Does hemorrhoid cream actually work to shrink hemorrhoids or stop the bleeding?
In adults with symptomatic internal or external hemorrhoids, how effective are topical over-the-counter hemorrhoid creams/ointments (e.g., containing hydrocortisone, phenylephrine, or witch hazel) compared with placebo or no treatment for reducing bleeding, shrinking hemorrhoid size, and relieving symptoms, and how long does improvement take?
Compiled 2026-10-05 · checked 2026-10-05 · next 2026-11-05 · automated review, how it works
What the evidence says
Bottom line
The evidence that hemorrhoid cream shrinks hemorrhoids or stops bleeding is weak and inconsistent.
Only one well-designed placebo-controlled trial was built to answer this exact question, and even it found mixed results — some symptoms improved, others didn't. Two other studies found the cream actually performed worse than a simple alternative (a salt-water soak, or no cream at all), so the overall signal leans toward uncertainty and possible harm rather than clear benefit.
How certain
Low
One well-conducted randomised trial addresses this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.
What it shows
Signal of harm
2 studies reported harm or tissue damage, including laboratory evidence.
- studies found
- 96studies found
- randomised trials
- 30randomised trials
- people studied
- 11,091people studied
- reviews of trials
- 5reviews of trials
- years covered
- 1976–2026years covered
- finished, never published
- 2finished, never published
Read this first
- A standard anti-hemorrhoid cream resolved hemorrhoid symptoms in fewer pregnant women than a simple warm salt-water soak did.
What the research shows
Symptom severity (itching, pain, swelling)
Multiple small trials found less itching, pain, or swelling with cream than with a placebo cream after 1 to 4 weeks, but other trials found the cream worked no better than a different active cream, making it hard to know how much credit the cream itself deserves.[1,2,3,4,5,6]
Possible improvement
Insufficient evidence
Recurrence of symptoms after stopping treatment
No study in this review followed people after they stopped using the cream to see whether bleeding or swelling came back.
Not studied
What it may help with
- In several placebo-controlled trials, hemorrhoid cream reduced itching, pain, or bleeding more than a fake (placebo) cream over 1 to 4 weeks.[1,2,3,4,5]
- One small placebo-controlled trial found bleeding stopped completely in people using an active cream/tablet combination, while bleeding continued in those given placebo.[1]
Important limitations
- Most studies that found a benefit had no placebo group at all — people were simply compared to themselves before treatment, so natural healing over time could explain the improvement rather than the cream.[1,2,3,4,5,6,7]
- The one randomized, placebo-controlled trial built specifically to answer this question found the cream helped with bleeding and itching but not with pain or tenderness — a mixed result from the single most trustworthy study available.[1]
- Two studies that compared cream directly against a simple non-drug option found the cream came out worse: a salt-water soak healed more pregnant women's hemorrhoids than cream did, and a nitroglycerin cream caused more pain after surgery than no cream at all.[1,2]
- Studies lump together many different products — herbal creams, steroid creams, numbing creams, vein-support creams — so a finding about one product doesn't necessarily apply to the tube of cream on a drugstore shelf.[1,2,3,4]
What the studies found
- Found a benefit58 · 60%
- Found no clear effect6 · 6%
- Mixed or unclear30 · 31%
- Found possible harm2 · 2%
What kind of studies
- Randomised trial30 · 31%
- Narrative review24 · 25%
- Animal study10 · 10%
- Prospective cohort10 · 10%
- Case series10 · 10%
- Retrospective5 · 5%
- Systematic review3 · 3%
- Meta-analysis2 · 2%
- Guideline1 · 1%
- Case-control1 · 1%
The studies that decided it
Zohalinezhad et al. 2026
Efficacy of an Herbal Cream on Patients with Hemorrhoids: a randomized triple-blind controlled trial
No better than standard cream.Randomised trialLow quality
110 people14 days intervention and 28 days follow-up
Both creams reduced symptoms over time, but there was no significant difference between the herbal cream and the conventional cream groups.
- Who was studied
- adults with grade I-II hemorrhoids
- What they received
- herbal cream (containing myrtle, chamomile, wild leek, and Russian olive extracts) applied topically
- Compared with
- a conventional hemorrhoid cream
- Main outcome
- hemorrhoid symptoms including anal pain, bleeding, pruritus, burning and difficulty defecating, measured on pain and symptom scales
- Quality
- The trial was small, had a high dropout rate (only 49 of 110 patients completed), and found no statistically significant difference between groups.
- Limitations
- High dropout rate and limited sample size reduced the ability to detect a difference between treatments.
Taken word for word from the abstract
- n
In total, 110 outpatients with hemorrhoids were randomly assigned to intervention (n = 58) and control (n = 52) groups.
- population
The HC was safe and well tolerated in patients with grade I-II hemorrhoids.
- intervention
an herbal cream (HC) containing common myrtle, chamomile, wild leek, and Russian olive extracts
- comparator
compared the effects of the HC and a conventional cream (CC) on hemorrhoids
- primaryOutcome
The outcomes were evaluated using the visual analog scale (VAS [1-10]); anal pain, difficult defecation, and burning sensation) and four-point Likert scale anal bleeding and anal pruritus)
- result
both HC and CC reduced hemorrhoidal symptoms over time (p = 0.011). However, no significant treatment-group effect (p = 0.50) or treatment-by-time interaction (p = 0.77) was observed.
J Pharmacopuncture · PMID 42812757 · Read it on PubMed ↗
Şahin et al. 2024
The efficacy of topical sodium pentaborate formulation on hemorrhoid disease: A randomized, double-blind, placebo-controlled trial
Less pain and bleeding with gel.Randomised trialModerate qualityRelated question
206 peoplefour weeks
the active gel group had less itching, less pain, less bleeding during defecation, and lower hemorrhoid degree than the placebo group
- Who was studied
- patients with grade 1, 2, and 3 hemorrhoid disease
- What they received
- topical gel with sodium pentaborate pentahydrate 3% (boron-based gel)
- Compared with
- placebo gel
- Main outcome
- hemorrhoid symptom severity and anoscopy findings after 4 weeks
- Quality
- it was a randomized, double-blind, placebo-controlled trial with a reasonable number of patients, but it only tested one specific boron gel for four weeks, so results may not apply to other hemorrhoid creams.
- Limitations
- abstract does not report long-term follow-up, dropout rates, or whether this specific boron gel formulation is representative of typical over-the-counter hemorrhoid creams.
Taken word for word from the abstract
- n
we applied a topical gel consisting of sodium pentaborate pentahydrate 3% on 206 eligible patients with the diagnosis of grade 1, 2, and 3 hemorrhoid diseases
- population
patients with the diagnosis of grade 1, 2, and 3 hemorrhoid diseases
- intervention
a topical gel consisting of sodium pentaborate pentahydrate 3%
- comparator
patients were randomly allocated to two groups of sodium pentaborate pentahydrate or placebo gel with a ratio of 1:1
- primaryOutcome
Patient hemorrhoid symptoms severity, hemorrhoid degree, and anoscopy findings were compared before and after the trial.
- result
bleeding during defecation (41.7% vs. 66.9%, p = 0.027), and hemorrhoid degree (p < 0.001) in the intervention group was less than the placebo group
Heliyon · PMID 38463771 · Read it on PubMed ↗
Sturiale et al. 2022
Safety and efficacy of topical drug-free cream in subjects with hemorrhoidal disease: a randomized, double blind, clinical trial
Eased hemorrhoid symptoms vs placebo.Randomised trialLow qualityRelated question
60 people14 days
significant improvement in all symptoms with the cream compared to placebo after 7 and 14 days
- Who was studied
- adults with grade I-II symptomatic hemorrhoidal disease
- What they received
- topical drug-free cream (Lenoid™)
- Compared with
- placebo cream
- Main outcome
- improvement in hemorrhoid symptoms such as pain, tenesmus, pruritus and anal discharge
- Quality
- small, short two-week trial measuring symptom scores rather than bleeding or hemorrhoid size, so it can't say much about shrinking hemorrhoids or stopping bleeding.
- Limitations
- Only 60 patients, very short 2-week follow-up, and outcomes were symptom questionnaires rather than objective measures like bleeding or hemorrhoid size.
Taken word for word from the abstract
- n
A total of 68 patients were screened and 60 (30 in each group) were enrolled into the study.
- population
Patients affected by I-II grade symptomatic HD were enrolled in the study
- intervention
a topical medical device (Lenoid™; International Health Science [IHS] - Biofarma Group, Mereto di Tomba, Udine, Italy)
- comparator
randomly assigned to Lenoid™ arm (LA) or placebo arm (PA)
- primaryOutcome
disease-specific questionnaires assessing symptoms such as pain, tenesmus, pruritus and anal discharge
- result
All patients belonging to LA showed a statistically significant improvement of each symptom after 7 and 14 days of treatment when compared to PA (P<0.001).
Minerva Gastroenterol (Torino) · PMID 35511655 · Read it on PubMed ↗
Shirah et al. 2018
Hemorrhoids during pregnancy: Sitz bath vs. ano-rectal cream: A comparative prospective study of two conservative treatment protocols
Cream healed fewer than Sitz baths.Prospective cohortLow quality
495 people2018
100% healed with Sitz bath versus 84.8% healed with cream, a statistically significant difference favoring Sitz bath
- Who was studied
- pregnant women with hemorrhoids
- What they received
- ano-rectal cream applied twice daily
- Compared with
- warm salty Sitz bath three times daily
- Main outcome
- complete healing of hemorrhoids
- Quality
- This was not randomized and groups were compared without blinding, so other differences between groups could explain the result.
- Limitations
- Not randomized, allocation method unclear, single-center Saudi population, no blinding reported
Taken word for word from the abstract
- population
pregnant females diagnosed to have hemorrhoids during pregnancy
- intervention
topical cream twice daily for 211 patients
- comparator
salty warm Sitz bath (using 20g of commercial salt) for 284 patients
- primaryOutcome
Complete healing was achieved in all patients
- result
Complete healing was achieved in all patients 284 (100%) in the Sitz bath group, compared to 179 (84.8%) in the cream group.
- n
495 pregnant females diagnosed to have hemorrhoids during pregnancy
Women Birth · PMID 29055673 · Read it on PubMed ↗
Hernández-Bernal et al. 2015
Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial
New drug beat hydrocortisone cream clearly.Randomised trialModerate qualityRelated question
510 people10 d
91.8% and 91.2% of rSK-treated patients responded by day 5 versus only 27.1% of hydrocortisone-treated patients
- Who was studied
- patients with acute symptoms of hemorrhoids
- What they received
- recombinant streptokinase (rSK) suppositories
- Compared with
- hydrocortisone acetate suppositories (a standard over-the-counter hemorrhoid treatment)
- Main outcome
- disappearance of pain and bleeding plus at least 70% shrinkage of the hemorrhoid by day 5
- Quality
- it was a randomized, multicenter trial but was open-label (no blinding), which can bias subjective symptom assessments like pain and bleeding.
- Limitations
- open-label design with no placebo arm, so it cannot show whether hydrocortisone alone works better than no treatment at all
Taken word for word from the abstract
- population
patients with acute symptoms of hemorrhoids
- intervention
suppositories of rSK 200000 IU
- comparator
25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations
- primaryOutcome
disappearance of pain and bleeding, and ≥ 70% reduction of the lesion size
- result
Fifth day complete response rates were 156/170 (91.8%; 95%CI: 87.3-96.2), 155/170 (91.2%; 95%CI: 86.6%-95.7%), and 46/170 (27.1%; 95%CI: 20.1%-34.0%) with rSK (schedule A and B) and hydrocortisone acetate suppositories, respectively
- n
156/170 (91.8%
- followUp
Evaluations were performed at 3, 5, and 10 d post-inclusion
World J Gastroenterol · PMID 26109819 · Read it on PubMed ↗
Cross et al. 2012
Glyceryl trinitrate ointment did not reduce pain after stapled hemorrhoidectomy: a randomized controlled trial
No pain relief; worse pain.Randomised trialModerate qualityRelated question
210 people2012
the ointment did not reduce pain, and the worst pain reported was higher in the ointment group
- Who was studied
- adults with grade 3/4 hemorrhoids having staple surgery for hemorrhoids
- What they received
- glyceryl trinitrate (GTN) ointment applied after the surgery
- Compared with
- usual post-surgery care without the ointment
- Main outcome
- pain after the operation
- Quality
- it was a randomized trial with over 200 patients, but it looked at pain after a specific surgery, not at using cream on untreated hemorrhoids.
- Limitations
- 16 patients in the ointment group stopped using it because of side effects, and patients needing a different surgical technique were excluded
Taken word for word from the abstract
- population
Patients with symptomatic grade 3/4 hemorrhoids were recruited.
- intervention
topical 0.2% glyceryl trinitrate (GTN)
- comparator
GTN after stapled hemorrhoidopexy was compared with routine postoperative management.
- primaryOutcome
Postoperative pain, pain duration, and complications were assessed.
- result
Maximum pain was higher in the GTN group (P = 0.015).
- result
GTN did not reduce postoperative pain after stapled hemorrhoidectomy.
- n
One hundred ten patients (74 men; mean age 50.6 years) were enrolled in the control group and 100 patients (57 men; mean age 49.8 years) in the GTN group.
