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Verywell Health / Jessica Juliao
Hemorrhoids, or swollen veins in the rectum and anus, are typically a result of increased pressure in those same areas. While some are symptom-free, some people can experience "anything from blood in a toilet to fullness to discomfort," says Henry Govekar, MD, colon and rectal surgeon at Rush University Medical Group in Chicago. That's where over-the-counter hemorrhoid treatments come in.
Treatments can include creams and ointments with ingredients like witch hazel, hydrocortisone, and phenylephrine, which can reduce swelling and calm itchy skin. Special pillows and bath salts can also provide relief. We researched dozens of over-the-counter hemorrhoid treatments and evaluated them for the following attributes: ingredients, price, and use.
Below, you'll find the best over-the-counter hemorrhoid treatments on the market today.
Courtesy of Amazon
Pros
Offers quick pain relief
Doesn’t stain clothing
Includes herbs and amino acids
Cons
Expensive
May not be effective for fissures
Who else recommends it? BestReviews and Health.com both picked Doctor Butler's Hemorrhoid & Fissure Ointment.
What do buyers say? 81% of 17,300+ Amazon reviewers rated this product 4 stars or above.
We recommend Doctor Butler's Hemorrhoid & Fissure Ointment and it's our top overall choice because it treats a variety of symptoms. It contains lidocaine to numb the pain, phenylephrine to shrink the enlarged veins, and a handful of soothing ingredients like aloe vera and horse chestnut to calm itching and inflammation.
We also like that Doctor Butler's is formulated as an ointment to help moisturize and protect the painful fissures that often occur with hemorrhoids. Plus, the package includes "finger cots" for easy and mess-free applications.
Price at time of publication: $35
Active Ingredients: Lidocaine USP (4%), Phenylephrine HCl (0.25%) | Dose: Apply to affected area up to three times daily | Uses: Treats hemorrhoids and fissures while offering pain and itching relief
Walmart
Pros
Contains zinc for maximum skin healing and protection
Can be used longer than ointments with hydrocortisone
Cons
Prescription needed for a formulation with hydrocortisone
Getting your hands on a tube of Anusol Plus is worth every penny. Sergey V. Kantsevoy, MD, director of The Center for Therapeutic Endoscopy at Mercy Medical Center in Baltimore, says Anusol is the best treatment for external hemorrhoids and the one he recommends to his patients.
Zinc oxide (sometimes formulated as zinc sulfate, depending on the product) is a powerful mineral often used to treat diaper rash on babies. Zinc goes a long way when it comes to healing and protecting sensitive, damaged skin. Anusol Plus also includes pramoxine, an analgesic, to numb the pain. If you want the version that contains hydrocortisone (Anusol HC), your doctor can usually prescribe it.
Price at time of publication: $19
Active Ingredients: Pramoxine Hydrochloride 1%, Zinc Sulfate 0.5% | Dose: Apply to affected area up to 5 times per day | Uses: Preventing and treating hemorrhoids
Courtesy of Amazon
Pros
Quick pain relief
Soft on skin
Doubles as a heat pack
Cons
Can be hard to keep in place
Don't let the marketing for these ice packs fool you. While they work wonders for postpartum women, the elongated shape and size make them perfect for instantly cooling and soothing irritated hemorrhoids. It's no secret that ice is a powerful pain reliever for your rear end, but it's not exactly a breeze to fit an ice pack into the tight, highly-sensitive area known as your perineum.
These ice packs, which include soft, skin-friendly covers, are made to stay flexible even when frozen, so they don't cause further irritation. (Speaking of covers, these are also removable and machine washable.) Plus, the fact that you get two ice packs means you can constantly rotate and switch them out, if needed, rather than waiting for the same one to freeze all the time. Another bonus? They can double as heat packs.
Price at time of publication: $15
Active Ingredients: Gel beads | Dose: Place on the sensitive area for up to 10 minutes at a time | Uses: Provides cooling relief for hemorrhoids
Courtesy of Amazon
Pros
Made with soothing, natural oils
Safe to use during pregnancy
Softens skin
Cons
May irritate sensitive skin
A sitz bath can be an incredibly soothing treatment for hemorrhoids and postpartum care, with both the warm water and the Epsom salts content working wonders for irritated, delicate skin.
