The Distinction Between Internal and External Hemorrhoids
Understanding whether your hemorrhoids are internal or external is the first step toward effective treatment. Hemorrhoids are swollen veins in your rectum and anus that can develop either inside or outside.
- External Hemorrhoids: These form under the skin around the anus. They are often visible and can cause significant discomfort, including itching, burning, and pain.
- Internal Hemorrhoids: These develop inside the rectum. They are typically painless but can cause bleeding during or after a bowel movement. In some cases, internal hemorrhoids can prolapse, meaning they push outside the anus, where they can become irritated and painful.
Many over-the-counter (OTC) hemorrhoid creams are formulated to treat both types and include an applicator for internal use. However, some products, like those containing certain local anesthetics such as pramoxine, are strictly for external use unless directed by a doctor. Always read the specific product's packaging to confirm its intended use.
Applying Cream for External Hemorrhoids
For external hemorrhoids, the application process is straightforward, but cleanliness is paramount to prevent irritation or infection.
Steps for external application:
- Cleanse: Before use, gently cleanse the affected anal area with mild soap and warm water. A sitz bath can also be beneficial.
- Dry: Pat the area dry gently with a soft cloth or tissue. Avoid harsh rubbing.
- Apply: Squeeze a small amount of cream onto your fingertip.
- Massage: Gently and carefully apply the cream to the skin around the outside of your anus.
- Wash: Thoroughly wash your hands with soap and warm water immediately after application.
Applying Cream for Internal Hemorrhoids
When treating internal hemorrhoids, an applicator is the correct tool to deliver the medication directly to the source of the problem, inside the rectum. Using a finger for internal application is discouraged and can be less effective.
Steps for internal application with an applicator:
- Prepare: Try to have a bowel movement before application. Also, wash and dry the area and your hands thoroughly.
- Attach Applicator: Remove the protective cover and attach the provided rounded applicator tip securely to the tube of cream.
- Fill and Lubricate: Squeeze the tube gently to fill the applicator with cream. For comfort, lubricate the applicator's tip with a small amount of the same cream or petroleum jelly.
- Insert: Gently insert the applicator's rounded tip just inside the rectum. Do not insert it forcefully or too deeply.
- Apply: While holding the applicator in place, gently squeeze the tube to dispense the cream inside.
- Remove and Clean: Withdraw the applicator and thoroughly wash it with soap and warm water. Replace its protective cover.
- Post-Application Care: Follow the product instructions for post-application recommendations.
Internal vs. External Application: A Comparison
| Feature | External Application | Internal Application (with applicator) |
|---|---|---|
| Indicated For | Visible hemorrhoids outside the anus. | Hemorrhoids inside the rectum. |
| Application Tool | Clean finger. | Included applicator nozzle. |
| Target Area | The skin and swollen veins around the anus. | The tissue just inside the rectal opening. |
| Primary Symptoms | Itching, burning, visible swelling, pain. | Bleeding, internal pressure, discomfort. |
| Recommended Timing | Follow product instructions. | Follow product instructions. |
| Cleaning Needed | Hand and external area cleaning. | Hand, external area, and applicator cleaning. |
Understanding Active Ingredients
Different creams use various active ingredients to provide relief. For instance, phenylephrine is a vasoconstrictor that can shrink swollen tissue, while pramoxine is a local anesthetic for pain and itching. Some products, like Preparation H Ointment, are designed for both internal and external hemorrhoids, whereas others may be specifically formulated for external use only. Always check the label to ensure the cream's ingredients and method of application align with your symptoms.
When to Seek Medical Advice
Over-the-counter hemorrhoid creams are for temporary symptom relief. If your symptoms do not improve within seven days of consistent use, or if you experience significant bleeding, worsening pain, or other concerning issues, it is time to consult a doctor or colorectal specialist. It's crucial to rule out more serious conditions, as hemorrhoid symptoms can sometimes mimic other health problems. Remember that topical treatments address symptoms, not the underlying cause, which often relates to lifestyle factors like diet and bowel habits.
Conclusion
To determine if you apply hemorrhoid cream inside or outside, first identify if your symptoms are stemming from internal or external hemorrhoids. Use a clean finger for external application on the anal area. For internal hemorrhoids, use the provided applicator and follow the instructions carefully for hygienic and effective treatment. Always cleanse the area before applying and wash your hands thoroughly afterward. If your symptoms persist, seek professional medical advice to ensure proper diagnosis and care.