Int Surg · PMID 23102076 · Read it on PubMed ↗
Franceschilli et al. 2013
Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study
Less pain healing after hemorrhoid surgeryRandomised trialModerate qualityRelated question
203 people6 weeks
GTN group had significantly less pain, faster wound healing, and shorter bleeding and discharge time after surgery
- Who was studied
- patients recovering from hemorrhoidectomy surgery
- What they received
- glyceryl trinitrate (GTN) ointment applied after surgery
- Compared with
- no ointment treatment
- Main outcome
- pain after hemorrhoid surgery
- Quality
- it was a randomized trial, but it only looked at post-surgical healing, not at treating hemorrhoids with cream to shrink them or stop bleeding without surgery
- Limitations
- studied patients after surgical removal of hemorrhoids, not people using cream as a standalone treatment for existing hemorrhoids; 15 patients stopped the ointment due to side effects
Taken word for word from the abstract
- n
203 patients with symptomatic haemorrhoids were enrolled in the study
- population
Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery
- intervention
received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery
- comparator
or not (100 patients) 0.4 % GTN ointment
- primaryOutcome
we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH
- result
GTN-treated group experienced significantly less pain during the first week after surgery (p < 0.0001)
- result
There were significant differences in terms of secretion time (p = 0.0052) and bleeding time (p = 0.02) in favor of GTN
- followUp
0.4 % GTN ointment for 6 weeks after surgery
Int J Colorectal Dis · PMID 22864620 · Read it on PubMed ↗
Herold et al. 2012
Intra-anal Iferanserin 10 mg BID for hemorrhoid disease: a prospective, randomized, double-blind, placebo-controlled trial
Less bleeding and itching, not pain.Randomised trialModerate quality
121 people14 days
iferanserin reduced bleeding and itching severity more than placebo, but did not improve pain, tenderness, or other symptoms
- Who was studied
- adults with internal hemorrhoids (grade I, II, or III) and bleeding
- What they received
- iferanserin 10 mg intra-anal ointment twice daily
- Compared with
- inactive placebo ointment
- Main outcome
- severity of bleeding and other hemorrhoid symptoms
- Quality
- this was a randomized, placebo-controlled trial but it was small and short-term (14 days), so it mainly shows short-term symptom changes, not long-term shrinkage or cure.
- Limitations
- study groups had different baseline hemorrhoid severity, and only some symptoms improved while others did not
Taken word for word from the abstract
- n
Of the 121 patients enrolled in the study, 118 were evaluable for tolerability and 111 for efficacy.
- population
Outpatients with Goligher grade I, II, and/or III hemorrhoids and bleeding
- intervention
10-mg twice-daily iferanserin intra-anal ointment
- comparator
inactive vehicle (placebo) BID for 14 days
- primaryOutcome
efficacy and tolerability of 10-mg twice-daily iferanserin intra-anal ointment for the cessation of bleeding and other symptoms associated with internal HD
- result
iferanserin was associated with significantly lower patient-reported severity ratings of daily bleeding and itching, beginning at day 1 for bleeding and at day 2 for itching (P < 0.05), but not with reduced ratings for severity of other HD symptoms, including pain, tenderness, difficulty with defecation, fullness, throbbing, and gas
Clin Ther · PMID 22244049 · Read it on PubMed ↗
What actually helps, on this site
More about the condition:
All 96 studiesEvery study that answered the question, with its design, size and result.
The other 88 studiesEverything else the search returned, including anything retracted.
Chen et al. 2026
Bioactive compound emodin from clinical formula Zhi-Lou-Xun-Xi decoction exerts rapid analgesic effects by targeting TRPV1
Reduces surgical pain, not hemorrhoid sizeAnimal studyVery low qualityRelated question
size not given2026
Emodin produced dose-dependent analgesia without inducing common TRPV1 antagonist-related side effects
- Who was studied
- patients having surgery to remove hemorrhoids (hemorrhoidectomy), studied together with animal pain models
- What they received
- emodin, a compound from the traditional Zhi-Lou-Xun-Xi decoction, acting on a pain receptor (TRPV1)
- Compared with
- no specific comparator described; compared against untreated or standard pain conditions in lab and animal models
- Main outcome
- pain relief (analgesia) after hemorrhoid surgery, via a nerve receptor mechanism
- Quality
- This is a laboratory and animal mechanism study with only a small retrospective clinical note, not a controlled human trial measuring hemorrhoid shrinkage or bleeding.
- Limitations
- No participant numbers given, no comparator group described, and the outcome studied is pain relief after surgery rather than shrinking hemorrhoids or stopping bleeding.
Taken word for word from the abstract
- population
Effective postoperative pain management after hemorrhoidectomy remains a significant clinical challenge
- intervention
Emodin was identified as the key TRPV1-antagonizing component in J5
- primaryOutcome
In multiple pain models, emodin produced dose-dependent analgesia
- result
emodin produced dose-dependent analgesia without inducing common TRPV1 antagonist-related side effects, particularly altered thermal sensitivity or hyperthermia
- comparator
Pharmacodynamic assays were conducted to evaluate its interaction with TRPV1
Phytomedicine · PMID 42275875 · Read it on PubMed ↗
Qureshi et al. 2026
AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review
Little evidence creams actually work.GuidelineVery low quality
size not given2026
Topical treatments can be considered but there is little data to support efficacy
- Who was studied
- people with symptomatic hemorrhoids
- What they received
- topical treatments (anesthetics, astringents like witch hazel, corticosteroids, vasoactive agents)
- Compared with
- no direct comparator specified
- Main outcome
- improvement in hemorrhoid symptoms
- Quality
- This is an expert opinion guideline, not based on systematic review of evidence, and explicitly states data on topical treatments is limited.
- Limitations
- Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
Taken word for word from the abstract
- population
symptomatic hemorrhoids
- intervention
Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents
- result
can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy
- primaryOutcome
treatment of symptomatic hemorrhoids
- comparator
BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy.
- limitations
Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
Clin Gastroenterol Hepatol · PMID 42067175 · Read it on PubMed ↗
Schiano di Visconte et al. 2026
Comparative Effectiveness of Lidocaine- Versus Nifedipine-Based Multimodal Conservative Regimens for Acute Hemorrhoidal Disease: A Multicenter Cohort Study
Faster pain and bleeding relief.RetrospectiveLow qualityRelated question
266 peoplewithin the first 14 days of treatment
the lidocaine-based multimodal regimen led to faster, greater reductions in pain and symptoms, less need for rescue pain medication, fewer urgent procedures, and more frequent early resolution of bleeding and swelling compared with standard care or the nifedipine-based regimen
- Who was studied
- patients with acute hemorrhoidal disease (early-stage or thrombosed hemorrhoids) treated at proctology clinics
- What they received
- a multimodal regimen combining oral phlebotonics, bromelain, and topical lidocaine cream (or topical nifedipine in another group)
- Compared with
- standard conventional conservative therapy
- Main outcome
- change in hemorrhoid symptom score and pain score (VAS)
- Quality
- this was a retrospective, non-randomized comparison across multiple treatments combined together, so it can't show whether the cream alone caused the improvement, and the authors themselves call for further prospective study.
- Limitations
- retrospective design, treatments given as part of a combined multi-drug regimen rather than testing cream alone, no randomization mentioned
Taken word for word from the abstract
- n
included 266 patients with AHD
- population
patients with acute hemorrhoidal disease (AHD)
- intervention
group A (n=90) received a multimodal approach with phlebotonics, bromelain, and topical lidocaine
- comparator
group B (n=83) received conventional conservative therapy
- primaryOutcome
Primary outcomes were changes in the Hemorrhoidal Disease Symptom Score (HDSS) and the visual analog scale (VAS) for pain.
- result
the lidocaine-based multimodal regimen (group A) was associated with earlier and more pronounced reductions in pain, symptom burden, and impairment in health-related quality of life (SHS-HD), particularly within the first 14 days of treatment
- result
Early resolution of bleeding and perianal oedema was also more frequent in the multimodal arms.
- followUp
particularly within the first 14 days of treatment
J Clin Gastroenterol · PMID 41837899 · Read it on PubMed ↗
Gao et al. 2026
Comparative efficacy of Ma Yinglong ointment and Gangtai suppository for hemorrhoids: A retrospective cohort study
Cream eased pain more, not bleeding.RetrospectiveLow qualityRelated question
514 people14 days
Cream reduced pain and swelling more, but suppository controlled bleeding slightly better; overall response rates were similar
- Who was studied
- adults with hemorrhoids
- What they received
- Ma Yinglong hemorrhoid ointment (cream)
- Compared with
- Gangtai suppository
- Main outcome
- symptom scores (pain, swelling, bleeding) and quality of life after treatment
- Quality
- It's a retrospective study comparing two active creams/suppositories without a placebo or untreated group, so it can't show whether either treatment truly shrinks hemorrhoids or stops bleeding compared with no treatment.
- Limitations
- Retrospective design, no placebo or untreated comparison group, short 14-day follow-up, and no information on how patients were assigned to groups.
Taken word for word from the abstract
- population
514 hemorrhoid patients (2024) were equally divided into Ma Yinglong (n=257) and Gangtai suppository (n=257) groups
- intervention
Ma Yinglong Hemorrhoid Ointment
- comparator
Gangtai Suppository
- primaryOutcome
Symptom scores, quality of life and adverse reactions were compared between the two groups at days 7 and 14
- result
demonstrated significant advantages in pain relief Visual Simulation Score (VAS score: 1.2 vs 2.0) and swelling reduction, with markedly improved quality of life scores (88.7 vs 76.3)
- result
The Gangtai Suppository treatment group showed superior bleeding control (bleeding score: 0.6 vs 0.7)
- n
514 hemorrhoid patients (2024) were equally divided into Ma Yinglong (n=257) and Gangtai suppository (n=257) groups
- followUp
After 14 days of treatment
Pak J Pharm Sci · PMID 41620906 · Read it on PubMed ↗
Fan et al. 2026
Comparison of Mayinglong musk hemorrhoids ointment and musk hemorrhoids suppository on postoperative pain and healing in mixed hemorrhoids after PPH or RPH
Mixed results, no clear winner post-surgeryRetrospectiveLow qualityRelated question
131 people2026
Suppository group had lower pain and wound scores, but ointment group had better anal function scores, less swelling, and faster wound healing time; no difference in overall healing success or complications
- Who was studied
- patients with mixed hemorrhoids who had surgery (PPH or RPH)
- What they received
- Mayinglong Musk Hemorrhoids Ointment applied after surgery
- Compared with
- Musk Hemorrhoids Suppository applied after surgery
- Main outcome
- pain scores and wound healing after hemorrhoid surgery
- Quality
- This was a retrospective study (not randomized) comparing two active treatments after surgery, not against no treatment, so it can't show whether either product shrinks hemorrhoids or stops bleeding on its own.
- Limitations
- Retrospective design, no placebo or untreated comparison group, conducted only in surgical patients
Taken word for word from the abstract
- n
after exclusions, 131 were analyzed
- population
139 mixed hemorrhoid patients who underwent PPH/RPH at the hospital from Jan to Dec 2024
- intervention
Group A (64 cases, Mayinglong Musk Hemorrhoids Ointment)
- comparator
Group B (67 cases, Musk Hemorrhoids Suppository)
- primaryOutcome
Main outcomes included VAS, wound healing time/effect
- result
Compared with Group A, Group B had lower VAS, WCS and wound granulation morphology scores (all P<0.05); Group A showed higher ADP, ARP, AMSP (all P<0.05), lower HZL and anal edema/exudation scores (all P<0.05) and superior wound healing time (P=0.047). No significant differences were found in wound healing effect or postoperative complication rate between the two groups
Pak J Pharm Sci · PMID 41620904 · Read it on PubMed ↗
Wang et al. 2025
Effects of Tongyangxiao lotion bidet therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, oedema, anxiety, and depression
Less swelling and pain with combo treatmentRetrospectiveLow qualityRelated question
268 people14 days
Hemorrhoid diameter and edema were smaller, comfort scores and treatment compliance were higher in the lotion+ointment group, with no difference in side effects
- Who was studied
- women with hemorrhoids after childbirth
- What they received
- Tongyangxiao lotion sitz bath therapy combined with Ziyu ointment
- Compared with
- wet compress with magnesium sulfate plus Ziyu ointment
- Main outcome
- hemorrhoid pain, edema, comfort, and psychological state
- Quality
- This was a retrospective, non-randomized study at a single hospital, so bias and confounding can't be ruled out.
- Limitations
- Retrospective design without randomization, single center, and the active treatment combined a sitz bath lotion with the ointment rather than testing the cream alone.
Taken word for word from the abstract
- n
n = 134 in each group
- population
patients with hemorrhoids
- intervention
Tongyangxiao lotion sitz bath therapy + Ziyu ointment
- comparator
wet compress with magnesium sulfate + Ziyu ointment
- primaryOutcome
Degree of pain, comfort level, compliance behavior with medical care, psychological state, therapeutic effect, hemorrhoid edema score, incidence of adverse reactions, and hemorrhoid diameter were compared.
- result
Hemorrhoid diameter and degree of edema were significantly smaller in the observation group than those in the control group 14 days post treatment.
- result
All GCQ dimension scores were significantly higher in the observation group than those in the control group 7 and 14 days post treatment.
- followUp
14 days post treatment
- design
A retrospective analysis was conducted at Hebei Hospital of Traditional Chinese Medicine
World J Psychiatry · PMID 41357914 · Read it on PubMed ↗
Schmuck et al. 2026
Incidence, Diagnosis, and Management of Proctological Conditions during Pregnancy
No direct evidence on cream.Narrative reviewVery low qualityRelated question
size not given2026
the abstract states conservative therapy is generally effective for symptom control but gives no specific data on cream shrinking hemorrhoids or stopping bleeding
- Who was studied
- pregnant women with proctological conditions such as hemorrhoids, anal fissures, and perianal thrombosis
- What they received
- conservative treatments including stool softeners, local cooling measures, and topical ointments
- Compared with
- surgical intervention reserved for refractory cases
- Quality
- This is a general narrative review of pregnancy-related proctological conditions, not a study testing hemorrhoid cream, so it provides no direct evidence on its effectiveness.
