**Use topical steroids only for short-term to avoid thining of skin. No more than 7 days.
- Lidocaine 5% topical ointment, apply 1-4 times daily as needed
- Dibucaine 1% topical ointment, apply tid-qid prn.
- Benzocaine 5 to 20% rectal ointment, apply up to six times daily as needed.
- Proctofoam HC (Hydrocortisone / Pramoxine topical)
- Pramoxine 1% rectal foam / ointment / wipes.
- Hydrocortisone rectal creams 1 to 2.5% (eg, Anusol-HC, Preparation H, Proctosol);
- Hydrocortisone rectal suppository 25 to 30 mg (eg, Anusol-HC)
- Nitroglycerin (glyceryl trinitrate) 0.2 to 0.5% ointment. Apply pea-sized amount twice daily.
- Phenylephrine 0.25% (Preparation-H, Rectacaine). Ointment/suppository. Use up to 4 times per day.
- Zinc oxide topical paste (Desitin cream). Apply as needed.
- Witch hazel (eg, Tucks, Preparation H pads). Apply as needed up to six times.
- Bulk-forming agents: Dietary fiber supplement e.g. Benefiber.
- Stool softeners like docusate sodium.
Phenylephrine is a good choice for temporary relief of acute symptoms like bleeding or pain on defecation. It is well tolerated. Side effects are rare.
Steroids decrease local inflammation and provide pain relief.
Nitroglycerin helps with anal sphincter spasm or thrombosed external hemorrhoids. Systemic side effects (eg, headache) are common. Be careful.
Zinc oxide protects the skin and has antiseptic properties.