Over-the-counter hemorrhoid treatment: what the studies say

Over-the-counter hemorrhoid treatment is what most people buy first: a cream, a pad, a fiber supplement, or a pill, with no prescription. Fiber has the clearest trial evidence for bleeding. Creams and pads are for comfort over days, not months. This page covers creams, ointments, suppositories, wipes and pads, flavonoid pills, fiber, stool softeners, sitz baths, and cushions, including the one-week limit on steroid creams.

The NIDDK page on hemorrhoid treatment says most people can start at home with high-fiber foods or a supplement such as psyllium, fluids, no straining, and a warm soak ¹. Creams, ointments, or suppositories may ease mild pain, swelling, and itching of external hemorrhoids, and doctors most often recommend those products for 1 week ¹. The wider path from home care to office treatment and surgery is in hemorrhoid treatment.

A tube from the pharmacy will not pull a hemorrhoid that keeps slipping out back where it belongs. It can make the sore days easier while stool gets softer. Match the product to the spot that hurts, stop a steroid on time, and book a visit if nothing has changed after a week.

Which store-bought product matches the symptom

Outside itching and a streak of blood on the paper are different jobs. External hemorrhoids sit under the skin and are the ones that itch, burn, and swell. Internal hemorrhoids are inside the canal. They often bleed and, unless they slip out, they usually do not hurt much.

Creams and ointments

Creams and ointments are for hemorrhoids on the outside. The NHS instructions for hydrocortisone for piles put creams, ointments, and sprays in that outside group, and suppositories in the inside group ³. You will usually use them several times a day: morning, night, and after a bowel movement. Check the leaflet in the box, because products differ ³.

A simple way to apply a cream or ointment:

1. Wash your hands.
2. Put a small amount on a finger.
3. Apply it to the skin around the anus, not deep inside, unless the label says the product is for internal use.
4. Wash your hands again.

A 2026 American Gastroenterological Association expert review says topical anesthetics, astringents such as witch hazel, corticosteroids, and vasoactive agents can be considered, and that there is little data that they work ⁴. The same review says topical steroids should not be used for more than 2 weeks at a time ⁴. The NHS is stricter about hydrocortisone products for piles: do not use them for more than 7 days ³. If symptoms have not improved after 7 days, or they come back quickly, make a doctor appointment ³. NIDDK uses the same one-week window for over-the-counter products in general, and says to call a doctor for a rash or dry skin around the anus ¹.

The studies above do not compare a cream with an ointment. Both are for outside symptoms. People with raw skin from wiping often want a thicker ointment that stays put. People with hot, burning skin often want a lighter cream. Our notes on those two jobs are in the best hemorrhoid creams and the best hemorrhoid ointments.

Suppositories

A suppository is a small insert for internal hemorrhoids. The NHS says to use the toilet first if you need to, wash your hands, clean around the anus with mild soap and water, rinse, and pat dry ³. Unwrap the suppository, insert it, and sit or lie still for about 15 minutes so it can melt ³. Hydrocortisone suppositories have the same 7-day limit as the creams ³.

Keep taking fiber if the bleeding comes with hard stools. If a hemorrhoid slips out, gentle pressure can sometimes ease it back in. If it will not stay in, see a doctor before you buy another box. Buyer notes on gentle inserts are in the best hemorrhoid suppositories.

Wipes and pads

Dry toilet paper is rough on sore skin. The NHS piles page says to keep the area clean and dry, and to pat it dry ². MedlinePlus says too much straining, rubbing, or cleaning around the anus can make external symptoms worse ¹¹. A soft wipe or a cooling pad is a way to clean without scraping. If a wipe stings or a rash shows up, stop it and go back to warm water.

Witch hazel pads are the drugstore classic for itch. The gastroenterology review lists witch hazel among astringents that clinicians can consider, and it says the proof these topicals work is thin ⁴. Wipes and pads we looked at are in the best hemorrhoid wipes. If you are choosing between the two best-known brands, Preparation H vs Tucks compares a cream with a cooling pad.

Flavonoid pills

Flavonoid pills, also called phlebotonics, are plant compounds sold for vein symptoms. Diosmin, often with hesperidin, is the formula most hemorrhoid trials used. They are supplements you take by mouth during a flare, along with fiber.

A Cochrane review of phlebotonics for hemorrhoids pooled 20 studies against a control treatment, with 2,344 people ⁷. The pills lowered the odds of itching (odds ratio 0.23), bleeding (odds ratio 0.12), and leakage, and they raised the odds of overall symptom improvement (odds ratio 15.99). Pain was not clearly better than control. The authors said safety worries in the trials were few, and they also said many trials had weak methods ⁷. That huge improvement number should be read with that warning attached.

A later review looked only at micronized purified flavonoid fraction, the formula closest to several bottles on the shelf. It included 10 randomized trials and 1,164 people ⁸. Three studies, pooled, favored the flavonoid group for bleeding (relative risk 1.46). The authors rated that bleeding evidence as low quality because the trials were few and did not all agree. They did not find a clear benefit for the other symptoms they checked ⁸.

