks bacterial buildup on the applicator.
A common mistake is not using enough lubrication on the applicator before insertion. The tip should feel slippery to the touch before you begin. Dry or under-lubricated plastic creates friction and can irritate already sensitive tissue.
How to Insert a Suppository
Suppositories require a slightly different technique but follow the same general idea of positioning and gentle insertion.
Start by applying a small amount of water-based lubricating jelly to the pointed end of the suppository. Don’t use petroleum jelly for this, as it can prevent the suppository from melting properly once inside. Use the same body positions described above: lying on your side with your top knee drawn up, or standing with one foot elevated on a chair.
Insert the suppository narrow end first, pushing it gently but firmly past the anal sphincter. You want it at least one inch inside, far enough that it stays in place rather than sliding back out. Once it’s in, stay lying down or seated for at least 15 minutes. Your body heat melts the suppository during this time, and the medication begins absorbing into the rectal tissue.
Timing matters with suppositories. Inserting one right after a bowel movement lets the medication stay in contact with the tissue longer, so you get more benefit from each dose.
How Often to Apply
Suppositories are typically used two to four times per day for up to one week. The ointment with the internal applicator follows a similar schedule, generally up to four times daily, including after each bowel movement and before bed.
One week is the standard window for self-treatment. If your symptoms haven’t improved after seven days of consistent use, that’s a signal to get evaluated by a healthcare provider. Prolonged use of phenylephrine-based products without medical guidance isn’t recommended.
Who Should Check With a Doctor First
Preparation H’s active ingredient, phenylephrine, constricts blood vessels. That’s how it reduces hemorrhoid swelling, but it also means the product can affect circulation more broadly. If you have heart disease, high blood pressure, diabetes, a thyroid disorder, or an enlarged prostate with urination problems, check with your doctor or pharmacist before using it.
Rectal bleeding during bowel movements always warrants a conversation with a healthcare provider, even if you’re fairly sure it’s hemorrhoids. Changes in bowel habits or stool color or consistency alongside bleeding can point to other conditions that need proper evaluation. Large amounts of rectal bleeding, lightheadedness, or faintness call for emergency care.
Tips for More Comfortable Application
The biggest barrier for most people is discomfort during insertion, which is almost always a lubrication or tension issue. Beyond using plenty of lubricant, try taking a few slow, deep breaths before inserting the applicator or suppository. Bearing down very slightly, as if having a bowel movement, relaxes the anal sphincter and makes the process easier.
Wash your hands thoroughly before and after application. If you’re using the ointment, you can also apply a small amount to the outside of the anus at the same time for additional relief from external irritation. Warm (not hot) baths before application can help relax the area and make the whole process less uncomfortable, particularly if you’re dealing with significant swelling or tenderness.