The best hemorrhoid creams for pain, itching and burning

For burning, itching, and soreness on the outside skin, start with Preparation H Maximum Strength Cream. It is the hemorrhoid cream with the longest buyer record in this set, and people usually describe relief within minutes to a few hours. If the pain is sharp enough that sitting hurts, use Preparation H Rapid Relief instead. If you want something light and cool, use the cooling gel.

Creams do not treat bleeding on their own, and they do not reach a swollen hemorrhoid inside the rectum. That job belongs to fiber, toilet habits, and sometimes a suppository. This page covers five creams and gels, who each one suits, what the studies actually found, and when to stop. External hemorrhoids are the type these tubes are made for. Every product type is listed on the best hemorrhoid products.

The NIDDK’s page on hemorrhoid treatment says over-the-counter creams may relieve mild pain, swelling, and itching of external hemorrhoids. Doctors most often recommend them for about a week ¹.

Our picks compared

The five products below are all for outside skin. They differ in how strong the numbing feels, how heavy the texture is, and whether you also get cooling pads.

Reviews of our picks

A short note sits under each award. The pattern in the reviews is speed for the Preparation H creams, a lighter feel for the gel, a two-piece kit for a first flare, and low odor for Tronolane.

How we chose these hemorrhoid creams

We started with creams and gels that already had strong overall ratings from a large number of buyers, then read recent reviews for the comments that kept repeating. Preparation H Maximum Strength, Rapid Relief, and the cooling gel all drew the same kind of praise: relief that starts quickly, and a cool or numbing feel. The complaints were practical. Tubes are small if you apply them several times a day, the Rapid Relief cap is hard to open, and the gel’s cool feeling is milder than the name suggests for some people.

The TUCKS kit made the list because childbirth reviews are consistently positive and the box solves two jobs at once: a cream plus pads. It is a starter, not a month’s supply. Tronolane has a much smaller review record than Preparation H, so it is a second choice. It stayed on the list because long-time buyers keep mentioning the same things: relief as soon as it goes on, little smell, and no stains. We did not rank these by price. No brand pays for a slot. How that works is on the affiliate disclosure.

What the research says

Creams are for comfort. The trial evidence for a specific drugstore tube is thin, and a 2019 review of hemorrhoid research says medical therapies have not been formally studied except for fiber, where results have been inconsistent ³. Family physicians still list topical over-the-counter products, along with fiber, fluids, stool softeners, and sitz baths, as the usual first treatment ². Our guide to over-the-counter treatment puts each product type next to the studies.

One modern placebo-controlled trial does exist, and it is small. Sixty adults with grade I or II hemorrhoids used either a drug-free topical cream or a placebo for two weeks. Every symptom the researchers tracked, including pain, itch, and discharge, improved more in the cream group at 7 days and at 14 days. No serious side effects were recorded ⁶. That cream is not one of the tubes on this page. It shows that a topical product can beat placebo in mild disease. It does not prove that every pharmacy cream will.

Numbing has better evidence after a procedure than for an ordinary itch. In a trial of 99 people after rubber band ligation (a small band placed around an internal hemorrhoid), 2 percent lidocaine ointment three times a day for five days lowered pain scores at one hour compared with placebo ointment ¹⁰. Adding diltiazem, a prescription drug that relaxes muscle, improved satisfaction and cut analgesic use by about 45 percent. The benefit looked short term ¹⁰. A separate safety study in 24 people with anorectal pain found that repeated use of a 5 percent lidocaine ointment kept blood levels below the concentrations the authors treated as the therapeutic and toxic thresholds ¹⁸.

For a clotted external hemorrhoid, researchers have tested lidocaine ointment on its own and with a prescription partner. In a trial of 98 people, 1.5 percent lidocaine ointment every 12 hours gave complete pain relief at 7 days in 24 of 48 people (50 percent). Adding 0.3 percent nifedipine raised that to 43 of 50 (86 percent). At 14 days the clot had resolved in 22 of 48 people on lidocaine alone (45.8 percent) and in 46 of 50 on the combination (92 percent) ¹¹. Nifedipine ointment is not an over-the-counter cream. A numbing ointment can help about half of people with this kind of lump by a week, and a doctor can add a prescription if the pain is severe. Symptoms in a chart review settled in an average of 24 days without surgery and in 3.9 days when the clot was removed ²². Excision in the first two or three days can cut pain sharply if it is offered ². See what a thrombosed hemorrhoid is.

Itch is a different target from sharp pain. A review of pruritus ani, the medical name for a chronically itchy anus, says topical anesthetics ease itch for only a few hours and can sensitize the skin ¹². For mild itch with little skin change, that review suggests 1 percent hydrocortisone morning and night after washing, then a switch to a barrier cream once the itch fades. Side effects are less common with 1 percent hydrocortisone than with stronger steroid creams, which can thin skin if they are used for a long time ¹². MedlinePlus lists hydrocortisone creams for pain and swelling, and lidocaine or another anesthetic for pain ⁴. How those two jobs differ is the point of anti-itch cream versus numbing cream. Witch hazel, which MedlinePlus suggests on a cotton swab for itch ⁴, is covered in does witch hazel work for hemorrhoids.

