Hemorrhoids are swollen veins located in the rectum and anus, often caused by straining during bowel movements, pregnancy, or chronic constipation. Over-the-counter hemorrhoid creams and ointments are formulated to address the immediate discomfort associated with a flare-up. These topical treatments do not cure the underlying condition but focus on the temporary management of symptoms like itching, pain, burning, and localized swelling. They offer targeted relief by delivering active compounds directly to the irritated tissue.
Primary Active Ingredients and Mechanisms of Action
Hemorrhoid creams contain several classes of ingredients that work together to combat different symptoms. One class includes vasoconstrictors such as phenylephrine, which act as alpha-adrenergic agonists. When applied topically, phenylephrine causes the small blood vessels in the affected area to narrow, a process called vasoconstriction. This temporary narrowing reduces blood flow to the swollen tissue, helping to shrink the hemorrhoidal mass and alleviate associated burning and swelling.
To address localized discomfort, many formulations include local anesthetics like pramoxine or lidocaine. These compounds work by stabilizing the neuronal membrane of nerve endings in the skin. This action inhibits the transmission of nerve impulses, effectively blocking pain signals from reaching the brain. Applying these anesthetics provides a numbing effect, offering temporary relief from pain and intense itching.
A third major category consists of protectants and emollients, which often include petrolatum, mineral oil, or glycerin. These ingredients form a physical barrier over the delicate, irritated anorectal surface. This barrier prevents further irritation from contact with stool and moisture, which is especially helpful in making bowel movements less painful. Protectants also prevent the tissue from drying out, offering a soothing, lubricating effect.
Other ingredients contribute specialized relief, such as astringents like witch hazel, which contain tannins. Witch hazel causes proteins in the skin cells to contract, which helps to tighten and shrink the inflamed tissue. This drying action reduces irritation and can help minimize minor bleeding. For more severe inflammation, a short course of a corticosteroid like hydrocortisone may be used, which is a topical steroid that suppresses the immune response and lowers inflammatory chemicals. This powerful anti-inflammatory effect directly reduces redness, severe swelling, and itching.
Proper Application and Safety Guidelines
The first step for effective application is to ensure the affected area is clean. Before using the cream, gently cleanse the area with mild soap and water, then pat or blot the area dry with a soft cloth. This preparation allows the active ingredients to better contact the skin and begin working. The frequency of application is typically up to four times daily, often recommended after each bowel movement and at bedtime.
Hemorrhoid creams are designed for both external and internal use, depending on the product and the location of the hemorrhoid. For external hemorrhoids, the cream or ointment is applied directly to the skin around the anus using a finger. Products intended for internal relief often come with a specialized applicator tip that screws onto the tube. This allows for gentle intrarectal insertion to deliver the medication to internal hemorrhoidal tissue.
It is essential to lubricate the applicator well before insertion to prevent additional pain. After internal application, the applicator must be thoroughly cleaned before being stored, and hands should always be washed before and after treatment. Always consult the specific product label for precise instructions, as the concentration of active ingredients can vary between brands and formulations. Over-application or excessive use of any topical medication should be avoided to prevent potential side effects.
Treatment Limitations and When to Consult a Doctor
Over-the-counter hemorrhoid treatments are only intended for short-term symptom relief. Most product labels advise against using the creams for more than seven consecutive days. If symptoms persist or worsen beyond this one-week period, it suggests the condition requires professional medical evaluation. Prolonged use of products containing hydrocortisone can be particularly problematic, as it may lead to side effects like thinning of the skin in the delicate perianal area.
You should stop using the product and seek immediate medical attention if you experience significant rectal bleeding. Severe or persistent pain that does not respond to the medication is another sign that a doctor’s visit is necessary. Individuals with pre-existing conditions like heart disease, high blood pressure, diabetes, or an enlarged prostate should consult a doctor before using vasoconstrictor-containing creams, due to a slight risk of systemic absorption.