"During a sitz bath, you soak the rectal area in warm water for 10 to 15 minutes, two to three times daily," says Dr. Arturo Bravo, a gastroenterologist at Houston Methodist Willowbrook Hospital. "Sitz baths work by improving blood flow and relaxing the muscle around the anus, called the internal anal sphincter."
This sitz bath made by Thena, which includes Epsom salts and dead sea salt as well as nourishing coconut and magnesium oils, is both soothing and healing, reducing inflammation while repairing tissue damage. It can be dissolved into a special sitz device or simply blended into a warm bath within your tub.
Price at time of publication: $33
Active Ingredients: 100% pure natural Epsom salts, 100% pure natural dead sea salt, organic coconut oil, and other natural oils | Dose: 1/2 cup for a sitz bath | Uses: Hemorrhoid relief during a sitz bath
Pros
Includes organic herbs
Offers itch and pain relief
While the first line of defense for most people with hemorrhoids is medicated creams and ointments, pregnant women have to take a pause before running to the pharmacy for an OTC drug.
"The topical hemorrhoidal agents have not been fully assessed for safety in pregnancy," says Matthew Bechtold, MD, a University of Missouri Health Care gastroenterologist. "Even though it's unlikely that the ingredients in topical hemorrhoidal agents will harm the third-trimester infant, a discussion needs to be had between you and your obstetrician regarding therapy."
Sitz baths are a pregnancy-safe treatment for hemorrhoids, but soaking your rectum three times a day isn't always possible—and when you're pregnant, you need hemorrhoid relief ASAP. Luckily, you can rely on good old-fashioned witch hazel to come through in a pinch, like this organic hemorrhoid balm by Motherlove. Made with witch hazel and yarrow, the balm can reduce inflammation and banish that frustrating hemorrhoid itch (in a totally baby-safe way).
Price at time of publication: $12
Active Ingredients: Extra virgin olive oil, beeswax, witch hazel leaf, plantain leaf | Dose: Use as needed on affected area | Uses: Reduces pain, swelling, and itching of pregnancy-induced hemorrhoids
Expert Insight
"Most people come to doctors after seeing blood in the toilet. Don't try to treat it. If you have this bleeding going on, you should see your doctor to make sure it's not something more serious. When I hear about a patient with rectal bleeding, I wonder about what it could be. Especially as we're seeing younger and younger people diagnosed with colon and rectal cancer." — Henry Govekar, MD
Courtesy of Amazon
Pros
Pressure-relieving
Portable
Easy to clean
Cons
Some say the cushion is too stiff
Sometimes the best hemorrhoid treatment is the one that gets your bum off hard surfaces, which can increase the pressure placed on hemorrhoids and worsen symptoms. A tailbone cushion, specially contoured to support your hips and pelvis while keeping your perineum from coming into contact with anything firm, is a solid complement to whatever other treatments or remedies you might be employing.
This ergonomic pillow is also massively portable, featuring a non-slip bottom for safety, a removable, washable cover, and non-deflating foam. You can use it at home, at work, in the car, or anywhere your inflamed bottom may need a little extra comfort.
Price at time of publication: $36
Active Ingredients: Foam and velour cover | Dose: N/A | Uses: Reduces pressure on the pelvis and lower body and relieves hemorrhoid pain
Pros
Immediate relief
Easy-to-transport packaging
Cons
-
Reapplication may be needed
When itching is severe enough, it can be as bad as coping with pain. If hemorrhoid itch is becoming extremely uncomfortable, you likely need a formula with hydrocortisone to reduce inflammation and quiet that frustrating itch.
The Soothing Relief Anti-Itch Cream by Preparation H is our pick for best itch relief. While some other forms of Preparation H include phenylephrine or pramoxine, this one contains 1% hydrocortisone to provide instant and long-lasting itch relief, a maximum-strength percentage you don't need a prescription for. We love that it can be used up to four times per day. But remember: Hydrocortisone hemorrhoid products should only be applied for one week unless otherwise instructed by a doctor.