- Limitations
- No original data, no control group, no specific outcome measures for topical hemorrhoid treatments; it is a general overview of diagnosis and management during pregnancy.
Taken word for word from the abstract
- population
Proctological diseases are highly prevalent during pregnancy, with reported incidence rates ranging from 45% to 68%.
- intervention
Conservative treatment includes increased fluid intake, the use of stool softeners, and local cooling measures.
- intervention
First-line treatment involves stool regulation, analgesic therapy, and the application of topical ointments.
- comparator
Surgical interventions should be reserved for refractory cases and only considered when absolutely necessary.
- result
Conservative treatment is the mainstay of management, with a focus on symptom control and regulation of bowel habits.
- result
Conservative therapy is generally effective, focusing on pain control.
Visc Med · PMID 41064523 · Read it on PubMed ↗
Chiarioni et al. 2025
The Combination of Fluocinolone Acetonide and Ketocaine Hydrochloride in the Conservative Management of Symptomatic Hemorrhoidal Disease: An Overview of Preclinical and Clinical Data
Eases pain and itching, not bleeding.Narrative reviewVery low qualityRelated question
size not given2025
the combination cream is described as effective and well tolerated for acute hemorrhoid symptoms, but no specific data on shrinking hemorrhoids or stopping bleeding are given
- Who was studied
- people with symptomatic hemorrhoidal disease
- What they received
- topical cream combining fluocinolone acetonide and ketocaine hydrochloride
- Main outcome
- relief from pain, itching, and inflammation of hemorrhoids
- Quality
- this is a narrative overview of previous preclinical and clinical data without specific numbers, so it cannot be weighed like an original trial.
- Limitations
- abstract gives no study design details, sample sizes, or statistical results; claims are general summaries, not direct evidence of shrinking hemorrhoids or stopping bleeding.
Taken word for word from the abstract
- intervention
Topical formulations containing fluocinolone acetonide (FLA) and ketocaine hydrochloride (KH) combine anti-inflammatory and anesthetic effects, providing rapid and sustained relief from pain, itching, and inflammation.
- primaryOutcome
providing rapid and sustained relief from pain, itching, and inflammation
- result
Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD.
- population
Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population.
J Gastrointestin Liver Dis · PMID 41004811 · Read it on PubMed ↗
Ashburn 2025
Hemorrhoidal Disease: A Review
No direct evidence cream stops bleeding.Narrative reviewLow qualityRelated question
size not given3 to 6 months
Phlebotonics reduced bleeding, rectal pain, and swelling, but most patients' symptoms came back within months; topical lidocaine was described only as a pain treatment for thrombosed external hemorrhoids presenting late, not as a treatment to shrink hemorrhoids or stop bleeding.
- Who was studied
- adults with hemorrhoidal disease (bleeding, pain, prolapse)
- What they received
- phlebotonics and topical/medical treatments such as 5% lidocaine cream for hemorrhoid symptoms
- Compared with
- other hemorrhoid treatments (dietary fiber, office-based procedures, surgery) and treatment cessation
- Main outcome
- relief of bleeding, pain, and swelling from hemorrhoids
- Quality
- This is a narrative review summarizing many studies and treatments without reporting its own trial data, sample sizes, or controlled comparisons, so it can't reliably show whether cream itself works.
- Limitations
- The abstract is a general review of hemorrhoidal disease management, not a study testing a topical cream specifically for shrinking hemorrhoids or stopping bleeding; it gives percentages from unnamed prior studies without details on design or quality.
Taken word for word from the abstract
- population
Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US.
- intervention
Phlebotonics (eg, flavonoids [thought to improve venous tone]) reduce bleeding, rectal pain, and swelling, although symptom recurrence reaches 80% within 3 to 6 months after treatment cessation.
- intervention
5% lidocaine
- comparator
If dietary modification and phlebotonics are ineffective, grade I to grade III internal hemorrhoidal disease can be treated with office-based interventions.
- primaryOutcome
Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse.
- result
Phlebotonics (eg, flavonoids [thought to improve venous tone]) reduce bleeding, rectal pain, and swelling, although symptom recurrence reaches 80% within 3 to 6 months after treatment cessation.
- result
Patients presenting more than 72 hours after external hemorrhoid acute thrombosis should receive medical treatment (eg, stool softeners, oral and topical analgesics such as 5% lidocaine).
JAMA · PMID 40824576 · Read it on PubMed ↗
Shityakov et al. 2026
Targeted Anti-Inflammatory Effects of Chloramphenicol via TLR4 Inhibition in Postoperative Hemorrhoid Treatment: A Clinico- Computational Cohort Study
Faster healing after hemorrhoid surgeryProspective cohortLow qualityRelated question
155 people2026
chloramphenicol sped up wound healing and granulation tissue formation and reduced pain scores compared to control
- Who was studied
- patients who had surgery to remove hemorrhoids (postoperative hemorrhoidectomy wounds)
- What they received
- chloramphenicol antibiotic ointment applied to the surgical wound
- Compared with
- a reference treatment ointment and a no-treatment control group
- Main outcome
- wound healing measured by swelling resolution, new tissue growth, and pain scores
- Quality
- it is a non-randomized cohort study of surgical wound healing, not a trial of cream for untreated hemorrhoids, and much of the paper is lab-based molecular modeling rather than patient outcomes.
- Limitations
- study is about healing of surgical wounds after hemorrhoid removal, not about shrinking existing hemorrhoids or stopping bleeding without surgery; not described as randomized; authors call for further long-term studies
Taken word for word from the abstract
- n
155 patients (55 CHL, 39 reference treatment [PR], 61 control)
- population
Postoperative hemorrhoidectomy wounds are prone to inflammation and microbial infection
- intervention
CHL ointment (≤120 mg/day) was applied topically until granulation tissue appeared
- comparator
55 CHL, 39 reference treatment [PR], 61 control
- primaryOutcome
Clinical outcomes, including edema resolution, granulation tissue formation, and pain scores, were assessed
- result
CHL significantly accelerated wound healing, with 53.2% of patients achieving complete edema resolution by day 3 (vs. 43.6% by day 4) and faster granulation tissue formation (3.58 ± 0.60 days vs. 7.08 ± 1.20 days in control, p<0.0001). Pain scores were significantly reduced in the CHL group.
Curr Med Chem · PMID 40755112 · Read it on PubMed ↗
Schwandner 2025
[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]
Review doesn't test if creams work.Narrative reviewVery low qualityRelated question
size not given2025
Early-stage disease treated with conservative/interventional options; advanced disease treated with surgery; acute prolapse treated conservatively/topically
- Who was studied
- People with hemorrhoidal disease at different stages
- What they received
- Stage-based treatments for hemorrhoids (conservative, topical, sclerotherapy, rubber band ligation, surgery)
- Compared with
- Comparison between conservative/topical treatments, minimally invasive procedures, and surgical procedures
- Main outcome
- Symptom control and long-term absence of recurrence
- Quality
- This is a general narrative review describing treatment approaches by stage, without data, outcomes, or comparisons from a specific study on creams.
- Limitations
- No specific data, patient numbers, or outcome measures are given for any treatment including topical creams; it is a general overview rather than a study of effectiveness.
Taken word for word from the abstract
- population
The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease.
- intervention
Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV).
- comparator
In this context, "conventional" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation).
- primaryOutcome
The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.
- result
In cases of acute anal prolapse, a conservative and topical approach is indicated.
Chirurgie (Heidelb) · PMID 40586790 · Read it on PubMed ↗
Schiano di Visconte 2025
Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study
Faster pain relief with lidocaine cream.RetrospectiveLow qualityRelated question
123 people21 days
lidocaine group had faster pain relief and better symptom scores at day 7 than nifedipine group
- Who was studied
- adults with acute hemorrhoid flare-ups
- What they received
- oral diosmin/hesperidin plus bromelain plus topical lidocaine cream
- Compared with
- oral diosmin/hesperidin plus bromelain plus topical nifedipine cream
- Main outcome
- pain and symptom scores over 21 days
- Quality
- this was a retrospective, non-randomized comparison of two active creams, not a placebo-controlled trial, so it cannot show whether either cream shrinks hemorrhoids or stops bleeding beyond no treatment.
- Limitations
- retrospective design, no placebo or untreated comparison group, both groups also received oral medications so the cream's individual effect is unclear
Taken word for word from the abstract
- n
Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed.
- population
Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition
- intervention
Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine
- comparator
Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine
- primaryOutcome
Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21.
- result
Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001).
Surgeon · PMID 40581544 · Read it on PubMed ↗
Palmieri et al. 2025
Tips and tricks of anorectal care with topical lidocaine (octose-dan) administration: retrospective, anecdotical, spontaneous, and observational study
Less pain and itching reportedCase seriesVery low qualityRelated question
30 peopletwo months
28 of 30 patients had significant improvement in symptoms after treatment
- Who was studied
- adults with grade 1, 2 or 3 hemorrhoids, anal fissures, or anal fistulas
- What they received
- 5% lidocaine ointment (Octosedan) applied around the anus before and after bowel movements for two months
- Compared with
- no control or comparison group - all patients received the same treatment
- Main outcome
- tolerability and relief of pain, itching, soiling and discomfort around bowel movements
- Quality
- This was a small, uncontrolled, self-described 'anecdotical' observational study with no comparison group or randomization, so it cannot show whether the cream itself caused the improvement.
- Limitations
- No control group, no randomization, mixed population of hemorrhoids plus fissures and fistulas, authors call it anecdotical and spontaneous, and the outcome measured was symptom relief rather than hemorrhoid shrinkage or bleeding stopping specifically.
Taken word for word from the abstract
- n
30 patients both sexes (15 males and 15 females)
- population
evaluation of grade 1,2,3 haemorrhoids (n=23), anal fistulas (n=2) and fissures (n=5) treatment
- intervention
treatment with a 5% lidocaine ointment (Octosedan Laboratori Baldacci S.p.A., Italy) for two months
- comparator
30 patients both sexes (15 males and 15 females), recruited from the Second Opinion Medical Consulting Network for a spontaneous anecdotical post marketing evaluation
- primaryOutcome
the primary endpoints of the investigation were tolerability and effectiveness to relieve pain, itching, soiling and discomfort at rest or during and after stool emission
- result
28/30 treated patients had significantly symptom impro-vement (p<0.0001)
Clin Ter · PMID 40176588 · Read it on PubMed ↗
Hu et al. 2024
Arginine Hydrochloride Reduce Rectal Mucosal Irritation of Sodium Aescinate: Molecular Docking, Physical Properties, Anti-Hemorrhoidal Activity, Safety and Topical Gel Formulations Investigation
Promising hemorrhoid gel in animal testing.Animal studyVery low qualityRelated question
size not given2024
the combined gel reduced rectal irritation, increased anti-inflammatory effect, and healed anal ulcers in the animal tests, with no major safety problems found
- Who was studied
- rabbits used to test a hemorrhoid gel formulation (not human patients)
- What they received
- a new hemorrhoid gel combining sodium aescinate with arginine hydrochloride (F5-SA gel)
- Compared with
- sodium aescinate gel without arginine hydrochloride (different mixing ratios)
- Main outcome
- reduction of rectal irritation, anti-inflammatory effect, and anti-hemorrhoidal activity
- Quality
- this was an animal and lab formulation study, not a trial in human hemorrhoid patients, so it cannot show whether the cream works in people
- Limitations
- study used rabbits and lab/physical testing rather than human patients, and does not report a sample size for the animal experiments
Taken word for word from the abstract
- intervention
The F5-SA gel demonstrated high efficacy against hemorrhoids, notably promoting anal ulcer healing.
- comparator
Gels for rectal administration were then formulated by combining SA with various ratios of Arg·HCl (from 1:0 to 1:10).
- population
When administered rectally to rabbits at a dose of 132 mg·kg-1·d-1
- primaryOutcome
The optimal gel formulation was determined based on rectal mucosal irritation tests and anti-inflammatory experiments.
- result
significantly reducing rectal mucosal irritation while enhancing anti-inflammatory activity
- result
no other obvious side effects were observed except a significant reduction in food intake on the day of administration
Pharmaceutics · PMID 39771477 · Read it on PubMed ↗
Gallo et al. 2024
Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis
Less hemorrhoid symptoms with combo treatment.Case-controlLow qualityRelated question
56 people60 days
the treated group had a large drop in symptom score while the control group showed almost no change, and fewer needed invasive treatment
- Who was studied
- adults with hemorrhoid disease needing treatment
- What they received
- combined oral flavonoid medication plus a sucralfate-based hemorrhoid rectal ointment, alongside usual care
- Compared with
- usual conservative care alone
- Main outcome
- change in hemorrhoid symptom severity score and need for further procedures
- Quality
- it was a small, non-randomized study with matched groups rather than random assignment, so differences could be due to other factors.
- Limitations
- not randomized, relatively small number of patients, short follow-up, and the treatment combined an oral medication with the ointment rather than testing the cream alone.
Taken word for word from the abstract
- population
Hemorrhoidal disease (HD) significantly impacts patients' quality of life.
- intervention
Cases received systemic and local therapy for HD, consisting of a rectal ointment containing 3% sucralfate and herbal extracts plus MPFF, in addition to conservative therapy
- comparator
while controls received conservative therapy alone
- primaryOutcome
The hemorrhoidal disease symptom score (HDSS), the Short Health Scale for HD (SHS-HD) score, and the Vaizey Incontinence Score were used to evaluate symptoms severity and their impact on quality of life and continence.
