Anti-itch or numbing cream: which one do hemorrhoids need?

Anti-itch cream and numbing cream answer different problems. Hydrocortisone is a mild corticosteroid, a steroid medicine that calms inflammation and itch. Lidocaine is a local anesthetic that blocks pain for a limited time. One does not do the other’s job. If the skin itches and feels raw, a short course of hydrocortisone is the closer match. If sitting hurts, or a lump is throbbing, a numbing cream is the closer match.

Hemorrhoid creams you can buy often mix these ideas, or use a different soothing drug entirely. This page stays with what the trials and the NHS say about hydrocortisone and about lidocaine: what each is for, how long a steroid is used, side effects described by Coondoo and by the NHS, and what is known in pregnancy. For the rest of the drugstore shelf, see over-the-counter hemorrhoid treatment.

What an anti-itch cream is for

Hydrocortisone treatments for piles and itchy bottom come as creams, ointments, sprays, and suppositories. The NHS page on hydrocortisone for piles says they can help pain and itching, and that they do not cure piles. Creams, ointments, and sprays stay on the outside skin, which is where external hemorrhoids and itchy skin live. Suppositories are for internal piles. You will usually apply a treatment several times a day: morning, night, and after a bowel movement. Pain and itching should ease within a few days ¹.

The evidence that a steroid ointment helps is real, and it is not huge. A meta-analysis of six randomized double-blind trials covered ointments for hemorrhoids, perianal eczema, or both, used for 2 weeks. Out of 1,070 patients, hydrocortisone ointment alone was rated satisfactory in 75%, compared with 52% for the plain ointment base. An ointment that combined hydrocortisone with an E. coli culture suspension was rated satisfactory in 83%, and that combination beat hydrocortisone alone on symptom scores in two trials (p = 0.036 and p = 0.019) ⁵. So a steroid ointment beat a plain base for burning, itching, redness, and soiling. It was not the strongest ointment in that set.

A much larger trial used hydrocortisone acetate suppositories as the comparison treatment for acute hemorrhoids. Patients used 25 mg every 8 hours, up to 24 doses. At day 5, a complete response (pain and bleeding gone, and the lesion at least 70% smaller) happened in 46 of 170 people, or 27.1%. Time to response in that group was 10 days. An experimental streptokinase suppository did better on those measures. That drug is not a product you can buy for home use ⁶.

Itch that flares at bedtime has its own pattern. The steps for that are in why hemorrhoids itch more at night.

What a numbing cream is for

Lidocaine numbs pain for a short time. Hydrocortisone is the one aimed at itch and irritation. The clearest trial of lidocaine ointment itself is after a procedure, not in an ordinary drugstore flare.

Rubber band ligation, also called banding, places a small band at the base of an internal hemorrhoid so it shrivels and falls off. It hurts less than cutting hemorrhoids out, and many people still have pain afterward. In an Australian trial, 99 adults were randomized to 2% lidocaine ointment, 2% lidocaine plus 2% diltiazem, or placebo, applied three times a day for 5 days (33 people in each group). At 1 hour, pain scores were lower with lidocaine than with placebo (odds ratio 4.15, 95% CI 1.12 to 15.41) and lower with the combination (odds ratio 3.85). The combination group used about 45% less pain medicine and was more satisfied. The authors described the pain relief as short term, and complication rates did not differ ¹⁰.

A second banding trial injected 2 ml of bupivacaine 0.5% with adrenaline into each banded hemorrhoid during the procedure. Pain scores were lower at 1 hour (p = 0.04) and no different at 4, 24, or 48 hours. Oral pain-medicine use did not differ ¹¹. The numb feeling shows up early and fades.

For a clot under the skin of an external hemorrhoid, timing matters. A 2025 JAMA review says that if you are more than 72 hours past the start of a thrombosed external hemorrhoid, medical care is reasonable: stool softeners, and oral and topical pain medicine such as 5% lidocaine. Clot removal is the option discussed when severe pain is still inside that first 72 hours ¹⁴. What that lump is, and why the clock matters, is covered under thrombosed hemorrhoid.

A European review looked at a different product, tribenoside plus lidocaine, sold as a cream (tribenoside 5% with lidocaine 2%) and a suppository (tribenoside 400 mg with lidocaine 40 mg). Across the studies they collected, the combination was compared with each ingredient alone and with steroid preparations. The authors concluded there was enough evidence to recommend it for low-grade hemorrhoids ¹². A related review focused on women reported relief starting about 10 minutes after a dose and lasting up to 10 to 12 hours, in postpartum use and in pregnancy after the first trimester ¹³. Those papers are about one combination product studied in Europe. They do not prove that every numbing tube in a US pharmacy will last 10 hours.

Drugstore numbing creams are the practical option when pain is why you cannot sit. Buyers of a rapid-relief cream often describe pain easing within a day. A few feel stinging, or no numbness at all, and the child-resistant cap is hard for some people to open. A maximum-strength numbing ointment is what people try when milder creams have not been enough. The texture is greasy, which is the complaint that comes up most. Our notes on hemorrhoid creams and hemorrhoid ointments sort those by symptom.

Steroid side effects and how long to use one

Follow the label. Two public limits sit close together, and they are not identical.

