When to Seek Stronger Treatment
Most mild to moderate hemorrhoid cases respond well to home care, which includes high-fiber diets, increased fluid intake, and using over-the-counter creams or wipes. However, if symptoms persist for more than a week, worsen, or include severe pain and bleeding, it is time to consult a doctor. A healthcare provider can not only prescribe stronger medications but also rule out other, more serious conditions that cause similar symptoms, such as anal fissures or certain cancers. For moderate to severe cases, stepping up from OTC treatments to prescription-strength options or other medical interventions may be necessary to achieve lasting relief.
Prescription Topical Medications
Unlike OTC products, which typically contain 1% hydrocortisone, prescription-strength topicals contain a higher concentration of active ingredients, providing more potent relief.
Combination Products (Hydrocortisone + Anesthetic)
These medications combine a strong corticosteroid with a local anesthetic to address both inflammation and pain simultaneously. Popular examples include Proctocream HC and Ana-Lex, which contain higher doses of hydrocortisone and lidocaine or pramoxine. They are typically applied rectally via a special applicator or as a suppository for internal hemorrhoids.
Ointments for Thrombosed Hemorrhoids
For painful, thrombosed external hemorrhoids—where a blood clot has formed—healthcare providers may prescribe specific medications to relax blood vessels and reduce pain. These can include nitroglycerin ointment (brand name Rectiv) or nifedipine ointment. Nitroglycerin works by relaxing the smooth muscles of the anus, while nifedipine, a calcium channel blocker, has a similar effect. Nifedipine ointment is often custom-made by a compounding pharmacy.
Oral Medications
Though less common than topical treatments, oral medications can be prescribed to address hemorrhoid symptoms systemically.
- Oral Flavonoids: Some doctors may recommend oral flavonoids, such as diosmin and hesperidin, for more severe cases. These compounds, found naturally in certain plants, are believed to strengthen vein walls and improve circulation, helping to reduce bleeding and swelling.
- Stool Softeners: For hemorrhoids caused or aggravated by straining due to constipation, stronger prescription stool softeners or laxatives may be used to help achieve easier, pain-free bowel movements.
Comparing Treatment Options
| Feature | Over-the-Counter Topicals (e.g., Preparation H) | Prescription Topicals (e.g., Proctocream HC, Rectiv) | Oral Medications (e.g., Diosmin, Fiber Supplements) | In-Office Procedures (e.g., Ligation, Sclerotherapy) |
|---|---|---|---|---|
| Strength | Lower concentration of active ingredients | Higher concentration; more potent anti-inflammatories and anesthetics | Systemic effect; strengthens veins and addresses constipation | Most definitive for unresolved internal hemorrhoids |
| Mechanism | Protectants, mild vasoconstrictors, and low-dose steroids to soothe symptoms | Stronger anti-inflammatory, numbing, or muscle-relaxing effects | Strengthens vein walls or softens stool from the inside | Cuts off blood supply or shrinks hemorrhoid tissue |
| Best For | Mild to moderate, short-term symptoms | Severe pain, inflammation, or thrombosed hemorrhoids | Chronic issues, strengthening vascular tone | Persistent or larger internal hemorrhoids |
| Drawbacks | May not be effective for severe or stubborn symptoms | Can cause side effects like skin thinning with prolonged use; some require compounding | Slower acting; can be less suitable for acute symptom relief | Small risk of pain, bleeding, or infection; potential for recurrence |
In-Office and Surgical Procedures
When medication fails to resolve the issue, particularly for higher-grade internal or prolapsed hemorrhoids, minimally invasive office-based procedures or surgery may be required.
- Rubber band ligation: A tiny rubber band is placed around the base of an internal hemorrhoid, cutting off its blood supply. The hemorrhoid then withers and falls off within a week.
- Sclerotherapy: A chemical solution is injected into the hemorrhoid tissue to shrink it. This is typically painless but may be less effective than banding.
- Infrared coagulation: Using bursts of infrared light, this procedure hardens and shrinks small, bleeding internal hemorrhoids.
- Hemorrhoidectomy: This surgical removal of hemorrhoid tissue is typically reserved for the most severe or recurring cases that haven't responded to other treatments. It is the most effective treatment but also involves the longest and most painful recovery.
Conclusion
Yes, there are stronger prescription medications available for hemorrhoids when over-the-counter options prove insufficient. These include more potent topical combinations of steroids and anesthetics, as well as specialized ointments for thrombosed hemorrhoids. Oral medications can also play a supportive role, addressing underlying issues like poor vein health. For persistent or advanced hemorrhoids, a doctor may recommend an in-office procedure or surgery for a more definitive resolution. It is crucial to consult a healthcare professional for persistent bleeding or pain to ensure a correct diagnosis and to discuss the most appropriate and potent treatment plan for your specific condition.
Medical Disclaimer
The information provided in this article is for informational purposes only and does not constitute medical advice. Please consult with a healthcare professional before starting any new medication or treatment, or if your symptoms do not improve.
Medical resource from Mayo Clinic for further reading on hemorrhoid treatment