- result
the intervention group showed a mean change in HDSS of -9 [95% confidence interval (CI) -10 to -8], and the control group showed no significant change (mean change of 0; 95% CI -1.5 to 0)
- n
56 patients were enrolled, with 28 in each group
- followUp
after 60 days of treatment (T1)
Tech Coloproctol · PMID 39287845 · Read it on PubMed ↗
Marik et al. 2024
Effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for hemorrhoidal symptoms: a prospective, observational study
Symptoms improved, but no control group.Case seriesLow quality
60 people4 weeks
symptom scores improved significantly after treatment in both ointment and suppository groups
- Who was studied
- adults with mild-to-moderate, symptomatic non-bleeding hemorrhoids
- What they received
- rectal ointment or suppositories containing sucralfate
- Compared with
- ointment versus suppository forms of the same sucralfate treatment, no placebo or control group
- Main outcome
- patient-reported hemorrhoid symptom severity score (mSSS)
- Quality
- This was a small, uncontrolled, observational study without a placebo group, so improvement could be due to natural healing rather than the cream itself.
- Limitations
- Open-label, no control or placebo group, small sample size, and authors state larger controlled trials are needed to confirm results.
Taken word for word from the abstract
- n
Five investigators enrolled 60 patients
- population
Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled.
- intervention
rectal ointment or suppositories containing sucralfate
- comparator
significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001)
- primaryOutcome
The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14).
- result
Mean patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001).
- limitations
Larger controlled trials are warranted to confirm the results.
- followUp
for a maximum of 4 weeks
Int J Colorectal Dis · PMID 38750150 · Read it on PubMed ↗
Porwal et al. 2024
Efficacy and Safety of Oral Euphorbia prostrata Tablet and Topical Cream in the Management of Hemorrhoids During Pregnancy: Results From a Prospective Multicenter Study
Symptoms improved with combined tablet and cream.Prospective cohortVery low qualityRelated question
100 peopleeight weeks and 30 days postpartum
large reductions in bleeding, pain, itching and swelling scores by 8 weeks
- Who was studied
- pregnant women with hemorrhoids
- What they received
- oral Euphorbia prostrata tablet plus topical Euphorbia prostrata cream
- Compared with
- none (no control group)
- Main outcome
- relief of hemorrhoid symptoms (bleeding, pain, itching, swelling) over follow-up
- Quality
- This was a small, non-randomized, open-label study with no comparison group, so improvements can't be separated from natural healing or placebo effect.
- Limitations
- Non-randomized, open-label, single-arm design with no control group; conducted only in pregnant women, not the general population asking about hemorrhoid cream.
Taken word for word from the abstract
- population
hemorrhoids during pregnancy
- n
A total of 100 patients (mean age 24.1 years) were included
- intervention
Sitcom® tablet (Euphorbia prostrata 100 mg) once daily and Sitcom® cream (Euphorbia prostrata 1%w/w) for 14 days
- comparator
non-randomized, open-label, prospective single-arm interventional multicentric study
- primaryOutcome
to assess hemorrhoidal symptoms relief during the follow-up periods
- result
The mean score of per-rectal bleeding and pain at defecation showed a significant reduction at each visit (86.6% and 49.3% (two weeks), 95.3% and 59.9% (four weeks), and 100% and 77.6% (eight weeks))
Cureus · PMID 38496090 · Read it on PubMed ↗
Gallo et al. 2024
Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review
Oral drug reduced bleeding, not a cream.Narrative reviewVery low qualityRelated question
size not given2024
mesoglycan reduced symptom severity and lowered the risk of rectal bleeding
- Who was studied
- people with chronic venous disease or hemorrhoids, including some after hemorrhoid surgery
- What they received
- oral mesoglycan (a drug related to blood vessel wall compounds, not a topical cream)
- Compared with
- standard care without mesoglycan
- Main outcome
- severity of hemorrhoid symptoms and rectal bleeding risk
- Quality
- this is a narrative review summarizing other trials without giving study numbers, methods, or statistics to judge reliability, and it is about an oral drug, not a topical cream.
- Limitations
- abstract does not report study sizes, designs, or statistical details for the hemorrhoid findings, and narrative reviews are not systematic.
Taken word for word from the abstract
- population
CVD and HD share etiological features and pathological changes affecting the structure and function of the tissue extracellular matrix
- intervention
Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate
- comparator
adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone
- primaryOutcome
mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding
- result
In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding.
Updates Surg · PMID 38356039 · Read it on PubMed ↗
Suh et al. 2024
Accelerated wound healing after topical application of hyaluronic acid cotton to hemorrhoidectomy wounds in a rat model
Faster wound healing in rats.Animal studyLow qualityRelated question
48 people2024
wounds treated with hyaluronic acid cotton healed faster and more completely than those with gauze
- Who was studied
- rats with surgical perianal wounds after hemorrhoid surgery (not human hemorrhoid patients)
- What they received
- hyaluronic acid-soaked cotton applied to the wound
- Compared with
- plain gauze dressing
- Main outcome
- how fast and completely the wound healed
- Quality
- this is an animal study in rats, not humans, so it cannot show whether hemorrhoid cream shrinks hemorrhoids or stops bleeding in people.
- Limitations
- study done in rats with surgically created wounds after hemorrhoid removal surgery, not in people with untreated hemorrhoids; tests a wound dressing material, not a typical over-the-counter hemorrhoid cream.
Taken word for word from the abstract
- population
Forty-eight 8-week-old Sprague-Dawley rats with perianal wounds created using a biopsy punch
- n
Forty-eight 8-week-old Sprague-Dawley rats
- intervention
topical HA-soaked cotton
- comparator
simple dressing with gauze (control)
- primaryOutcome
Wound healing rate and completeness of recovery were evaluated by measuring the healed area and conducting histological analyses.
- result
The HA-cotton group exhibited a shorter complete wound healing duration compared to the control group (13.9 days vs. 16.4 days, P = 0.031).
Ann Surg Treat Res · PMID 38318095 · Read it on PubMed ↗
Yu et al. 2024
The beneficial effect of Sanhuang ointment and its active constituents on experimental hemorrhoids in rats
Reduced swelling in rats, not humans.Animal studyVery low qualityRelated question
size not given11 days
The ointment reduced inflammation, swelling, and pain-related markers in rats with induced hemorrhoids
- Who was studied
- rats with chemically induced hemorrhoids
- What they received
- Sanhuang ointment (herbal cream) applied to the anal area
- Compared with
- two other commercial hemorrhoid creams (Mayinglong musk ointment and Taining cream)
- Main outcome
- inflammation, pain-related markers, and tissue swelling in the anal area
- Quality
- This was an animal study using an herbal cream, so it may not predict what happens in humans using over-the-counter hemorrhoid creams.
- Limitations
- Animal model only, no human data, compares a traditional Chinese herbal ointment rather than typical standard hemorrhoid creams used by patients.
Taken word for word from the abstract
- population
Hemorrhoids were induced by 6% balsam and glacial acetic acid respectively in the anorectal region of rats.
- intervention
SHO was administered externally to the anorectal region of rats at doses of 185 mg/g (crude drug/ointment), 370 mg/g (crude drug/ointment) and 740 mg/g (crude drug/ointment) for 11 days.
- comparator
Mayinglong musk hemorrhoids ointment (1 g/kg) and Taining cream (1 g/kg) were used as reference anti hemorrhoids drugs.
- primaryOutcome
hemorrhoids were evaluated by measuring the biochemical parameters of hemorrhoids in rats and the histology of anorectal tissues.
- result
SHO could alleviate the edema caused by the exudation of anorectal tissue fluid in rats by anti-inflammatory effect and reducing the Vascular permeability of rats.
J Ethnopharmacol · PMID 37741471 · Read it on PubMed ↗
Snopková et al. 2023
Effects of a sucralfate-containing ointment on quality of life and symptoms associated with hemorrhoidal disease: patient-reported results of a Slovakian, pharmacist-led observational survey
Symptoms and quality of life improved.Prospective cohortVery low quality
144 people14 days
Quality-of-life score improved and symptom frequency decreased significantly by day 14, with many patients reporting relief from pain and itching within hours
- Who was studied
- Adults in Slovakia using a sucralfate-containing hemorrhoid cream who had hemorrhoid symptoms in the past week
- What they received
- Sucralfate-containing rectal ointment for hemorrhoid symptoms
- Compared with
- No control group; patients compared to their own symptoms before treatment
- Main outcome
- Change in quality-of-life score related to hemorrhoid symptoms over 14 days
- Quality
- This was an uncontrolled pharmacy survey with no comparison group, so improvement could be due to natural healing or placebo rather than the cream itself.
- Limitations
- No control or placebo group, open-label, relies on patient self-report, and the authors themselves call for randomized trials to confirm results.
Taken word for word from the abstract
- n
Of the 241 patients enrolled in the survey, 144 had experienced hemorrhoidal symptoms within the preceding 7 days
- population
Pharmacists invited adults (≥18 years) using sucralfate-containing ointment for their HD-related symptoms to participate.
- intervention
a rectal ointment containing sucralfate
- comparator
the total HEMO-FISS-QoL score decreased (i.e., quality of life was improved) from baseline by a mean of -8.7
- primaryOutcome
The primary endpoint was the change in HEMO-FISS-QoL scores in patients with hemorrhoidal symptoms during the 7 days before the initial pharmacy visit.
- result
the total HEMO-FISS-QoL score decreased (i.e., quality of life was improved) from baseline by a mean of -8.7 (95% confidence interval -12.6, -6.2; P<0.001) at day 14. The frequency of hemorrhoidal symptoms was significantly reduced (P<0.001 vs baseline).
- followUp
14-day survey period
Front Gastroenterol (Lausanne) · PMID 41821779 · Read it on PubMed ↗
Fiordaliso et al. 2023
Treatment of haemorrhoids in pregnancy: A retrospective review
Not enough evidence either way.Systematic reviewLow qualityRelated question
size not given2023
evidence for topical cream or oral medication safety and effectiveness in pregnancy is lacking, so they are recommended only with caution
- Who was studied
- pregnant women with hemorrhoids
- What they received
- topical hemorrhoid cream or oral phlebotonic medication
- Compared with
- other treatments such as fiber supplements, stool softeners, laxatives, or surgery
- Main outcome
- safety and effectiveness of hemorrhoid treatments during pregnancy
- Quality
- This is a non-systematic literature review without pooled data or quality grading of the studies it cites.
- Limitations
- The abstract reports no formal quality assessment of included studies, no sample sizes, and focuses specifically on pregnant patients rather than the general population.
Taken word for word from the abstract
- population
Haemorrhoids are common in young women and commoner during pregnancy and the puerperium.
- intervention
Topical medication or oral phlebotonics may be used with special caution
- comparator
Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women.
- primaryOutcome
the strong evidence of their safety and efficacy in pregnancy is lacking
- result
Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking.
Ann Ital Chir · PMID 37530049 · Read it on PubMed ↗
Lohsiriwat et al. 2023
Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review
No cream-specific evidence found.Systematic reviewLow qualityRelated question
size not given2023
Micronized purified flavonoid fractions improved main symptoms more than other treatments, but no studies were found showing whether systemic or topical treatments reduce recurrence
- Who was studied
- adults with hemorrhoidal disease
- What they received
- systemic or topical pharmacological treatments for hemorrhoids, including phlebotonics and flavonoid pills
- Compared with
- other pharmacological treatments or surgery
- Main outcome
- rates of disease recurrence and improvement in hemorrhoid symptoms
- Quality
- The review pooled very different studies with widely varying recurrence rates and found no real-world data at all on topical treatment recurrence, so conclusions about creams specifically are weak.
- Limitations
- Abstract notes a lack of consistent epidemiology/recurrence data, wide variation in reported recurrence (0-56.5%), and no real-world studies found on recurrence after systemic or topical treatment specifically.
Taken word for word from the abstract
- population
adults with HD
- intervention
SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD
- comparator
micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments
- primaryOutcome
summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD
- result
The SLRs did not identify any RWE studies reporting recurrence in patients receiving systemic or topical treatments, highlighting the need for future research in this area.
- result
micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments
Adv Ther · PMID 36331754 · Read it on PubMed ↗
Picciariello et al. 2022
Management and Treatment of External Hemorrhoidal Thrombosis
Unclear if creams help.Narrative reviewVery low qualityRelated question
size not given2022
abstract states both medical and surgical treatment have been proven effective, but says trials are still needed
- Who was studied
- people with external hemorrhoidal thrombosis (a painful swollen clot in a hemorrhoid)
- What they received
- various treatments including topical creams (flavonoids, lidocaine-nifedipine mix, glyceryl trinitrate) and other conservative options
- Compared with
- surgical treatment options such as drainage or excision
- Main outcome
- whether treatment resolves the thrombosed hemorrhoid
- Quality
- This is a narrative mini-review summarizing various studies without systematic methodology, and it admits no clear guidelines or randomized trials exist.
- Limitations
- The abstract itself states there are no specific guidelines, management remains controversial, and randomized clinical trials are still needed; it does not report results of a single study.
Taken word for word from the abstract
- population
External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease.
- intervention
a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate
- comparator
different surgical treatments are recommended when EHT fails to respond to conservative management
- primaryOutcome
The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.