Price at time of publication: $9
Active Ingredients: Hydrocortisone (1%) | Dose: Blot on affected area up to 4 times daily | Uses: For hemorrhoid and anal itching relief
Final Verdict
Doctor Butler's Hemorrhoid & Fissure Ointment is our favorite overall pick for treating hemorrhoids that are itchy, swollen, or painful (or all three). With ingredients to soothe, shrink, and numb those pesky hemorrhoids, it can treat the majority of your symptoms day or night. If you need drug-free soothing, reach for Thena Sitz Bath Soak, which feels oh-so-good and is pregnancy safe.
How We Selected
When selecting the best hemorrhoid treatments, we spoke with doctors and spent hours combing the web for the best and most effective products. After taking all of our options into consideration, we determined which to feature based on a few key criteria as recommended by dermatologists: key ingredients, form, and dosage.
Once we narrowed down our options, we compared each hemorrhoid treatment's benefits to its price tag. While some choices on our list may be more expensive than others, we wanted to give a wide range of options for buyers that would fit all needs and budgets. Based on all of these factors, we compiled this list of the best OTC hemorrhoid treatments.
What to Look for in an Over-the-Counter Hemorrhoid Treatment
Ingredients
There are several types of ingredients you may find in hemorrhoid treatments, and they're generally designed to provide different kinds of relief.
According to Dr. Bechtold, you should consider products containing one or more of the following ingredients:
- Witch hazel or zinc oxide, which can soothe, protect, and reduce itching and swelling
- Hydrocortisone, a topical steroid that can relieve swelling and itching
- Pramoxine or lidocaine, topical pain relievers that can numb the affected area
- Phenylephrine, which narrows blood vessels in the affected area
Creams vs. Ointments
The best approach may be one that doesn't rely too heavily on any one ingredient but mixes and matches, as needed, to get the symptom relief you need. No matter what, don't overuse any product containing hydrocortisone: "Limit use to one week if the product contains steroids," Dr. Bechtold advises.
There are usually creams and ointments available for the OTC treatment of hemorrhoids, and there isn't much difference in the ingredients between the two formulations, says Dr. Bechtold. Instead, the difference is found in the consistency or texture.
"Creams and ointments [have a different] ratio of oil and water," he explains. "Creams have about the same amount of oil and water, [making them] good for treating wet or oozing skin conditions, [while] ointments have more oil than water, making them thicker and greasier."
- Ointments: In general, ointments add moisture to the skin and can stay on the skin surface longer, so if you need intense hydration and skin protection, an ointment may be the better choice.
- Creams: If you want something that absorbs more quickly into the skin and doesn't leave any residue behind, a cream is your best bet.
Stool Softeners and Fiber
Since hemorrhoids usually develop as a result of constipation and straining to have bowel movements, Dr. Bravo says stool softeners actually play an important role in treatment.
"One of the most important steps in treating hemorrhoids is avoiding constipation—hard or infrequent stools—and stool softeners are a good option if you have chronic constipation," he says. Increasing the amount of fiber in your diet by eating more fruits and vegetables is another good way to soften your stools, he says, adding that the recommended amount of dietary fiber is around 20 to 35 grams per day.
You can try an OTC stool softener like Colace (docusate), which doesn't force you to have a bowel movement but simply makes it easier to pass stool. You can also try a natural stool softener with ingredients like psyllium, which is helpful if you can't get enough fiber in your diet through the foods you eat.
Lifestyle Changes
No, you can't buy a one-size-fits-all dietary supplement to prevent constipation and simplify your bowel movements. However, you can create a lifestyle that helps keep you regular (thereby relieving and, in many cases, avoiding constipation).
"The first step in the treatment of hemorrhoids is to eliminate constipation and restore regular, daily bowel movements with soft stool and without any straining," says Dr. Kantsevoy. "Increase your fiber and fluid intake [and] if diet alone does not eliminate constipation, you should start taking bulking agents like Metamucil and Miralax."
Make sure you also refrain from straining or lingering on the toilet, sitting for prolonged periods of time, and—if possible—taking medications that cause diarrhea or constipation, says Dr. Bechtold.
Frequently Asked Questions
Who is at risk for symptomatic hemorrhoids?
"Hemorrhoids are not uncommon, but the exact number of Americans with hemorrhoids is not accurate since many people attribute any anorectal discomfort to hemorrhoids," says Dr. Bechtold. He adds that people at risk for symptomatic hemorrhoids include those who do any prolonged sitting, have diarrhea, chronic constipation, or pelvic tumors, or perform straining activities. Older adults as well as pregnant people are at risk as well.
