What is a prescription for hemorrhoids? Understanding Your Medication Options

October 9, 2025 •

4 min read

Hemorrhoids affect approximately one-third of the population who seek treatment each year, with many requiring more than over-the-counter options for relief. A prescription for hemorrhoids is typically reserved for more severe, persistent, or complex cases, involving stronger medications than those available without a doctor's supervision. These treatments are designed to manage more intense inflammation, pain, and other symptoms that do not respond to basic home care.

Quick Summary

Prescription hemorrhoid medications include stronger topical corticosteroids to reduce inflammation, combination products with local anesthetics for pain relief, and specialized ointments for thrombosed hemorrhoids. Oral flavonoids may also be prescribed to strengthen blood vessels. These are options for severe or persistent cases unresponsive to over-the-counter treatments.

Key Points

Stronger Corticosteroids: A prescription for hemorrhoids often includes higher-concentration hydrocortisone to reduce intense inflammation and itching that over-the-counter products can't address.
Combination Medications: Doctors may prescribe combination products that pair a potent steroid like hydrocortisone with a local anesthetic such as lidocaine or pramoxine, offering both anti-inflammatory and numbing effects (e.g., Analpram HC).
Thrombosed Hemorrhoid Relief: For the severe pain of a thrombosed external hemorrhoid, specialized topical prescriptions like nitroglycerin ointment may be recommended to relax blood vessels, even if not FDA-approved for hemorrhoid treatment.
Oral Treatment Options: In some cases, an oral flavonoid medication like diosmin (Hemovel) may be prescribed to address hemorrhoids systemically by strengthening blood vessel walls and improving circulation.
Professional Diagnosis is Key: Seeing a healthcare provider for a proper diagnosis is crucial, as persistent symptoms may indicate a need for a stronger prescription or even an in-office procedure, rather than continued use of inadequate home treatments.
Limited Duration of Use: Prescription steroid creams should be used for a limited time (typically a couple of weeks) under medical supervision to avoid side effects like skin thinning.

While mild hemorrhoid symptoms can often be managed with lifestyle changes and over-the-counter (OTC) products, a persistent or severe case warrants a visit to a healthcare provider. Your doctor can determine if a more potent prescription medication is necessary and rule out other potential causes of your symptoms. Prescription medications for hemorrhoids generally offer a stronger dose of active ingredients to combat significant inflammation, swelling, and pain.

Topical Prescription Medications

For many patients, especially those with external hemorrhoids, topical prescriptions are the first line of medical intervention beyond basic OTC treatments. These products are formulated to target the affected area directly and are often more potent than their non-prescription counterparts.

Corticosteroid Creams and Suppositories

High-strength corticosteroids are a common prescription for hemorrhoids due to their powerful anti-inflammatory properties. These work by suppressing the inflammatory chemicals that cause swelling, redness, and itching.

Hydrocortisone Acetate (e.g., Anusol-HC, Proctozone-HC): These are available in higher concentrations by prescription. The cream is applied externally, while suppositories are used for internal hemorrhoids and conditions like proctitis. Patients are often advised to use these for a limited period, typically two weeks, as prolonged use can lead to skin thinning.

Combination Products

To provide comprehensive relief, some prescriptions combine a corticosteroid with a topical anesthetic or numbing agent.

Hydrocortisone and Pramoxine (e.g., Analpram HC, Pramosone): This combination provides dual action, using hydrocortisone to reduce inflammation and pramoxine to numb the area and relieve pain and itching.
Hydrocortisone and Lidocaine (e.g., Ana-Lex): Similar to pramoxine, lidocaine is a local anesthetic that numbs the skin. Combined with hydrocortisone, it offers potent relief from both inflammation and pain.

Specialized Ointments for Severe Pain

For the severe pain associated with a thrombosed (clotted) external hemorrhoid, a doctor might prescribe specialized treatments.

Nitroglycerin Ointment (e.g., Rectiv): While more commonly used for anal fissures, topical nitroglycerin has been used off-label to help relieve the pain of a thrombosed hemorrhoid by relaxing blood vessels and decreasing anal sphincter pressure.
Nifedipine Ointment: This must be prepared by a compounding pharmacy, as it is not commercially available for hemorrhoid treatment. It also works by relaxing the anal sphincter muscles to reduce pain.