- result
Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
Front Surg · PMID 35592120 · Read it on PubMed ↗
Nallajerla et al. 2022
Evaluation Of Anti-inflammatory Mediated Anti-hemorrhoidal Activity of Lawsonia inermis on Croton Oil Induced Hemorrhoidal Rats
Reduced inflammation markers in rats only.Animal studyVery low qualityRelated question
size not given2022
The plant extract reduced inflammatory markers in a dose-dependent way in rats
- Who was studied
- rats with croton oil-induced hemorrhoids
- What they received
- Lawsonia inermis (henna) leaf extract applied at two doses
- Compared with
- Pilex ointment (reference standard) and untreated/control
- Main outcome
- levels of inflammatory markers (TNF-α, IL-6, neutrophils) linked to hemorrhoid swelling
- Quality
- This is an animal and lab study, not a human trial, so it cannot show whether this works for people with hemorrhoids.
- Limitations
- Animal model only, no human data, small/unclear sample size not reported, and no information on actual hemorrhoid shrinkage or bleeding outcomes.
Taken word for word from the abstract
- population
croton oil-induced hemorrhoidal rats
- intervention
ethanolic leaf extract of L. inermis at different doses of 200 mg/kg/ir and 400 mg/kg/ir
- comparator
Pilex ointment is taken as a reference standard in the present study
- primaryOutcome
significant reduction of serum Proinflammatory mediators TNF-α, IL-6, and plasma neutrophils
- result
a dose-dependent effect was found for ethanolic leaf extract of Lawsonia inermis at 200 mg/kg and 400 mg/kg causing a significant reduction of serum Proinflammatory mediators TNF-α, IL-6, and plasma neutrophils in croton oil-induced hemorrhoidal rats
Antiinflamm Antiallergy Agents Med Chem · PMID 35362397 · Read it on PubMed ↗
Lu et al. 2021
The effects of modified Buzhong Yiqi decoction combined with Gangtai ointment on the wound healing and anal function in circumferential mixed hemorrhoid patients
Faster healing after hemorrhoid surgery.Randomised trialLow qualityRelated question
120 people14 days
the combined decoction and ointment group had a higher effective rate, less pain, less swelling, better quality of life, faster wound healing, and fewer adverse reactions than the hydrogel group
- Who was studied
- patients with circumferential mixed hemorrhoids who had surgery
- What they received
- oral herbal decoction (modified Buzhong Yiqi) plus Gangtai medicated ointment applied to the wound
- Compared with
- chitosan hydrogel wound dressing
- Main outcome
- wound healing and anal function after hemorrhoid surgery
- Quality
- this is a small single study of a combined oral-and-topical treatment given after surgery, not a plain cream used on its own, so it doesn't directly test whether hemorrhoid cream alone shrinks hemorrhoids or stops bleeding.
- Limitations
- abstract does not mention blinding, and the ointment was combined with an oral herbal medicine and used only after surgical removal of hemorrhoids, not in patients with untreated hemorrhoids.
Taken word for word from the abstract
- n
Patients (n=120) with circumferential mixed hemorrhoids were recruited as the research cohort.
- population
Patients (n=120) with circumferential mixed hemorrhoids were recruited as the research cohort. All the patients underwent surgical treatment
- intervention
The research group was administered modified Buzhong Yiqi decoction (1 dose a day, orally) combined with Kangtai ointment for external application (twice a day, for two consecutive weeks).
- comparator
The control group was administered chitosan hydrogels for wound healing, once a day.
- primaryOutcome
To investigate the effects of modified Buzhong Yiqi decoction combined with Gangtai ointment on the wound healing and anal function of circumferential mixed hemorrhoid patients.
- result
Compared with the control group, the research group had a higher effective rate (P<0.01), a lower pain index, and a lower perianal edema score (both P<0.001), a higher quality of life score (P<0.001), a shorter wound healing time, a shorter pain resolution time, and fewer adverse reactions than the control group (both P<0.001).
Am J Transl Res · PMID 34377319 · Read it on PubMed ↗
Mehdi et al. 2021
Efficacy and safety of Hemoheal cream in patients with hemorrhoids: a randomized double-blind placebo controlled clinical trial
Less bleeding and pain, mixed results.Randomised trialLow quality
52 people3 weeks
significant improvement in anal irritation, bleeding, pain, swelling sense, and overall subjective improvement compared to placebo, but no significant difference in anal itching or defecation discomfort
- Who was studied
- patients with symptomatic hemorrhoids
- What they received
- Hemoheal cream, an herbal anti-hemorrhoid cream applied for 3 weeks
- Compared with
- placebo cream
- Main outcome
- improvement in symptoms including anal irritation, bleeding, itching, pain, defecation discomfort, swelling, and overall subjective improvement
- Quality
- Small trial of only 52 patients over a short 3-week period makes the results easy to overturn with more evidence.
- Limitations
- Small sample size, short follow-up duration of 3 weeks, and some symptoms showed no significant difference between groups.
Taken word for word from the abstract
- n
Fifty-two patients with symptomatic hemorrhoids were randomized to receive hemoheal cream or placebo for 3 weeks.
- population
Fifty-two patients with symptomatic hemorrhoids
- intervention
Hemoheal cream, an anti-hemorrhoid herbal preparation
- comparator
randomized to receive hemoheal cream or placebo for 3 weeks
- primaryOutcome
evaluated before and after the intervention in terms of the severity of anal irritation, bleeding, anal itching, pain, defecation discomfort and swelling sense, and overall subjective improvement
- result
distribution of anal irritation, bleeding, pain as well as swelling sense were significantly different (P < 0.05), while the analysis showed no significant differences between two groups for anal itching and defecation discomfort (P > 0.05)
- followUp
for 3 weeks
J Tradit Chin Med · PMID 33825411 · Read it on PubMed ↗
Giua et al. 2021
The effect of sucralfate-containing ointment on quality of life in people with symptoms associated with haemorrhoidal disease and its complications: the results of the EMOCARE survey
Symptoms and quality of life improved.Prospective cohortLow qualityRelated question
290 people~14 days (mean 13 days)
quality of life scores and symptom frequency significantly improved after about 13 days of treatment, with 39.4% symptom-free
- Who was studied
- adults with hemorrhoid symptoms in the past week seeking treatment at pharmacies in Italy
- What they received
- sucralfate ointment with herbal extracts
- Compared with
- no comparison group (before-and-after treatment)
- Main outcome
- change in quality of life score related to hemorrhoid symptoms
- Quality
- this was an uncontrolled survey with no placebo or comparison group, so improvement could be due to natural healing or other factors, not just the cream.
- Limitations
- no control group; survey design with self-reported outcomes; short follow-up
Taken word for word from the abstract
- population
Eligible participants (≥18 years) were those with haemorrhoidal symptoms in the last 7 days and were willing to initiate a treatment with the sucralfate ointment and herbal extracts (calendula, witch hazel leaf (hamamelis), chamomile).
- intervention
A rectal ointment containing 3% of sucralfate and herbal extracts (calendula, witch hazel leaf (hamamelis), chamomile), became available in Italy in 2019 for the treatment of symptoms associated with haemorrhoidal disease.
- comparator
A survey was administered by the investigating pharmacists at the beginning and end (~14 days) of treatment.
- primaryOutcome
The primary endpoint was the change in HEMO-FISS-QoL scores.
- result
the sucralfate ointment significantly improved total HEMO-FISS-QoL scores (mean change from baseline: -10.41; 95%CI -11.95, -8.86; P<0.001)
- result
At the end of treatment, 39.4% of participants reported that they no longer had haemorrhoidal symptoms
- n
Of the 290 (mean age 53.1 years old; 58.3% female) enrolled, 287 attended the follow-up visit.
Acta Biomed · PMID 33683221 · Read it on PubMed ↗
Stratta et al. 2021
Conservative Treatment of Hemorrhoidal Disease
Not enough solid evidence either way.Narrative reviewVery low qualityRelated question
size not given2021
Topical medications were described as potentially beneficial, especially during flare-ups or after surgery, but the review found very few controlled trials to confirm real benefit
- Who was studied
- people with hemorrhoidal disease (early stages)
- What they received
- conservative treatments including topical medications (creams), diet/lifestyle changes, and oral phlebotonic drugs
- Compared with
- not specified
- Main outcome
- symptom control / management of hemorrhoidal disease
- Quality
- This is a narrative review that itself says most evidence is from uncontrolled case series with very few randomized trials, so no reliable conclusion can be drawn.
- Limitations
- Abstract states very few randomized controlled trials exist and most studies are uncontrolled case series; it does not report specific data on cream reducing size or bleeding.
Taken word for word from the abstract
- population
patients complaining of early stages of the disease
- intervention
The use of topical medications, particularly during the acute phase or in the post-operative period can also be beneficial for all patients complaining of HD.
- result
very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series
- primaryOutcome
Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease.
- comparator
Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease.
Rev Recent Clin Trials · PMID 33087033 · Read it on PubMed ↗
Dönmez et al. 2020
From nutrition to medicine: Assessing hemorrhoid healing activity of Solanum melongena L. via in vivo experimental models and its major chemicals
Helped hemorrhoids in rats, not humans.Animal studyVery low qualityRelated question
size not given2020
eggplant extract was highly effective against hemorrhoid in comparison to the controls and the commercial preparation
- Who was studied
- rats with croton oil-induced hemorrhoids
- What they received
- eggplant (Solanum melongena) methanolic extract
- Compared with
- commercial Pilex tablet and cream, and controls
- Main outcome
- healing of hemorrhoids measured by tissue and blood tests
- Quality
- This was an animal study using a chemically induced hemorrhoid model, not a human trial, so it cannot show whether hemorrhoid cream works in people.
- Limitations
- Study was conducted in rats, not humans, with no participant numbers reported and no mention of blinding or randomization.
Taken word for word from the abstract
- population
Hemorrhoid, which was induced by applying croton oil to the anal area of the rats.
- intervention
In vivo anti-hemorrhoidal activity of the methanolic extract prepared from eggplant was evaluated
- comparator
The healing potential was comparatively assessed with a reference Pilex® tablet and cream.
- primaryOutcome
evaluated by experimental hemorrhoid model, subsequently histological and biochemical analysis
- result
eggplant extract is highly effective against hemorrhoid in comparison to the controls and the commercial preparation
J Ethnopharmacol · PMID 32687958 · Read it on PubMed ↗
Sturiale et al. 2020
Safety and Efficacy of Proctosoll Allevia in the Management of Haemorrhoidal Disease in Adults: A Prospective Randomized Clinical Trial
Faster symptom relief with cream.Randomised trialLow quality
45 people14 days
significantly greater symptom improvement with the cream than with diet alone within 14 days, no major side effects
- Who was studied
- adults with first or second degree hemorrhoids with symptoms
- What they received
- Proctosoll Allevia cream applied topically, plus controlled diet
- Compared with
- controlled diet alone, no treatment
- Main outcome
- improvement in hemorrhoid symptoms within 14 days
- Quality
- Very small study with unclear blinding and no detail on how symptoms were measured, so the result is not very reliable.
- Limitations
- Small sample size (45 patients), short study period (one month of enrollment), no mention of blinding, and the abstract does not describe how symptom improvement was measured.
Taken word for word from the abstract
- n
45 (13 F- 32 M) enrolled in the study
- population
patients affected by symptomatic HD
- population
complaining of first or second degree hemorrhoidal symptoms
- intervention
treated with the Proctosoll Allevia® and were under a controlled diet
- comparator
patients were only under a controlled diet without any treatment - control group
- primaryOutcome
statistically significant improvement of symptoms within 14 days
- result
All the patients treated with topical application of the cream showed a statistically significant improvement of symptoms within 14 days from the beginning of the therapy if compared to patients who were treated only with a controlled diet.
- result
No major adverse events associated with the use of the new product were recorded.
Rev Recent Clin Trials · PMID 32316899 · Read it on PubMed ↗
Amaturo et al. 2020
Treatment of haemorrhoidal disease with micronized purified flavonoid fraction and sucralfate ointment
Less pain and swelling reported.Case seriesVery low qualityRelated question
3 people2020
good results in pain and itching control and reduction of edema
- Who was studied
- people with hemorrhoidal disease
- What they received
- combined oral micronized purified flavonoid fraction (MPFF) and a sucralfate rectal ointment with herbal extracts (calendula, witch hazel, chamomile)
- Compared with
- none reported
- Main outcome
- pain, itching, and swelling (edema)
- Quality
- This is a tiny report of only three patients with no comparison group, so it can't reliably show the treatment works.
- Limitations
- Only three cases, no control group, and treatment combined an oral drug with a topical ointment so the cream's individual effect isn't clear.
Taken word for word from the abstract
- n
three cases
- population
Hemorrhoidal disease is a very common disease characterized by the presence of a mucous prolapse of the rectum and by varicosis of the hemorrhoidal plexus.
- intervention
combined use of MPFF and a topical medical device in the form of rectal ointment, composed by sucralfate and herbal (calendula, witch hazel leaf (hamamelis), chamomile) extracts
- comparator
Our experience with three cases treated with combined use of MPFF and a topical medical device
- primaryOutcome
good results in terms of pain and itching control and in edema reduction
- result
has shown good results in terms of pain and itching control and in edema reduction
Acta Biomed · PMID 32191669 · Read it on PubMed ↗
Gaj et al. 2020
Relief of hemorrhoid symptoms: pilot study of a new topical ally
Symptoms improved, but no control group.Case seriesVery low quality
48 people30 days
severity scores and resting anal pressure significantly decreased from baseline through follow-up visits
- Who was studied
- patients with grade I-III hemorrhoids
- What they received
- a new ointment (Hemolen®) applied twice daily for 30 days
- Compared with
- no comparison group; symptoms measured before and after treatment in the same patients
- Main outcome
- hemorrhoid symptom severity scores (bleeding, discomfort, itching, edema, thrombosis, congestion, inflammation, pain) and resting anal pressure
- Quality
- this was a small uncontrolled pilot study without a comparison group, so improvements can't be separated from natural healing or placebo effect.
