What Is Stronger Than Preparation H for Hemorrhoids?

October 6, 2025 •

4 min read

While Preparation H is a widely recognized brand for treating hemorrhoid symptoms, nearly a third of patients who experience hemorrhoids seek treatment each year, often looking for more potent relief. When standard over-the-counter (OTC) products don't suffice, a range of stronger options, including higher-potency OTC creams and prescription medications, are available.

Quick Summary

This guide details medication options that offer more potent relief than standard Preparation H. It covers stronger over-the-counter formulas, prescription corticosteroids, and advanced procedures for managing severe hemorrhoid symptoms.

Key Points

Stronger OTC Numbing: Over-the-counter creams with higher concentrations of topical anesthetics like lidocaine can offer a more potent numbing effect for pain and itching than standard Preparation H formulas.
Enhanced Anti-Inflammatory Relief: Over-the-counter products containing 1% hydrocortisone provide stronger anti-inflammatory action for reducing swelling and itching compared to standard vasoconstrictors.
Prescription-Strength Steroids: A doctor can prescribe more potent corticosteroid creams and suppositories for severe inflammation.
Advanced Prescription Treatments: For severe pain, especially from thrombosed hemorrhoids, specialized prescription ointments containing certain active ingredients may be used.
Addressing Root Cause is Key: For all hemorrhoid treatments, lifestyle changes such as increased fiber intake and proper hydration are crucial for long-term management and prevention.
When to See a Doctor: If symptoms are severe, persistent, or don't improve with OTC treatments, consult a healthcare provider. This is especially important for thrombosed hemorrhoids.
Consult a Professional: Always seek medical advice before using stronger medications, especially prescription treatments, and follow directions precisely to avoid side effects.

Understanding the Active Ingredients in Hemorrhoid Treatments

Before considering what is stronger than Preparation H for hemorrhoids, it's beneficial to understand the active ingredients found in different treatments. Standard Preparation H products typically contain vasoconstrictors, such as phenylephrine, which helps reduce swelling, and protectants like petrolatum. Other active ingredients commonly found in stronger treatments include topical anesthetics for pain relief and corticosteroids to reduce inflammation.

Over-the-Counter Options Stronger Than Standard Preparation H

For many individuals, greater relief than standard Preparation H can be found with other over-the-counter products that contain different or more concentrated active ingredients.

Max-Strength Topical Anesthetics

Some Preparation H products may contain lidocaine, but for a more powerful numbing effect, higher-strength lidocaine creams are available. Certain over-the-counter products provide the highest strength of lidocaine available without a prescription, offering enhanced relief for pain, burning, and itching. Lidocaine is a local anesthetic that works by numbing the nerve endings in the affected area, potentially providing faster and more potent pain relief than some other topical anesthetics.

1% Hydrocortisone Creams

Over-the-counter hydrocortisone creams, such as certain Preparation H Anti-Itch creams, contain a low-dose corticosteroid. This ingredient is designed to reduce inflammation, redness, and severe itching more effectively than the vasoconstrictors in standard formulas. However, it's important to follow package directions and consult a doctor if considering use beyond a short duration, as prolonged use of corticosteroids can potentially cause skin thinning.

Prescription Medications for Enhanced Efficacy

When OTC treatments prove insufficient, a healthcare provider can prescribe stronger medications. These are typically reserved for more severe cases or when symptoms don't resolve with standard care.

Prescription-Strength Corticosteroids

For more intense inflammation and itching, doctors can prescribe stronger corticosteroid formulations, which often contain a higher percentage of hydrocortisone than OTC options. These are available in various forms, including creams (e.g., Proctozone HC, Proctocream HC) and suppositories (e.g., Anusol-HC, Anucort-HC). Combining a steroid with a local anesthetic, as found in some prescription products, can provide potent relief for both pain and inflammation.

Compounded Analgesic Ointments

For particularly painful or thrombosed hemorrhoids (where a blood clot has formed), topical treatments can be prescribed to reduce discomfort. Certain prescription ointments, though sometimes used for anal fissures, can help decrease rectal pain. Similarly, other compounded ointments can provide pain relief but must be specially prepared by a pharmacy.

Medical Procedures for Severe Hemorrhoids

In cases where both OTC and prescription medications fail to provide adequate relief, minimally invasive procedures performed in a doctor's office or surgery may be the next step. These treatments address the underlying issue more directly than topical creams.