The NHS says do not use hydrocortisone treatments for piles and itchy bottom for more than 7 days, and do not repeat courses too often. Short use rarely causes side effects. A little extra burning in the first few minutes is common and usually fades after a few days. Used for a long time, hydrocortisone can thin the skin around the anus. If an infection is already there, the steroid can make it worse, so wash the area and pat it dry before you apply anything. Very rarely the medicine is absorbed into the blood. Call a doctor or urgent care for skin that is more inflamed, or for a very upset stomach, severe dizziness, muscle weakness, unusual tiredness, mood changes, or loss of appetite and weight, which can signal an adrenal problem ¹.

The AGA expert review says topical anesthetics, astringents, corticosteroids, and vasoactive agents can be tried, that there is little data behind them, and that topical steroids should not be used for more than 2 weeks at a time ³. The NIDDK treatment page says doctors most often recommend any over-the-counter hemorrhoid product for 1 week, and to call if you get dry skin or a rash ⁴.

For home use, 7 days is the limit to follow unless a doctor tells you otherwise. That matches the NHS advice written for these exact products, and it sits inside the NIDDK’s 1 week and the AGA’s 2 weeks. The ointment trials above ran for 2 weeks, which is longer than the NHS piles advice. Do not stretch a tube to match a study.

Coondoo’s dermatology review explains why the clock is short. Local side effects of topical steroids show up with longer treatment, and they depend on how strong the steroid is, what it is mixed in, and where you put it. They are more common with higher-potency steroids and on thin skin such as the face and genitals. The most common local effect is atrophy, meaning the skin gets thin. The review also lists stretch marks, easy bruising, acne-like rashes, color change, slower wound healing, and infections that get worse. Systemic effects, including suppression of the adrenal axis that controls your own cortisol, are more likely when a strong steroid is used for a long time on thin skin or on raw, inflamed skin. Children and babies are at higher risk because their skin area is large compared with their body size ². Hemorrhoid hydrocortisone is a lower-potency steroid than the strong creams Coondoo focuses on. The perianal skin is still thin, and a flare leaves it raw, so the same caution applies: short course, then stop.

Numbing creams do not have a separate 7-day steroid rule, because they are not steroids. The NHS notes that a local anesthetic combined with hydrocortisone can make skin sensitive, which is part of the 7-day cap on those combination products ¹. The banding trial used lidocaine ointment for 5 days, and the benefit they measured was at 1 hour ¹⁰. The NIDDK’s 1-week window for over-the-counter hemorrhoid products is a sensible outer bound for a numbing cream too ⁴. Pain that still needs numbing every day after that needs an exam, not a bigger tube.

Pregnancy and breastfeeding

Hemorrhoids show up in a large share of pregnancies. The AGA review says they occur in up to two-thirds of women during pregnancy, and that treatment should stay conservative: fiber, care of constipation, and topical ointments ³. A 2008 review for family doctors put the same habits first (fiber, a stool softener, fluids, toilet habits) and wrote that common topical agents had not been formally studied for pregnancy safety, while harm to a baby in the third trimester was unlikely ⁹. Later studies have filled in part of that gap.

The NHS says hydrocortisone creams, ointments, sprays, and suppositories for piles can be used in pregnancy. Only a small amount reaches the blood, and the NHS states that this will not harm the baby. The same products can be used while breastfeeding for a short time. Wash your hands after applying the medicine and before you pick up the baby. If the baby feeds less well or does not gain weight as expected, talk to a midwife, health visitor, or doctor ¹.

One Canadian study followed 204 women who used Proctofoam-HC, a hydrocortisone foam that also contains the numbing drug pramoxine, in the third trimester, plus a similar group who were not exposed. Exposure was not tied to differences in birth weight, gestational age, prematurity, or complications before or after birth. The authors called that foam safe for hemorrhoids in late pregnancy ⁸. The study covers one product, used in the third trimester.

A small Malaysian trial randomized 23 women after 28 weeks to 1% hydrocortisone cream or to a toilet-seat device that supports the perineum. Both groups improved on pain, itch, swelling, discomfort, and bleeding. The device group did better on pain, swelling, discomfort, well-being, and overall improvement. The authors called it preliminary ⁷. Hydrocortisone was not useless in that trial. It also was not the only thing that helped, and 23 people is too few to rank the two approaches for good.

The tribenoside-plus-lidocaine review said that combination had been used after the first trimester and after birth ¹³. Ask your obstetric provider before you start a steroid or a numbing cream. Stool-softening habits come first, and they are laid out in hemorrhoids during pregnancy. Product choices while breastfeeding are in postpartum hemorrhoids.

What to do if the cream is not enough

Give a steroid a few days, which is when the NHS says itch and pain should start to ease ¹. If nothing has changed at 7 days, stop and get checked. A numbing cream that wears off in an hour or two is behaving the way the banding studies suggest. Using it to get through a bowel movement or a commute is reasonable. Needing it all day for more than a week means the flare is not settling with home care.

Softer stools still do more for the next flare than another tube. If home care fails, the next steps, from office banding to surgery, are in the hemorrhoid treatment guide.

GuideWhen to see a doctor for hemorrhoids

When to see a doctor for hemorrhoids: red flags, which clinician to book, what the exam includes, how to prepare, and telehealth limits.

The USPSTF screening recommendation starts at age 45 ¹⁵. If you are still using a steroid or a numbing cream after 7 days, book the visit and bring the tube.