Hydrocortisone has a hard stop. The NHS instructions for hydrocortisone for piles say creams and ointments are for external piles, usually morning, at night, and after a bowel movement, and not for more than 7 days. See a doctor if you are no better after 7 days or symptoms come back quickly ⁵. NIDDK uses the same one-week window for over-the-counter products in general, and says to follow up if the skin gets dry or a rash appears ¹.

Fiber is still the treatment with a meta-analysis for bleeding. Seven trials and 378 people: fiber cut the risk of bleeding by about half and cut the risk that symptoms would not improve by 47 percent ¹³. A cream can sit on top of that plan. It does not replace it. The fiber supplement guide is the next page if blood on the paper is the main complaint. Read bleeding hemorrhoids for what is ordinary and what is not.

Pregnancy studies are small and do not match these brand tubes one for one. In 23 pregnant women, 1 percent hydrocortisone cream improved pain, itch, swelling, bleeding, and discomfort. A special toilet seat did better on pain, swelling, and discomfort. The authors called it a preliminary trial ⁷. In a much larger comparison, 211 pregnant women used a topical cream twice a day and 284 used salty warm sitz baths three times a day. Both groups also used glycerin suppositories before bowel movements and a daily psyllium supplement. Complete healing was reported in 84.8 percent of the cream group and in all of the sitz group ¹⁶. A Cochrane review found that diet changes and local treatments in pregnancy have not been properly tested in randomized trials ¹⁷.

On safety, the NHS page on hydrocortisone in pregnancy says those creams can be used in pregnancy and, for a short time, while breastfeeding. Wash your hands before you pick up a baby ¹⁹. A study of 204 women exposed to a hydrocortisone-and-pramoxine foam in the third trimester found no difference in birth weight, prematurity, or complications compared with unexposed women ⁸. A 2008 review still noted that common topical hemorrhoid products had not been assessed one by one in pregnancy, and that symptoms often fade after birth ⁹. Ask your obstetric provider, and read hemorrhoids during pregnancy before you choose a medicated tube.

How to choose

If the skin is raw from wiping or loose stools, an ointment that stays put often works better than a cream that rubs off. That comparison is on the best hemorrhoid ointments. If the swelling is inside, use hemorrhoid suppositories. Pads and wipes, including the ones in the TUCKS kit, are compared in Preparation H versus Tucks.

Skip a medicated cream, or ask a clinician first, if you have a skin infection, you have reacted to a numbing cream before, or the person who needs it is a child. The NHS says most adults 18 and older can use hydrocortisone treatments for piles, some products are limited at ages 16 and 17, and children 2 to 15 need a prescription for the products that are allowed ²¹. Tell a pharmacist if you take codeine or another medicine that constipates you, because hard stools will keep the flare going ²¹.

How to use them safely

Follow the leaflet in the box you bought. The steps below are the ones the NHS gives for hydrocortisone creams and ointments used on external piles, and they are a sensible pattern for the creams on this page ⁵.

1. Go to the toilet first if you need to, then pat dry. Do not rub.
2. Wash your hands. Put a small amount on a finger and apply it to the skin around the anus, not deep inside, unless your label says internal use. None of the creams on this page are the internal product.
3. Wash your hands again.
4. For hydrocortisone treatments, the usual rhythm is morning, at night, and after a bowel movement ⁵. Other creams may say up to four times a day. The label wins.
5. Stop at 7 days for hydrocortisone ⁵. For other over-the-counter hemorrhoid products, NIDDK’s usual limit is about a week ¹.
6. Stop sooner if you get a rash, the skin turns very dry, or stinging gets worse instead of easing ¹. A few Rapid Relief buyers report irritation. Switch to a plain barrier ointment and ask a pharmacist.
7. If you forget a dose of a hydrocortisone product, use it when you remember unless the next dose is only a few hours away. Then skip and continue ⁵. Using more than the label is unlikely to cause a crisis, but call a pharmacist if a child has used a lot ⁵.
8. If day 7 is no better, or the itch returns as soon as you stop, book a visit. Do not start a second week on your own ^1,5.

The NHS advice on piles says a pharmacist can help you choose a cream, and that many pharmacies have a private space if you do not want to talk at the counter ¹⁵. Piles often improve after a few days of home care ¹⁵. A cream that you are still depending on next month is past the window these pages describe.

While breastfeeding, the NHS says hydrocortisone treatments for piles can be used for a short time. Wash your hands before you hold the baby. If feeding or weight gain changes, call your clinician ¹⁹.

When to see a doctor instead

A cream is the wrong tool when the symptom might not be a hemorrhoid. The American Cancer Society’s list of colorectal cancer symptoms includes blood that makes stool look dark brown or black, a change in bowel habits lasting more than a few days, belly pain, weakness, and unintended weight loss ²⁰. The US Preventive Services Task Force recommends colon cancer screening from age 45 for adults at average risk ¹⁴.

NIDDK says to get care right away for severe anal pain and rectal bleeding, particularly with belly discomfort, diarrhea, or fever ¹. If home treatment has not helped, the next step is an exam, not a stronger cream from the same shelf. When to see a doctor for hemorrhoids covers what that visit is like. Office procedures, including banding, are on the hemorrhoid treatment overview if creams and fiber have already had a fair week.