Rubber band ligation: A tiny rubber band is placed around the base of an internal hemorrhoid to cut off its blood supply, causing it to wither and fall off within a week.
Sclerotherapy: A chemical solution is injected into the hemorrhoid tissue to cause it to shrink and scar.
Infrared coagulation: Using infrared light or heat, this technique causes small, internal hemorrhoids to harden and shrivel.
Hemorrhoidectomy: A surgical procedure to remove hemorrhoids, typically reserved for the most severe cases.

Comparison of Hemorrhoid Treatments


Treatment Type	Example Ingredients	Active Ingredients	Relative Strength vs. Prep H	Best For	Considerations
Standard OTC (Prep H)	Phenylephrine HCl, Petrolatum	Vasoconstrictor, Protectant	Baseline	Mild swelling, itching, and discomfort	Provides temporary relief; often combined with other ingredients.
OTC Max-Strength Numbing	Lidocaine	Local Anesthetic	Stronger	Rapid relief of pain, burning, and itching.	Doesn't treat underlying cause; for short-term use.
OTC 1% Hydrocortisone	1% Hydrocortisone	Low-dose Corticosteroid	Stronger	Persistent itching and inflammation.	Use according to package directions; consult a doctor for prolonged use.
Prescription Corticosteroids	Higher-potency Hydrocortisone (e.g., 2.5%)	Higher-dose Corticosteroid	Much Stronger	Severe inflammation and itching unresponsive to OTCs.	Requires a prescription; for short-term, medically supervised use.
Combination Prescriptions	Hydrocortisone + Local Anesthetic	Corticosteroid + Numbing Agent	Much Stronger	Combined severe pain and inflammation.	Combines the effects of a numbing agent and anti-inflammatory; prescription needed.

Conclusion

While Preparation H can be effective for mild hemorrhoid symptoms, many stronger alternatives are available for more persistent or severe cases. Over-the-counter options with higher concentrations of topical anesthetics or the addition of 1% hydrocortisone can offer enhanced relief for pain and inflammation. For the most potent topical treatments, prescription-strength corticosteroids and compounded analgesics are available through a healthcare provider. Ultimately, for any hemorrhoid symptoms that are severe, prolonged, or fail to respond to initial treatment, consulting a doctor is essential. They can accurately diagnose the condition and recommend the most effective and safest course of treatment, including discussing minimally invasive procedures if necessary.

Lifestyle Changes and Prevention

No medication is a substitute for addressing the root causes of hemorrhoids. A high-fiber diet, adequate water intake, and avoiding straining during bowel movements are foundational to both preventing and managing the condition. Soaking in a warm sitz bath for 10-15 minutes can also provide significant relief from discomfort and irritation. For comprehensive advice on managing hemorrhoid symptoms and prevention, it is always best to consult with a healthcare professional.

Mayo Clinic's guide to hemorrhoid diagnosis and treatment

Frequently Asked Questions

If your hemorrhoid symptoms, such as pain, swelling, and itching, are severe, persistent, or have not improved after about a week of using standard over-the-counter products like Preparation H, it's time to consider consulting a healthcare provider about stronger options.

Over-the-counter creams containing the highest available concentration of lidocaine are often considered among the strongest topical numbing agents. For inflammation, an OTC 1% hydrocortisone cream offers more potent anti-inflammatory effects.

Yes, a doctor can prescribe stronger options, including higher-potency corticosteroid creams and suppositories, and combination products that include both steroids and local anesthetics.

It is generally not recommended to mix different products unless instructed by a healthcare provider. Some products have overlapping ingredients, and combining them could potentially lead to adverse effects. It is important to follow the specific instructions for each product.

Over-the-counter hydrocortisone creams should be used according to package directions. For use beyond a short duration, it is advisable to consult with a doctor. Prolonged use can potentially lead to adverse effects, including thinning of the skin.

For persistent or severe hemorrhoids that do not respond to medication, medical procedures may be necessary. Options include rubber band ligation, sclerotherapy, infrared coagulation, and, in advanced cases, a hemorrhoidectomy.

A thrombosed hemorrhoid occurs when a blood clot forms in an external hemorrhoid, causing a painful, bluish lump. If you experience intense, severe pain along with a noticeable lump, consult a healthcare provider, as this often requires medical attention.