- Limitations
- no control group; pilot study design; authors state randomized controlled trials are needed to confirm results
Taken word for word from the abstract
- n
48 patients (25 females; mean age 47±15.8 years) were enrolled
- population
Pilot study on patients with grade I-III hemorrhoids.
- intervention
The ointment was applied twice daily for 30 days
- comparator
follow-up visits were scheduled 7 days (T1), 14 days (T2) and 30 days (T3) after recruitment (T0)
- primaryOutcome
Signs and symptoms (bleeding, discomfort, itching, edema, thrombosis, congestion, inflammation, pain) were evaluated at each visit using dedicated scores and VAS scale.
- result
The severity scores significantly dropped from T0 to each scheduled visit and a significant reduction of resting anal pressure was observed from T0 to 1 hour after application (z=13.5; p<0.001) and from T0 to T1 (z=6; p<0.001).
- limitations
Prospective, randomized controlled trials are needed to confirm these encouraging results.
G Chir · PMID 32038023 · Read it on PubMed ↗
Cohee et al. 2020
Benign Anorectal Conditions: Evaluation and Management
Fiber, not cream, is main treatment.Narrative reviewLow qualityRelated question
size not given2020
The primary treatment for hemorrhoids is fiber supplementation. Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery. Acutely thrombosed external hemorrhoids should be excised.
- Who was studied
- Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence.
- What they received
- The primary treatment for hemorrhoids is fiber supplementation.
- Compared with
- Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery.
- Quality
- This is a general overview article for physicians, not a study that tests whether a cream shrinks hemorrhoids or stops bleeding.
- Limitations
- The abstract does not describe hemorrhoid cream as a treatment at all, and gives no data, methods, or numbers for any intervention.
Taken word for word from the abstract
- population
Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence.
- intervention
The primary treatment for hemorrhoids is fiber supplementation.
- comparator
Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery.
- result
The primary treatment for hemorrhoids is fiber supplementation.
- result
Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery.
- result
Acutely thrombosed external hemorrhoids should be excised.
Am Fam Physician · PMID 31894930 · Read it on PubMed ↗
Kestřánek 2019
Hemorrhoid management in women: the role of tribenoside + lidocaine
Review claims fast symptom relief.Narrative reviewLow quality
size not givennot reported
review states the combination improved symptoms and relieved them quickly, based on cited studies
- Who was studied
- women with hemorrhoids, including postpartum and pregnant women
- What they received
- tribenoside + lidocaine cream or suppository (Procto-Glyvenol)
- Main outcome
- relief of hemorrhoid symptoms (subjective and objective)
- Quality
- this is a narrative review discussing a branded product without presenting its own trial data or numbers.
- Limitations
- abstract does not describe study methods, sample sizes, or statistical results; it is a review summarizing other studies.
Taken word for word from the abstract
- population
Hemorrhoids are commonly reported in women.
- intervention
a medical preparation containing tribenoside + lidocaine, available as a rectal cream (tribenoside 5%/lidocaine 2%) and a suppository (tribenoside 400 mg/lidocaine 40 mg)
- primaryOutcome
In pregnant women, the tribenoside/lidocaine combination significantly improved both subjective and objective symptoms of hemorrhoids.
- result
Fast onset of symptom relief was reported from 10 minutes after administration, lasting up to 10-12 hours.
Drugs Context · PMID 31555338 · Read it on PubMed ↗
Wu et al. 2019
Clinical study of external application of liuhe dan in the treatment of anal edge edema after mixed hemorrhoid operation
Less swelling and pain after surgery.Prospective cohortLow qualityRelated question
160 people2019
the treatment group had significantly lower edema and pain scores, and shorter hospital stay and wound healing time than the control group
- Who was studied
- patients with anal edge swelling (edema) after surgery for mixed hemorrhoids
- What they received
- external application of Liuhe Dan (a topical traditional medicine) on the swollen area
- Compared with
- routine post-operative nursing care
- Main outcome
- anal edge edema score and wound pain score after surgery
- Quality
- the study does not say whether patients were randomly assigned or whether anyone was blinded, so bias cannot be ruled out.
- Limitations
- abstract does not mention randomization, blinding, or how edema/pain were scored, and it studies post-surgical swelling rather than un-operated hemorrhoid shrinkage or bleeding.
Taken word for word from the abstract
- n
A total of 160 patients
- population
patients who had been treated for lotion anal edge edema
- intervention
external application of Liuhe Dan
- comparator
control group accepting routine nursing methods
- primaryOutcome
anal edge edema score and wound pain score
- result
The anal edge edema score and wound pain score of the research group were significantly lower than those of the control group (p<0.05).
Pak J Pharm Sci · PMID 31551227 · Read it on PubMed ↗
Malekuti et al. 2019
Comparison of the effect of Myrtus communis herbal and anti-hemorrhoid ointments on the hemorrhoid symptoms and quality of life in postpartum women with grade I and II internal hemorrhoid: A triple-blinded randomized controlled clinical trial
Both creams eased symptoms similarly.Randomised trialModerate qualityRelated question
134 people8 weeks
Both ointments reduced hemorrhoid symptoms with no significant difference between them, except itching was lower with the herbal ointment and satisfaction was higher
- Who was studied
- postpartum women with grade I and II internal hemorrhoids
- What they received
- Myrtus communis herbal ointment applied rectally twice daily for 4 weeks
- Compared with
- standard anti-hemorrhoid ointment applied the same way
- Main outcome
- severity of hemorrhoid symptoms and quality of life
- Quality
- It was a triple-blind randomized trial with a reasonable sample size, but it compared two active creams rather than a placebo, so it cannot show whether either cream works better than no treatment.
- Limitations
- No placebo or untreated comparison group was used, so it's unclear if either ointment outperforms no treatment at all.
Taken word for word from the abstract
- population
women with grade I and II hemorrhoid referring to health centers in Tehran, Iran
- n
randomly assigned to two groups of 67 people through block randomization method
- intervention
The intervention group received the Myrtus communis herbal ointment
- comparator
the control group received anti-hemorrhoid ointment twice a day
- primaryOutcome
to compare the effect of Myrtus communis herbal and anti-hemorrhoid ointments on symptoms of hemorrhoid and quality of life (primary outcomes)
- result
The severity of all symptoms of hemorrhoid decreased in both two group and there was no statistically significant difference between the two groups (p>0.05).
- result
the mean of anal itching at 4 and 8 weeks after the intervention was significantly lower in the Myrtus communis ointment group (p<0.05)
J Complement Integr Med · PMID 31433782 · Read it on PubMed ↗
Rodríguez-Wong et al. 2019
Randomized clinical trial with topical diltiazem for post-hemorrhoidectomy wound healing
Faster wound healing after hemorrhoid surgery.Randomised trialLow qualityRelated question
52 people6 weeks
wounds healed faster with diltiazem (about 3.19 weeks) than with placebo (about 3.92 weeks), and more patients had healed by week three with diltiazem
- Who was studied
- patients who had surgery to remove hemorrhoids (closed hemorrhoidectomy)
- What they received
- topical diltiazem cream applied to the anal area three times a day
- Compared with
- placebo cream
- Main outcome
- time for the surgical wound to heal
- Quality
- it is a small double-blind randomized trial of only 52 people studying wound healing after hemorrhoid surgery, not whether cream shrinks hemorrhoids or stops bleeding in people who haven't had surgery.
- Limitations
- small sample size (26 per group); studies a different population (post-surgical wound healing) and different outcome than shrinking hemorrhoids or stopping bleeding in unoperated hemorrhoids.
Taken word for word from the abstract
- population
two groups of patients that underwent closed hemorrhoidectomy
- n
There were 26 patients in each group.
- intervention
Group A received topical diltiazem in the anal region three times a day.
- comparator
Group B received a placebo.
- primaryOutcome
Cicatrization time was documented for 6 weeks through digital photography.
- result
Mean healing time for the group treated with diltiazem was 3.19 weeks (22.33±0.884 days) and 3.92 weeks (27.44±1.130 days) for the control group (p=0.012 95% CI).
- followUp
Cicatrization time was documented for 6 weeks through digital photography.
Rev Gastroenterol Mex (Engl Ed) · PMID 30591198 · Read it on PubMed ↗
Wilson et al. 2018
The Effect of Nonoperative Management of Chronic Anal Fissure and Hemorrhoid Disease on Bowel Function Patient-Reported Outcomes
Diet and fiber improved bowel symptoms, not cream.Prospective cohortLow qualityRelated question
64 people2018
hemorrhoid disease patients showed statistically significant improvement in incontinence and stool-related aspects of bowel function scores
- Who was studied
- patients with chronic anal fissures or hemorrhoid disease
- What they received
- dietary counseling with fiber supplementation, toileting strategies (plus topical calcium channel blockers for fissure patients only)
- Compared with
- same patients' scores before treatment (no separate control group)
- Main outcome
- change in patient-reported bowel function scores
- Quality
- This was a small, uncontrolled observational study without a comparison group, and the researchers were unsure if patients even followed the treatment as prescribed.
- Limitations
- This study was limited by the small cohort size and unclear patient adherence to medical management.
Taken word for word from the abstract
- n
A cohort of 64 patients was included, 37 patients (58%) with chronic anal fissure and 27 patients with hemorrhoid disease.
- population
chronic anal fissures and hemorrhoid disease
- intervention
All patients received standardized dietary counseling including fiber supplementation as well as toileting strategies. Those with chronic anal fissures were also prescribed topical calcium channel blockers.
- comparator
The Colorectal Functional Outcome questionnaire was administered at baseline and at first follow-up visit.
- primaryOutcome
The primary outcomes measured were the mean change in patient-reported bowel function scores after nonoperative management for each disease and in aggregate.
- result
hemorrhoid disease demonstrated a statistically significant improvement in incontinence and stool-related aspects
- limitations
This study was limited by the small cohort size and unclear patient adherence to medical management.
Dis Colon Rectum · PMID 30192331 · Read it on PubMed ↗
Mott et al. 2018
Hemorrhoids: Diagnosis and Treatment Options
No specific evidence on creams given.Narrative reviewLow qualityRelated question
size not given2018
Lists topical over-the-counter preparations as part of initial medical management but does not report any specific outcome data on whether they shrink hemorrhoids or stop bleeding
- Who was studied
- people with hemorrhoids
- What they received
- topical over-the-counter creams and other medical treatments (stool softeners, topical nitroglycerine, dietary changes, sitz baths)
- Quality
- This is a general narrative review that mentions creams only as a category of initial treatment without presenting evidence or data on their effectiveness.
- Limitations
- No specific study data, outcomes, or comparisons are given for topical over-the-counter creams specifically; it is a broad overview of hemorrhoid management options.
Taken word for word from the abstract
- intervention
topical over-the-counter preparations
- population
Many Americans between 45 and 65 years of age experience hemorrhoids.
- result
Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine), dietary modifications (e.g., increased fiber and water intake), and behavioral therapies (sitz baths) are the mainstays of initial therapy.
Am Fam Physician · PMID 29431977 · Read it on PubMed ↗
Mahboubi 2017
Effectiveness of Myrtus communis in the treatment of hemorrhoids
Eased hemorrhoid pain and bleeding.Narrative reviewVery low quality
size not given2017
significantly improved bleeding, pain, irritation, itching and heaviness, and helped some patients who had not responded to standard treatment
- Who was studied
- patients with hemorrhoids types I and II
- What they received
- Myrtus communis essential oil (lotion or ointment)
- Compared with
- current chemical treatments (anti-hemorrhoids ointment)
- Main outcome
- bleeding, pain, anal irritation, itching and heaviness
- Quality
- This is a narrative review that just describes findings from unspecified clinical studies without giving study design, numbers, or statistics, so it carries little weight.
- Limitations
- The abstract gives no details on study design, sample sizes, or how 'significant' improvement was measured; it is a narrative summary rather than a rigorous review.
Taken word for word from the abstract
- population
patients with hemorrhoids types I and II
- intervention
M. communis essential oil (lotion or ointment)
- comparator
current chemical treatments (anti-hemorrhoids ointment)
- primaryOutcome
bleeding, permanent pain, pain during defecation, anal irritation, anal itching and anal heaviness
- result
can significantly improve bleeding, permanent pain, pain during defecation, anal irritation, anal itching and anal heaviness in patients with hemorrhoids types I and II
J Integr Med · PMID 28844211 · Read it on PubMed ↗
Xu et al. 2017
Enhancement of Wound Healing by the Traditional Chinese Medicine Herbal Mixture Sophora flavescens in a Rat Model of Perianal Ulceration
Herbal cream healed rat wounds faster.Animal studyVery low qualityRelated question
size not given2017
Medium and high doses of CSF significantly improved ulcer healing compared to untreated control; high dose also reduced inflammatory markers
- Who was studied
- rats with induced perianal ulcers (model for post-surgery hemorrhoid wounds)
- What they received
- topical herbal compound Sophora flavescens (CSF), low/medium/high dose
- Compared with
- untreated control and potassium permanganate (PP)
- Main outcome
- healing of perianal ulcer (macroscopic and histological assessment)
- Quality
- This is an animal study using a chemically induced ulcer model, not human hemorrhoid patients, so it cannot show whether this works in people.
- Limitations
- Animal model only, induced by acetic acid injection rather than natural hemorrhoid disease; no information on bleeding or hemorrhoid shrinkage; small unspecified group sizes.
Taken word for word from the abstract
- population
A rat model of perianal ulceration was induced by subcutaneous injection of 75% glacial acetic acid.
