Yes, there are several prescription hemorrhoid medications, and they’re typically stronger than what you can buy over the counter. Most contain higher concentrations of anti-inflammatory or pain-relieving ingredients, and a few work through entirely different mechanisms that aren’t available without a prescription. Whether you need one depends on how severe your symptoms are and how well OTC products have worked for you.
Prescription Steroid Creams and Ointments
The most commonly prescribed hemorrhoid medication is hydrocortisone rectal cream at prescription strength. Over-the-counter hydrocortisone tops out at 1%, but prescription versions go higher and come in formulations specifically designed for rectal use. Brand names include Anusol HC, Proctosol-HC, and Proctocream-HC. These work by reducing swelling, itching, and pain in inflamed hemorrhoidal tissue.
The key limitation with prescription steroids is that you can’t use them for long. The NHS recommends keeping treatment to 7 days or less and not repeating courses too frequently. Prolonged use can thin the skin around the anus, which creates new problems rather than solving old ones. These creams are meant to break the cycle of inflammation during a flare-up, not serve as ongoing maintenance.
Combination Creams With Numbing Agents
Some prescriptions combine a steroid with a local anesthetic like lidocaine. These two-in-one formulations tackle both inflammation and pain simultaneously, which is particularly useful when hemorrhoids make bowel movements painful. The lidocaine numbs the area while the hydrocortisone brings down swelling. This combination is also prescribed for anal fissures and general anal itching, so your doctor may recommend it even if hemorrhoids aren’t your only issue.
Nitroglycerin Ointment for Muscle Tension
Nitroglycerin rectal ointment works through a completely different approach. Instead of reducing inflammation, it relaxes the muscles around the anus, lowering pressure in the area. It’s more commonly associated with anal fissures than hemorrhoids, but doctors sometimes prescribe it when tight sphincter muscles are contributing to hemorrhoid symptoms.
The most common side effects are headache and dizziness, which makes sense given that nitroglycerin is the same compound used in heart medications to relax blood vessels. Some people feel lightheaded when standing up quickly while using it. These side effects limit its usefulness for some patients, but for those who tolerate it well, it offers a different pathway to relief that OTC products simply can’t provide.
Oral Medications That Target Veins
A class of oral medications called phlebotonics takes yet another approach. These are plant-derived compounds (typically flavonoids) that work from the inside out. They’re thought to improve blood drainage from hemorrhoidal tissue, reduce capillary leakage, and decrease inflammation in the swollen vein cushions that cause symptoms.
The evidence here is mixed. Phlebotonics perform better than placebo for short-term symptom relief, but long-term data is limited. The American Society of Colon and Rectal Surgeons gives these medications only a weak recommendation because of that gap. They’re more widely prescribed in Europe and parts of Asia than in the United States, where doctors tend to lean on topical treatments and procedures instead.
When Prescriptions Make Sense
Hemorrhoids are graded on a scale from I to IV based on how far they protrude from the anal canal, and treatment recommendations follow that grading. The first-line approach for all hemorrhoids is dietary and behavioral changes: more fiber, more water, less straining. According to clinical practice guidelines from the American Society of Colon and Rectal Surgeons, this recommendation is backed by strong evidence.
Prescription medications typically enter the picture when those lifestyle changes and OTC products haven’t provided enough relief. For Grade I and II internal hemorrhoids that don’t respond to conservative treatment, doctors often move to office-based procedures like rubber band ligation rather than just upgrading to prescription creams. Grade III and IV hemorrhoids, which are larger and may protrude permanently, sometimes require surgical removal.
This means prescription medication occupies a specific middle ground. It’s stronger than what you can get at the pharmacy, but it’s still a conservative option compared to procedures. Your doctor might prescribe a short course of high-strength hydrocortisone to get a bad flare under control, then shift you back to fiber supplements and OTC maintenance. Or they might use a combination cream to make you comfortable enough to address the underlying causes through diet and bowel habits.
OTC vs. Prescription: What’s Actually Different
Many OTC hemorrhoid products contain the same types of ingredients found in prescriptions, just at lower concentrations or in simpler formulations. Phenylephrine, a vasoconstrictor that temporarily shrinks swollen tissue and relieves burning, is available over the counter at 0.25%. Low-dose hydrocortisone, witch hazel, and various skin protectants are all available without a prescription.
What you can’t get OTC is the higher-potency steroid formulations, the combination products that pair steroids with prescription-strength numbing agents, or the nitroglycerin ointment. The gap between OTC and prescription isn’t enormous for mild symptoms, but for moderate to severe flare-ups, the prescription options offer meaningfully more anti-inflammatory power and pain control. If you’ve been cycling through OTC products without lasting improvement, that’s a reasonable signal to ask about prescription alternatives.