The 6-ish OTC Treatments for Hemorrhoids (Piles)

What are Hemorrhoids?

Hemorrhoids, also known as piles, are a group of symptoms caused by out-of-place anal cushions. What are anal cushions, then? Anal cushions are muscles attached to your anal sphincter. These muscles have two functions: during bowel movements, they mold your stool; when you’re not pooping, they form a seal around your anal sphincter.

Hemorrhoids (piles) occur when your anal cushions “fall” downward, and bulge out of your anus.

What Causes Hemorrhoids (Piles)?

Although the exact cause of hemorrhoids is not known, many factors can increase your risk. A few risk factors for hemorrhoids are:

  • Pregnancy
  • Anal sex
  • Activities that require sitting for a long time
  • Constipation (pharmacist’s tip: use docusate (Colace) to reduce pain associated with hemorrhoids)
  • Old age
  • Low fiber Western diet (pharmacist’s tips: add fiber to your diet with Metamucil (psyllium) 

Hemorrhoid Treatment #1: fiber therapy

In our opinion, fiber therapy with a soluble fiber, like psyllium, is the best treatment for piles. Ten grams of fiber, taken three times daily, will reduce bleeding, pain and itching. Fiber therapy usually takes 10-14 days to work, however.

Hemorrhoid Treatment #2: numbing agents

Numbing agents (pramoxine, benzocaine, cinchocaine or dibucaine) are useful for mild pain and itching. Use these drugs for less than 5 days, however; they can worsen piles by causing rash-like side effects. Pramaxine is least likely to cause rash-like side effects.

Hemorrhoid Treatment #3: astringents

Astringents (witch hazel, zinc oxide or zinc sulfate) are useful for wet piles. Astringents may also sooth burning temporarily.

Hemorrhoid Treatment #4: steroids

Hydrocortisone has anti-inflammatory and anti-itch effects. Do not use hydrocortisone for more than seven days, as chronic use can cause yeast infections and viral infections. Hydrocortisone may also increase your risk of rectal bleeding.

Hemorrhoid Treatment #5: cryotherapy (Anurex)

Anurex is the only cryotherapy available over-the-counter. Anurex works by cooling your piles. Given it’s high cost, and questionable effectiveness, we do not recommend Anurex.

Hemorrhoid Treatment #6-ish: prevention

Prevention is the best treatment for piles. Here are a few prevention tips:

  1. Keep toilet bowel visits short (~ 2 minutes)
  2. Avoid straining on the toilet. If you must, use stool softeners.
  3. Lose weight

Pharmacist’s Tips

  • See your doctor if you have had hemorrhoids for more than 7 days. 30% of such patients may have one the following serious medical conditions: anal fissure, fistula, abscess or colorectal cancer.
  • Treatment is not always necessary; hemorrhoids usually go away within 1 week. However, if your symptoms are too bothersome, don’t hesitate to grab one of the nine OTC hemorrhoid remedies. 

Got a question about your drugs? Ask. We'll answer :)