- intervention
The animals with induced perianal ulcer received topical treatment of low, medium, and high doses of CFS twice daily.
- comparator
Potassium permanganate (PP); 0.02%) was given to the animals for comparison.
- primaryOutcome
Macroscopic and histological assessments of the ulcerated area were performed after treatment.
- result
Topical administration of medium- and high-dose CSF significantly enhanced perianal ulcer healing as compared to the untreated control (p<0.05).
In Vivo · PMID 28652418 · Read it on PubMed ↗
Lorenc et al. 2016
Tribenoside and lidocaine in the local treatment of hemorrhoids: an overview of clinical evidence
Claimed to relieve hemorrhoid symptomsNarrative reviewLow quality
size not given2016
review concludes the combination is effective and safe, but does not give pooled numeric results
- Who was studied
- people with low-grade hemorrhoids, including some pregnant or postpartum women
- What they received
- combination cream/suppository of tribenoside and lidocaine
- Compared with
- tribenoside alone, lidocaine alone, or steroid creams
- Main outcome
- relief of hemorrhoid symptoms and safety
- Quality
- this is a non-systematic narrative overview of past studies chosen by the authors, not a pooled analysis with reported data, so it carries less weight.
- Limitations
- no systematic search criteria, no quantitative results given, studies only described as 'well-conducted' without detail, potential conflict of interest given product is named by brand
Taken word for word from the abstract
- population
low-grade hemorrhoids
- intervention
The combination of tribenoside+lidocaine (Procto-Glyvenol®) is a medical preparation for the local treatment of hemorrhoids, delivered as a suppository or rectal cream.
- comparator
either versus its two individual components (tribenoside and lidocaine) or versus steroids in the same setting
- primaryOutcome
The efficacy of the combination of tribenoside+lidocaine in relieving symptoms caused by hemorrhoids and its safety have been assessed in several clinical studies
- result
Enough evidence exists to recommend the use of this combination therapy as a fast, effective and safe option for the local treatment of low-grade hemorrhoids.
Eur Rev Med Pharmacol Sci · PMID 27383331 · Read it on PubMed ↗
Tripathi et al. 2015
Efficacy and safety of a polyherbal formulation in hemorrhoids
More symptom relief than standard care.Randomised trialLow qualityRelated question
90 people14 days
15 patients on the polyherbal kit reached a symptom score of 0 versus 6 on standard therapy, with significant improvement in straining sensation, anal muscle spasm, and hemorrhoid grade
- Who was studied
- patients with hemorrhoids
- What they received
- a 7-day polyherbal kit (oral tablets and powder plus topical cream, Arshkeyt™)
- Compared with
- standard therapy (oral Isabgul powder plus 2% lidocaine gel)
- Main outcome
- number of patients with symptoms and signs fully resolved (composite score of 0) after 14 days
- Quality
- it was a small randomized trial of only 90 people with a short follow-up and no mention of blinding patients or clinicians to treatment assignment
- Limitations
- small sample size, short 14-day duration, and the tested product combined oral tablets and powder with the cream rather than testing cream alone
Taken word for word from the abstract
- n
Patients (n = 90) with hemorrhoids were randomly allocated
- population
Patients (n = 90) with hemorrhoids
- intervention
"Arshkeyt™, a 7 day kit," which consists of oral tablets and powder along with topical cream
- comparator
standard therapy (combination of oral Isabgul powder and 2% lidocaine gel)
- primaryOutcome
The primary endpoint was number of patients achieving composite score 0 at the end of therapy (day 14)
- result
On day 14, the composite score of 0 was achieved in 15 patients of Arshkeyt™ group versus 6 patients receiving standard therapy.
- result
The symptoms and signs which showed significant improvement in Arshkeyt™ group compared to standard treatment group were the tenesmus (visual analog score) score (P = 0.047), anal sphincter spasm (P = 0.0495) and a decrease in the grade of hemorrhoids (P = 0.0205) on day 14.
J Ayurveda Integr Med · PMID 26834421 · Read it on PubMed ↗
Mosavat et al. 2015
Topical Allium ampeloprasum subsp Iranicum (Leek) extract cream in patients with symptomatic hemorrhoids: a pilot randomized and controlled clinical trial
Leek cream worked as well as standard cream.Randomised trialLow quality
20 people3 weeks
Both creams reduced bleeding severity and defecation discomfort similarly, with no significant difference between groups and no change in pain scores
- Who was studied
- patients with symptomatic hemorrhoids
- What they received
- topical leek extract cream
- Compared with
- standard antihemorrhoid cream
- Main outcome
- bleeding severity, defecation discomfort, pain, and anal itching
- Quality
- Very small pilot study with only 20 patients, making it hard to be confident in the results.
- Limitations
- Small pilot study sample size of only 20 patients
Taken word for word from the abstract
- population
Twenty patients with symptomatic hemorrhoids
- intervention
receive the topical leek extract cream
- comparator
or standard antihemorrhoid cream for 3 weeks
- primaryOutcome
in terms of pain, defecation discomfort, bleeding severity, anal itching severity, and reported adverse events
- result
A significant decrease was observed in the grade of bleeding severity and defecation discomfort in both the leek and antihemorrhoid cream groups after the intervention, while no significant change was observed in pain scores. There was no significant difference between the leek and antihemorrhoid cream groups with regard to mean changes in outcome measures.
- n
Twenty patients with symptomatic hemorrhoids
J Evid Based Complementary Altern Med · PMID 25608984 · Read it on PubMed ↗
Lim et al. 2015
Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial
Device worked better than cream.Randomised trialLow quality
23 people2015
both groups improved, but the support device group had significantly better improvement in pain, swelling, discomfort and overall well-being than the cream group
- Who was studied
- pregnant women past 28 weeks with symptomatic hemorrhoids
- What they received
- a perineal support toilet seat device (Hai's Perianal Support)
- Compared with
- topical hydrocortisone cream 1% (Procort)
- Main outcome
- improvement in pain, itching, swelling, discomfort and bleeding from hemorrhoids
- Quality
- Very small trial of only 23 women comparing two active treatments without a placebo, so it cannot show whether the cream itself does anything beyond no treatment.
- Limitations
- Small preliminary trial; authors state more clinical trials are needed to reconfirm findings.
Taken word for word from the abstract
- n
23 pregnant women with gestation above the 28th week
- population
pregnant women with gestation above the 28th week and presented with symptomatic hemorrhoids
- intervention
the test group was provided and taught to use a HPS, a posterior perineal support toilet seat device (Colorec)
- comparator
The control group was treated with topical hydrocortisone cream 1%
- primaryOutcome
data on symptoms of pain, itching, swelling, discomfort and bleeding associated with hemorrhoids
- result
statistically significant differences were found on symptoms of pain, swelling and discomfort between the test and control groups. There was also a statistically significant difference in well-being and overall improvement between the test and control groups
J Obstet Gynaecol Res · PMID 25256125 · Read it on PubMed ↗
Hall 2013
Modern management of hemorrhoidal disease
No specific findings reported.Narrative reviewVery low qualityRelated question
size not given2013
not clearly stated for any specific treatment
- Who was studied
- people with hemorrhoid symptoms
- What they received
- nonoperative and operative treatments for hemorrhoids
- Compared with
- not specified
- Main outcome
- relief of hemorrhoid symptoms
- Quality
- This is a general review article that does not report specific study data, numbers, or outcomes for any single treatment like cream.
- Limitations
- No data, no specific results, and no mention of hemorrhoid cream specifically; it is a broad overview of management options.
Taken word for word from the abstract
- population
Complaints secondary to hemorrhoidal disease have been treated by health care providers for centuries.
- intervention
This article reviews the pathophysiology of hemorrhoidal disease and the most commonly used techniques for the nonoperative and operative palliation of hemorrhoidal complaints.
- comparator
Surgical hemorrhoidectomy is usually reserved for patients who are refractory to or unable to tolerate office procedures.
- primaryOutcome
Most symptoms referable to hemorrhoidal disease can be managed nonoperatively.
- result
When symptoms do not respond to medical therapy, procedural intervention is recommended.
Gastroenterol Clin North Am · PMID 24280398 · Read it on PubMed ↗
Gurel et al. 2013
Herbal haemorrhoidal cream for haemorrhoids
Reduced inflammation in rats only.Animal studyVery low qualityRelated question
28 people15 days
Herbal creams reduced inflammation and oxidative stress markers compared to untreated inflamed controls, with the cream containing horse chestnut showing the greatest improvement
- Who was studied
- Wistar albino rats with chemically induced anal inflammation (hemorrhoid model)
- What they received
- herbal hemorrhoid creams (fig leaves, artichoke leaves, walnut husks, with or without horse chestnut fruit)
- Compared with
- saline-treated rats with croton oil-induced inflammation
- Main outcome
- inflammation and oxidative stress markers in anal tissue
- Quality
- This is a small animal study using a chemically induced model, not human patients with hemorrhoids, so it cannot show whether the cream works in people.
- Limitations
- Animal model using chemically induced inflammation rather than natural human hemorrhoids; small sample size; no human data on bleeding or hemorrhoid shrinkage.
Taken word for word from the abstract
- n
Twenty-eight male Wistar albino rats
- population
Twenty-eight male Wistar albino rats, 6-8 weeks old and weighing 160-180 g, were used in this study
- intervention
croton oil+fig leaves+artichoke leaves+walnut husks+horse chestnut fruit
- comparator
rats were treated with 0.1 ml of cream or saline twice a day for 15 days
- primaryOutcome
Tissue and blood samples were collected for histological, immunohistochemical and biochemical studies
- result
The third group showed partial improvement in inflammation; however, the greatest degree of improvement was seen in the fourth group, and some recovered areas were observed.
Chin J Physiol · PMID 24032710 · Read it on PubMed ↗
Altomare et al. 2013
Pharmacological treatment of hemorrhoids: a narrative review
Opinion only, no real evidence givenNarrative reviewVery low qualityRelated question
size not given2013
the review states these treatments can help manage symptoms, especially in early-stage disease, but does not report specific outcome data
- Who was studied
- people with hemorrhoids, including early and advanced stages, and pregnant women
- What they received
- medical treatments including topical ointments, phlebotonic drugs, lifestyle changes, and fiber supplements
- Main outcome
- relief of hemorrhoid symptoms
- Quality
- This is an expert opinion narrative review without original data, trial numbers, or statistical results, so it cannot show whether treatments actually work.
- Limitations
- The abstract itself notes conservative measures are rarely supported by adequate trials, and this is an expert opinion piece rather than a study with original data or outcome measurements.
Taken word for word from the abstract
- population
Hemorrhoid disease is the cause of most proctologic complaints
- population
pregnancy and hemorrhoids
- intervention
lifestyle changes, fiber supplement, topical ointments and phlebotonic drugs
- primaryOutcome
relieve symptoms
- result
Early stages (I/II degrees) of this disease could be effectively managed conservatively with several approaches as lifestyle changes, fiber supplement, topical ointments and phlebotonic drugs.
- result
This expert opinion, based also on long-lasting clinical practice, also supports the use of medical treatment in symptoms relief in patients with hemorrhoid disease.
- limitations
the utility of conservative measures are rarely scientifically supported by adequate trials
- design
This narrative review is based on the search and analysis of full papers
Expert Opin Pharmacother · PMID 24024752 · Read it on PubMed ↗
Gulati 2014
Pycnogenol® in chronic venous insufficiency and related venous disorders
Claims faster healing, no real data shownNarrative reviewVery low qualityRelated question
size not given2014
the review states Pycnogenol can enhance the healing of venous ulcers and haemorrhoidal episodes, without giving specific data
- Who was studied
- people with chronic venous insufficiency and related venous problems, including hemorrhoids
- What they received
- Pycnogenol (pine bark extract), taken orally and/or applied topically
- Compared with
- not stated
- Main outcome
- healing of venous ulcers and hemorrhoid flare-ups
- Quality
- this is a general narrative review summarizing the compound's biology and claims across many conditions, without presenting actual trial numbers, methods, or specific results for hemorrhoids.
- Limitations
- abstract gives no study design details, sample sizes, or specific results for the hemorrhoid-related claim; it bundles hemorrhoids in with several unrelated venous conditions.
Taken word for word from the abstract
- intervention
Pycnogenol
- population
chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids
- result
enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration
- primaryOutcome
enhance the healing of venous ulcers and haemorrhoidal episodes
- comparator
Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration.
Phytother Res · PMID 23775628 · Read it on PubMed ↗
Fargo et al. 2012
Evaluation and management of common anorectal conditions
No evidence given on effectiveness.Narrative reviewVery low quality
size not given2012
the abstract states these are used for management but gives no data on how well they shrink hemorrhoids or stop bleeding
- Who was studied
- people with symptomatic external hemorrhoids
- What they received
- topical steroids, dietary changes, and pain relievers
- Compared with
- not specified
- Main outcome
- symptom management of external hemorrhoids
- Quality
- this is a general overview article that states treatment recommendations without presenting trial data or outcomes for hemorrhoid creams.
- Limitations
- no study data, statistics, or outcome measures are given for the cream/steroid treatment itself; it is a general practice review
Taken word for word from the abstract
- population
Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics.
- intervention
topical steroids, and analgesics
- primaryOutcome
Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics.
- result
Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics.
- comparator
Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics.