Oral Prescription Medications

Beyond topical treatments, oral medications can also play a role, particularly in addressing the underlying vascular issues related to hemorrhoids.

Oral Flavonoids (e.g., Diosmin)

Hemovel (Diosmin): In regions where it is available, diosmin is an oral supplement that has been clinically proven to reduce the duration and severity of hemorrhoid symptoms. It works from the inside out by strengthening vein walls and improving blood circulation.

The Prescription Process and Consultation

Obtaining a prescription for hemorrhoids begins with a proper diagnosis from a healthcare provider. The process typically involves a consultation to discuss symptoms, medical history, and any previous treatments attempted.

Your doctor will perform an exam to determine the type and severity of your hemorrhoids. Based on their findings, they may recommend a specific prescription or refer you for other procedures. It's crucial to follow your doctor's instructions, as misuse of certain medications, such as prolonged use of steroids, can cause adverse effects.

When to Consider a Prescription

A prescription is generally warranted when:

OTC products and home remedies fail to provide sufficient relief after a week of use.
Symptoms are severe, such as intense pain, significant swelling, or recurring bleeding.
A thrombosed hemorrhoid is diagnosed, requiring more potent pain management.
An accurate diagnosis is needed to rule out other conditions that can cause similar symptoms, such as anal fissures or more serious issues.

Comparison of Treatment Options


Feature	Over-the-Counter (OTC)	Prescription	In-Office Procedures
Best For	Mild, occasional symptoms (itching, swelling, pain).	Severe, persistent, or complex cases unresponsive to OTC.	Large, internal, prolapsed, or recurring hemorrhoids.
Examples	Hydrocortisone 1% cream, witch hazel pads (Tucks), Preparation H.	Stronger hydrocortisone, combination products (Analpram HC), oral flavonoids.	Rubber band ligation, sclerotherapy, hemorrhoidectomy.
Active Ingredients	Low-dose anti-inflammatories, protectants, astringents.	High-dose corticosteroids, local anesthetics, vasodilators.	Specialized surgical or chemical agents to remove or shrink tissue.
Application	Topical creams, ointments, pads, suppositories.	Potent topical creams, suppositories, oral pills.	Surgical instruments applied in a clinic or hospital setting.
Speed of Relief	Symptom relief is often temporary and can take several days.	Can provide faster, more potent relief for severe symptoms.	Definitive, long-term solution, though recovery time is needed.
Risks	Mild skin irritation with prolonged use.	Side effects from stronger steroids, potential drug interactions.	Potential pain, bleeding, and complications; depends on procedure.

Conclusion

For those suffering from hemorrhoid symptoms that are not adequately relieved by home care and OTC products, a prescription from a healthcare professional offers a range of more potent and targeted treatments. From stronger topical corticosteroids that combat intense inflammation to specialized ointments for severe pain and oral options that address the underlying vascular issue, there are effective medical interventions available. Consulting with a doctor is the first step towards an accurate diagnosis and a personalized treatment plan that can finally provide lasting relief from persistent hemorrhoids.

For more information on hemorrhoid treatment options, including in-office procedures, consult the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/treatment

Frequently Asked Questions

You should see a doctor if your hemorrhoid symptoms are severe, include significant bleeding, or if they do not improve after a week of using over-the-counter medications and home remedies.

Prescription hemorrhoid creams often contain higher concentrations of active ingredients, particularly corticosteroids like hydrocortisone, making them more potent for treating severe inflammation and pain.

Yes, oral flavonoid medications like diosmin (branded as Hemovel in some countries) may be prescribed to help reduce the duration and severity of hemorrhoid symptoms by strengthening blood vessel walls.

For the intense pain of a thrombosed hemorrhoid, a doctor might prescribe topical nitroglycerin or a compounded nifedipine ointment. In some cases, a minor in-office procedure to remove the clot may be recommended.

Prescription suppositories often contain a higher dose of hydrocortisone. They are inserted rectally to deliver the anti-inflammatory medication directly to the internal hemorrhoid tissue, reducing swelling and itching.

While OTC pain relievers like ibuprofen are sometimes recommended for temporary relief, specific topical numbing agents (e.g., lidocaine combined with hydrocortisone) can be prescribed for more targeted and potent pain management.

Prescription steroid creams should only be used as directed by your doctor, typically for a limited period such as one to two weeks, to prevent side effects like skin thinning.