Two single trials show why the timing matters:

• In a triple-blind trial of 134 people in an acute flare, a mix of diosmin, troxerutin, and hesperidin reduced pain, bleeding, swelling, and clots by 12 days compared with placebo. By day 6 that group also used fewer paracetamol tablets ⁹.
• In a double-blind trial of 100 people with grade 1 or grade 2 internal hemorrhoids, everyone got a bulk laxative. Adding diosmin beat placebo on exam findings at day 4. By day 14 the groups were no longer different ¹⁰.

So a flavonoid pill is a reasonable two-week trial if bleeding is the main symptom and you are already taking fiber. It is a weak plan if a hemorrhoid keeps prolapsing and you hoped a capsule would replace a clinic visit. The four reviews of these pills are compared in diosmin for hemorrhoids, and other plant pills in herbal supplements for hemorrhoids. Products in this group are compared on the best hemorrhoid pills.

Fiber

Fiber is the store-bought treatment with the best evidence for hemorrhoid bleeding. The meta-analysis above is why clinicians still put it first ⁵. Studies that checked more than once usually looked again at about 6 weeks and at 3 months, and the benefit held at both points ⁵. Psyllium is the fiber used in several of those hemorrhoid trials ⁵.

NIDDK lists a fiber supplement such as psyllium or methylcellulose alongside high-fiber foods and enough nonalcoholic drinks ¹. Start low and add water, or the first week can feel bloated. Capsules, powders, and gummies are compared on the best fiber supplements for hemorrhoids.

Stool softeners

NIDDK lists a stool softener as another way to avoid straining ¹. The clearest head-to-head trial we have compared psyllium with docusate sodium in 170 people with chronic constipation, not hemorrhoids ⁶. After a two-week placebo run-in, psyllium at 5.1 grams twice a day raised stool water content more than docusate at 100 mg twice a day (a 2.33 percent rise versus 0.01 percent). In the second treatment week, bowel movements averaged 3.5 a week with psyllium and 2.9 with docusate ⁶.

A softener still has a short job: the days after childbirth or surgery, when a fiber drink is hard to face and a hard stool would hurt. Follow the label. Fiber is the one to stay on after that short stretch. Options are on the best stool softeners for hemorrhoids.

Sitz baths and cushions

A sitz bath is a soak of the anal area in a few inches of warm water. NIDDK suggests one several times a day for pain ¹. The NHS suggests a warm bath for itching and pain ². The gastroenterology review says sitz baths are often advised and that the scientific data are limited ⁴. Water temperature, soak length, and whether to add anything are in how to take a sitz bath.

A seat cushion is for the hours you have to sit. We did not find a trial showing that a donut pillow or a flat cushion shrinks hemorrhoids or stops bleeding. Use one if a hard chair makes a flare worse, and keep treating the stool and the skin. Shape and firmness are compared on the best hemorrhoid pillows.

Pregnancy and breastfeeding

Hemorrhoids are common late in pregnancy. The gastroenterology review says treatment should stay conservative: fiber, care of constipation, and topical ointments ⁴. The NHS page on hydrocortisone in pregnancy and breastfeeding says hydrocortisone creams, ointments, sprays, and suppositories for piles can be used in pregnancy, because only a small amount reaches the blood and that amount will not harm the baby ¹². While breastfeeding, the same page says to keep the course short, wash your hands before you pick the baby up, and that products which also contain a local anesthetic are still acceptable ¹². If the baby feeds poorly or does not gain weight as expected, talk to a midwife, pharmacist, or doctor ¹².

One study followed 204 women who used a hydrocortisone-pramoxine foam in the third trimester and a similar group who did not. Exposure was not tied to lower birth weight, earlier birth, or more complications ¹³. That is one product in late pregnancy, not a blank check for every pill on the shelf.

A Cochrane review of conservative care in pregnancy found that oral rutoside pills looked helpful for symptoms in two small trials, and said they should not be recommended until safety is clearer ¹⁴. Diet changes and local treatments, the things most people actually use, had not been properly studied ¹⁴. Check flavonoid pills with your obstetric provider before you start them.

If a week of store treatment does not help

MedlinePlus says symptoms of external hemorrhoids go away within a few days for many people ¹¹. Give home care that week. NIDDK and MedlinePlus both say to contact a clinician if you are no better after 1 week of treatment at home ^1,11. The NHS says to see a GP if symptoms are getting worse, if there is no improvement after home treatment, or if piles keep coming back ².

New rectal bleeding needs a check even when hemorrhoids seem likely. MedlinePlus notes that Crohn’s disease, ulcerative colitis, colorectal cancer, and anal cancer can bleed too ¹¹. The US Preventive Services Task Force recommendation on colorectal cancer screening says screening should start at age 45 for adults at average risk ¹⁵.

NIDDK says to seek care right away for severe anal pain and rectal bleeding, particularly with abdominal discomfort, diarrhea, or fever ¹. The NHS says nonstop bleeding, a lot of blood, large clots, or severe pain need emergency care ². If the week of fiber and a short cream course has not changed the bleeding or the lump, the next conversation is about office treatment, which is laid out in hemorrhoid procedures.