What is the best way to treat hemorrhoids?
Dr. Bechtold says the first steps to take when treating hemorrhoids are usually related to your lifestyle. This includes increasing your fiber and water intake, getting regular exercise, and limiting fatty foods and alcohol. If these don't work, however, you'll need to reach for some OTC treatments to feel better while your hemorrhoids heal (and your digestive system returns to some kind of regularity with its bowel movements).
"After dietary and lifestyle modifications, you can try some medications for relief of symptoms," Dr. Bechtold explains. "These include topical analgesics and steroids, venoactive agents, antispasmodic agents, and sitz baths."
Are OTC hemorrhoid treatments effective?
Yes, OTC hemorrhoid treatments are effective. Dr. Govekar suggests first seeing a doctor to make sure you have a hemorrhoid before trying an OTC treatment. He then suggests doing a warm sitz bath for about 10 minutes a day to reduce swelling. He also encourages patients to get on a fiber diet through vitamins or food changes to maintain a soft stool that's easy to pass.
Dr. Bravo advises his patients not to overuse OTC treatments since some can weaken and irritate the skin with prolonged use. "You should not use hemorrhoid creams and suppositories, particularly hydrocortisone, for longer than one week unless your health care provider approves."
How long does it take a hemorrhoid treatment to work?
Many hemorrhoids will improve quickly with treatment, at least in terms of pain; often, you’ll notice fewer symptoms in just a few days.
The actual healing process can take longer, though, depending on the type of hemorrhoid you have. Internal hemorrhoids are treated with sitz baths, diet modifications, and OTC products. Dr. Govekar usually waits four to six weeks, and many patients see symptoms disappear in about a month. External hemorrhoids can take a few weeks to a month to go down in size.
What OTC hemorrhoid treatments are safe for pregnancy?
According to Dr. Bechtold, dietary and lifestyle modifications (like eating more fiber, limiting fatty foods, and getting regular exercise) are safe in pregnancy and should be tried first.
"After that, I recommend warm—but not hot—sitz baths," he says, "sitting in about 3 to 4 inches of water for about 15 minutes."
If that doesn't work, you can try medicated wipes containing witch hazel, which are considered safe in pregnancy and are a treatment recommended by the American College of Obstetricians and Gynecologists.
Can an internal hemorrhoid be cured by home treatments?
In many cases, yes, but there are times when you should avoid treating an internal hemorrhoid at home. "If they are not large, complicated with fissures, or thrombosed, [you can treat them at home]," says Dr. Bravo.
Fissures are tears in the skin around the hemorrhoid, and a thrombosed hemorrhoid is one that contains a blood clot. If your hemorrhoids bleed, you may need medical treatment. This might include rubber band ligation or other surgical procedures designed to cut off the hemorrhoid's blood supply (causing it to shrink).
What’s the difference between hemorrhoids and fissures?
There's a big difference between hemorrhoids and fissures, though you can have both types of issues at the same time. According to Dr. Kantsevoy, hemorrhoids are enlarged or engorged veins that can be inside or outside the rectum; fissures, meanwhile, are vertical splits or tears in the lining of the anus.
"Fissures are extremely painful and usually happen in patients who have constipation and have strained [during bowel movements]," he explains. "Acute fissures happen in many people, and if constipation is corrected, they usually heal in seven to 10 days."
However, fissures can quickly become chronic and difficult to treat if constipation persists (unlike hemorrhoids, which are more easily treated and may go away without treatment). Some cases of chronic fissures may eventually require surgery, says Dr. Kantsevoy.
When should you seek professional treatment for hemorrhoids?
Hemorrhoids are fairly common, affecting about 10% of adults, says Dr. Kantsevoy. Most of these, he adds, won't need medical treatment unless they're bleeding or causing intense pain. Anal bleeding could point to a more serious case of hemorrhoids—or something else entirely.
"Bleeding could be caused by something other than hemorrhoids, so you should have it checked out by a physician," says Dr. Bravo, "[and] if you continue to have symptoms from hemorrhoids despite medical therapies or office-based procedures, you may require surgery."
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