Hemorrhoids (piles) are swollen, inflamed veins around the anus or lower rectum, often linked to straining, constipation, prolonged sitting, or pregnancy. Most cases are mild and tend to settle on their own within a few days to a week with self-care and over-the-counter products that relieve symptoms. No medicine "cures" a hemorrhoid; treatment focuses on easing pain, itching and swelling while you address the underlying constipation or straining. Persistent, severe, or bleeding hemorrhoids need a clinician, who can offer prescription medicines or in-office procedures. Rectal bleeding should always be checked rather than assumed to be "just piles."
Available without a prescription — follow each label.
Phenylephrine HCl (rectal) Preparation H Topical vasoconstrictor (OTC anorectal) | Cream, ointment, gel or suppository that temporarily relieves itching, burning and discomfort and can reduce swelling of anorectal tissue. Per the Drug Facts label, ask a doctor before use if you have heart disease, high blood pressure, thyroid disease, diabetes, or trouble urinating due to an enlarged prostate, or if you take a prescription drug for high blood pressure or depression. Stop and see a doctor if you have rectal bleeding or the condition does not improve within 7 days. |
Witch hazel (hamamelis) Tucks medicated pads, Preparation H pads Astringent (OTC anorectal) | Medicated pads or liquid that soothe and help reduce itching, irritation and burning. Generally well tolerated and useful for gentle cleansing and external itch. MedlinePlus notes applying witch hazel to help reduce itching, and the NHS describes soothing wipes and creams for symptom relief. |
Pramoxine HCl Preparation H Rapid Relief, Tronolane Topical local anesthetic (OTC anorectal) | Numbs the area to help relieve pain, soreness and itching. It is not in the ester/amide '-caine' class, so it is sometimes chosen for people with sensitivity to those anesthetics. Apply to the external area as directed; stop use if irritation or an allergic reaction develops, or if symptoms last more than 7 days. |
Hydrocortisone 1% (anti-itch) Cortizone-10, store brand Low-dose topical corticosteroid (OTC) |
A doctor may prescribe these — not for self-treatment.
Prescription or rectal corticosteroid preparations (sometimes combined with a local anesthetic) Topical/rectal corticosteroid combination | MedlinePlus notes that corticosteroid creams such as hydrocortisone can be over-the-counter or prescription. A clinician may prescribe stronger or rectal-foam corticosteroid preparations, sometimes combined with an anesthetic, for short courses when OTC creams are not enough. These are doctor-prescribed and time-limited because prolonged steroid use can thin and irritate anal skin; do not self-start or extend a course on your own. |
Prescription local anesthetic creams (e.g. lidocaine) Topical anesthetic | MedlinePlus notes prescription hemorrhoid creams with lidocaine or another anesthetic to help reduce pain. These are prescribed by a clinician when OTC products are not controlling pain. |
Prescription laxatives for constipation Laxatives (osmotic, stimulant, and others) | The NHS notes a GP may prescribe stronger medicines for constipation when fiber and OTC softeners are not enough. A clinician chooses the type and duration based on the cause of the constipation. |
Oral phlebotonics (flavonoid venoactive agents) Venotonic / phlebotonic agents | Used in some countries and sometimes prescribed to reduce hemorrhoidal bleeding and swelling. The evidence is limited and mixed, and they are not a standard US OTC option. Use only if a clinician recommends, and never as a substitute for having bleeding evaluated. |
Match the medicine to your main symptom. For itching and inflammation, a short course of OTC hydrocortisone 1% or a witch-hazel pad can help. For pain and soreness, a pramoxine (anesthetic) cream or oral acetaminophen is reasonable; the NHS advises not taking ibuprofen if you are bleeding. For swelling and discomfort flares, a phenylephrine vasoconstrictor cream or suppository may help, but ask a pharmacist or doctor first if you have high blood pressure, heart disease, thyroid disease, diabetes, or an enlarged prostate. Protectant ointments such as petrolatum or zinc oxide are the gentlest option for raw, sensitive skin. Importantly, address the cause: increase dietary fiber and fluids, consider a fiber supplement (psyllium) or stool softener (docusate) so you strain less, avoid lingering on the toilet, and use warm sitz baths (sitting in warm water about 10 to 15 minutes, several times a day) to ease pain. Be realistic about limits: OTC anorectal products relieve symptoms but do not make hemorrhoids permanently disappear, and the labels say to stop and see a doctor if there is no improvement within 7 days. Larger or recurrent hemorrhoids that do not improve with home care often need an office procedure such as rubber-band ligation, sclerotherapy or infrared coagulation, and severe cases may need surgery (hemorrhoidectomy). These are decisions for a clinician, not the pharmacy aisle.
See a doctor (routine visit) if symptoms last more than about a week despite self-care, if hemorrhoids keep coming back, or before assuming bleeding is "just piles" — rectal bleeding can also signal more serious conditions such as colorectal cancer and should always be checked, especially if you are over 40, have a change in bowel habits, dark or tarry stools, unexplained weight loss, or a family history of bowel cancer. Get urgent or emergency care for bleeding that will not stop or is heavy, passing large blood clots, severe anal pain, signs of infection (fever, pus, or spreading redness), or feeling faint or dizzy from blood loss. A painful, hard lump at the anus may be a thrombosed (clotted) hemorrhoid, which a clinician can treat and which is generally best treated early. Do not keep using OTC hemorrhoid products for more than 7 days without a doctor's advice.
General reference, not medical advice, and not a substitute for your doctor or pharmacist. The right choice depends on your symptoms, health conditions, age, and other medicines — always read each label and confirm before taking anything.
| Helps reduce itching and inflammation of external hemorrhoids. Use short-term only (do not use for more than 7 days unless a doctor directs); do not insert OTC hydrocortisone into the rectum and do not use on broken skin. MedlinePlus lists over-the-counter or prescription corticosteroid creams such as hydrocortisone among treatments. Higher-strength and rectal hydrocortisone preparations are prescription-only. |
Protectant ointments (white petrolatum, glycerin, mineral oil, zinc oxide, cocoa butter) Preparation H ointment, A+D, store brands Skin protectant (OTC anorectal) | Form a barrier over irritated skin to reduce contact with stool and friction, which can ease burning and make bowel movements less uncomfortable. Low risk and a reasonable gentle first option for sensitive or raw skin. |
Psyllium fiber supplement Metamucil Bulk-forming fiber laxative | Softens and bulks stool so you strain less, which addresses a common underlying cause rather than just symptoms. NHS and MedlinePlus both emphasize fiber and fluids. Take with plenty of water; the effect builds over days, and it can help reduce recurrence. |
Docusate sodium Colace Stool softener (emollient laxative) | Makes stool easier to pass, which can reduce straining during a painful flare. Useful short-term when hard stools are the problem. Pair with fluids and fiber, and see a doctor for ongoing constipation. |
Tylenol Oral analgesic | For pain relief, the NHS suggests paracetamol (acetaminophen). The NHS specifically advises not taking ibuprofen if your piles are bleeding. Follow label dosing. |