Am Fam Physician · PMID 22534276 · Read it on PubMed ↗
Joksimovic et al. 2012
Efficacy and tolerability of hyaluronic acid, tea tree oil and methyl-sulfonyl-methane in a new gel medical device for treatment of haemorrhoids in a double-blind, placebo-controlled clinical trial
Less pain and bleeding, small trial.Randomised trialLow quality
36 people14-day treatment
the gel significantly reduced all symptoms compared to placebo after 14 days
- Who was studied
- patients with grade 1-3 hemorrhoids
- What they received
- gel containing hyaluronic acid, tea tree oil and methyl-sulfonyl-methane
- Compared with
- placebo gel
- Main outcome
- anal pain, pain during defecation, visible bleeding, itching and irritation/inflammation
- Quality
- Very small trial of only 36 patients, which limits confidence in the result.
- Limitations
- Small sample size; abstract does not describe how blinding or randomization was carried out in detail.
Taken word for word from the abstract
- n
The total number of 36 haemorrhoidal patients (grade 1-3) was enrolled
- population
36 haemorrhoidal patients (grade 1-3) was enrolled
- intervention
a new gel medical device (Proctoial) containing hyaluronic acid with tea tree oil and methyl-sulfonyl-methane as major components
- comparator
double-blind, placebo-controlled clinical trial
- primaryOutcome
The anal pain, pain during defecation, visible bleeding, pruritus and irritation/inflammation were recorded before and after 14-day treatment
- result
The new gel medical device statistically significantly reduced all the symptoms after the treatment compared to placebo.
Updates Surg · PMID 22492249 · Read it on PubMed ↗
Perrotti et al. 2010
Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: results of a multicentre, prospective, randomized, double-blind study
Slightly less post-surgery pain, not shrinkage.Randomised trialModerate qualityRelated question
270 people14 days
slightly better pain scores with nifedipine plus lidocaine at 6 hours and day 7 after surgery, but no difference in time to needing rescue pain medication
- Who was studied
- patients recovering after surgical hemorrhoid removal (hemorrhoidectomy)
- What they received
- topical nifedipine with lidocaine ointment
- Compared with
- lidocaine ointment alone
- Main outcome
- pain after hemorrhoidectomy, measured on a pain scale
- Quality
- it was a large, well-designed randomized double-blind trial, but it studied pain after surgical removal of hemorrhoids, not whether the cream shrinks hemorrhoids or stops bleeding, and the benefit found was small.
- Limitations
- No difference in time to rescue analgesic use; benefit was only a 'slight significant difference' on a pain scale at specific timepoints; study focused on post-surgical pain rather than hemorrhoid size or bleeding.
Taken word for word from the abstract
- n
In all, 135 patients per group participated (270 total).
- population
reducing pain after hemorrhoidectomy
- intervention
0.3% nifedipine and 1.5% lidocaine ointment
- comparator
1.5% lidocaine ointment alone
- primaryOutcome
A physician unaware of the treatment arm measured pain by use of the Analogue Chromatic Continuous Scale (ACCS)
- result
revealed better pain control in the group that received nifedipine with lidocaine at 6 hours after surgery and on day 7 (p < 0.011 and p < 0.054, respectively). We noticed no difference between groups for time of administration of rescue analgesic
Can J Surg · PMID 20100408 · Read it on PubMed ↗
Belcaro et al. 2010
Pycnogenol treatment of acute hemorrhoidal episodes
Stopped hemorrhoid bleeding, eased symptoms faster.Randomised trialLow qualityRelated question
84 people14 days
symptoms improved more with Pycnogenol than placebo, and bleeding stopped completely in Pycnogenol-treated patients but continued in the placebo group
- Who was studied
- patients with acute hemorrhoid flare-ups
- What they received
- Pycnogenol taken orally and/or applied as a cream
- Compared with
- placebo
- Main outcome
- hemorrhoid signs/symptoms and bleeding
- Quality
- small randomized trial with limited detail on blinding and methods, so results need confirmation by larger studies
- Limitations
- small sample size and the abstract gives few details on blinding or how scores were measured
Taken word for word from the abstract
- n
a controlled, randomized study with 84 subjects
- population
the management of acute hemorrhoidal attacks
- intervention
orally and topically applied Pycnogenol
- comparator
the control group given placebo
- primaryOutcome
signs and symptoms were scored
- result
The most prominent symptom, hemorrhoidal bleeding, was completely absent in all patients treated with Pycnogenol for seven days and also at the 14 days follow-up. In contrast, bleedings were still observed in the control group during the two weeks follow-up.
Phytother Res · PMID 20041428 · Read it on PubMed ↗
Vohra et al. 2009
The effectiveness of Proctofoam-HC for treatment of hemorrhoids in late pregnancy
Hemorrhoid symptoms improved significantly.Prospective cohortLow quality
88 people2009
all hemorrhoidal symptoms decreased significantly and overall well-being improved
- Who was studied
- pregnant women in their last trimester with hemorrhoids
- What they received
- Proctofoam-HC topical cream applied to hemorrhoids
- Compared with
- no control group; statistical correction for potential placebo effect
- Main outcome
- change in hemorrhoidal symptoms (pain, itching, swelling) and overall well-being
- Quality
- This was an open-label study with no real control group and self-reported symptoms, so it can't rule out a placebo effect.
- Limitations
- Open-label, observational design without a true placebo control group; relies on patient-reported telephone interviews.
Taken word for word from the abstract
- n
A total of 88 women completed the study.
- population
pregnant women prescribed Proctofoam-HC
- intervention
Proctofoam-HC used during the last trimester of pregnancy
- comparator
The improvement was clinically very significant after correction for potential placebo effect.
- primaryOutcome
All hemorrhoidal symptoms, including pain, pruritus, swelling, itching, decreased significantly
- result
All hemorrhoidal symptoms, including pain, pruritus, swelling, itching, decreased significantly (P < 0.001) and overall well-being improved.
J Obstet Gynaecol Can · PMID 19761640 · Read it on PubMed ↗
Staroselsky et al. 2008
Hemorrhoids in pregnancy
No evidence cream works.Narrative reviewVery low qualityRelated question
size not given2008
not assessed for effectiveness; abstract only discusses safety and notes symptoms usually resolve on their own after birth
- Who was studied
- pregnant women with hemorrhoids, specifically a third-trimester patient
- What they received
- topical hemorrhoid creams (anesthetic, corticosteroid, anti-inflammatory agents)
- Quality
- this is an expert opinion answer to a clinical question, not a study testing whether the cream works, and it explicitly says safety hasn't been formally assessed
- Limitations
- no data on effectiveness for shrinking hemorrhoids or stopping bleeding; focuses on safety in pregnancy, not outcome testing
Taken word for word from the abstract
- population
One of my patients is in the third trimester of her first pregnancy.
- intervention
none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy
- result
In most women, most symptoms of the condition will resolve spontaneously soon after giving birth.
- result
Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third-trimester infant.
Can Fam Physician · PMID 18272631 · Read it on PubMed ↗
Vazquez 2008
Constipation, haemorrhoids, and heartburn in pregnancy
No results reported for cream.Systematic reviewVery low qualityRelated question
size not given2008
the abstract lists haemorrhoid cream ingredients as topics covered but does not report any outcome data or effect
- Who was studied
- pregnant women with constipation, haemorrhoids, or heartburn
- What they received
- topical anaesthetic agents, topical corticosteroid agents, and compound corticosteroid and anaesthetic agents for haemorrhoids
- Main outcome
- not stated in abstract
- Quality
- the abstract only lists which treatments were reviewed without giving any actual results, so no conclusion can be drawn from it alone.
- Limitations
- abstract does not report specific findings, numbers, or effect sizes for any intervention including hemorrhoid creams
Taken word for word from the abstract
- population
the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women
- intervention
compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical)
- intervention
anaesthetic agents (topical)
- result
We found five systematic reviews, RCTs or observational studies that met our inclusion criteria.
- primaryOutcome
What are the effects of interventions to prevent or treat haemorrhoids in pregnancy?
BMJ Clin Evid · PMID 19450328 · Read it on PubMed ↗
Tjandra et al. 2007
Rectogesic (glyceryl trinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures
Less bleeding and pain reported.Prospective cohortLow quality
58 people28 days
significant reduction in rectal bleeding and improvement in pain, throbbing, itching, irritation, and bowel movement difficulty after treatment
- Who was studied
- patients with early-stage hemorrhoids and high anal canal pressure causing ongoing symptoms
- What they received
- glyceryl trinitrate 0.2% ointment (Rectogesic) applied to the anus three times daily for 14 days
- Compared with
- no comparator group; patients compared to their own symptoms before and after treatment
- Main outcome
- rectal bleeding, anal pain, throbbing, itching, irritation, and difficulty with bowel movements
- Quality
- this was a small open-label study with no comparison group, so improvements could be partly due to natural healing or expectation rather than the cream itself
- Limitations
- open label study with no placebo or control group, and nearly half of patients experienced headache as a side effect
Taken word for word from the abstract
- n
This was a prospective, two-centre, open label study of 58 patients with persistent haemorrhoidal symptoms.
- population
Patients with first or second degree haemorrhoids and a maximum resting anal canal pressure > 70 mmHg were included.
- intervention
Rectogesic was applied three times a day for 14 days.
- comparator
This was a prospective, two-centre, open label study of 58 patients with persistent haemorrhoidal symptoms.
- primaryOutcome
This recorded the incidence of rectal bleeding, and visual analogue scales for anal pain, throbbing, pruritus, irritation and difficulty in bowel movement.
- result
there was significant reduction in rectal bleeding (P = 0.0002), and significant improvement of anal pain (P = 0.0024), throbbing (P = 0.0355), pruritus (P = 0.0043), irritation (P = 0.0000) and difficulty in bowel movement (P = 0.001)
Colorectal Dis · PMID 17504344 · Read it on PubMed ↗
Al-Waili et al. 2006
The safety and efficacy of a mixture of honey, olive oil, and beeswax for the management of hemorrhoids and anal fissure: a pilot study
Less bleeding and itching reported.Case seriesVery low quality
15 people4 weeks
significantly reduced bleeding and relieved itching in hemorrhoid patients; significant reduction in pain, bleeding, and itching in fissure patients
- Who was studied
- patients who presented with anal fissure or first- to third-degree hemorrhoids
- What they received
- topical mixture of honey, olive oil, and beeswax applied for 12 hours
- Compared with
- no comparator, symptoms before vs after treatment
- Main outcome
- change in bleeding, itching, swelling, redness, and pain scores
- Quality
- This was a tiny uncontrolled pilot study with only 15 patients and no comparison group, so improvement could be due to natural healing rather than the treatment.
- Limitations
- Small sample size, no control group, not randomized or blinded, described as a pilot study paving way for future randomized trials.
Taken word for word from the abstract
- n
Fifteen consecutive patients, 13 males and 2 females, median age 45 years (range: 28-70)
- population
who presented with anal fissure (5 patients) or first- to third-degree hemorrhoids (4 with first degree, 4 with second degree, and 2 with third degree)
- intervention
were treated with a 12-h application of a natural mixture containing honey, olive oil, and beeswax in ratio of 1:1:1(v/v/v)
- comparator
Efficacy of treatment was assessed by comparing the symptoms' score before and after treatment
- primaryOutcome
Bleeding, itching, edema, and erythema were measured using a scoring method
- result
The honey mixture significantly reduced bleeding and relieved itching in patients with hemorrhoids. Patients with anal fissure showed significant reduction in pain, bleeding, and itching after the treatment.
ScientificWorldJournal · PMID 17369999 · Read it on PubMed ↗
Yang et al. 2005
[Comparison of the efficacy and safety of compound carraghenates cream and compound carraghenates suppository in the treatment of mixed hemorrhoids]
Faster pain relief with cream.Randomised trialLow qualityRelated question
252 people6 days
both treatments improved symptoms similarly, but the cream relieved pain faster and more than the suppository
- Who was studied
- patients with mixed hemorrhoids
- What they received
- titanoreine (compound carraghenates) cream
- Compared with
- compound carraghenates suppository
- Main outcome
- relief of pain, bleeding and edema measured by a symptom score
- Quality
- it was a small, open-label (not blinded) trial comparing two active treatments rather than cream versus no treatment, so it can't show whether cream works better than doing nothing.
- Limitations
- open trial design without blinding, no placebo group, and the comparator was another active treatment (suppository) rather than no treatment
Taken word for word from the abstract
- n
Two hundred and fifty-two patients with mixed hemorrhoids were enrolled
- population
Two hundred and fifty-two patients with mixed hemorrhoids were enrolled
- intervention
titanoreine cream (study group, n=133)
- comparator
compound carraghenates suppository (control group, n=119)
- primaryOutcome
The symptomatic relief including pain,bleeding and edema was evaluated by scoring system
- result
Symptoms were significantly improved in both groups (87.3%, 94.8%, respectively) excepting symptom of pain relief, but there was no significant difference between two groups (P > 0.05). The pain scores were lower at every observing point in the study group than those in the control group (P< 0.05).
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 16167232 · Read it on PubMed ↗
Misra et al. 2005
Drug treatment of haemorrhoids
Helps control bleeding, not a cureNarrative reviewLow quality
size not given2005
these drugs have been effective and well tolerated in controlling acute bleeding, but are not a cure
- Who was studied
- people with symptomatic hemorrhoids of various grades
- What they received
- drug treatments for hemorrhoids (oral and topical, including flavonoids, calcium dobisilate, nitrates, nifedipine)
- Main outcome
- control of acute symptoms, especially bleeding
- Quality
- This is a narrative review describing various drugs without giving study details, numbers, or controlled comparisons, so it cannot be weighed heavily.
- Limitations
- No individual study data, sample sizes, or trial design details are given; it is a general review article.
Taken word for word from the abstract
- population
all grades of symptomatic haemorrhoids
- intervention
Flavonoids, in the new formulation of micronised purified flavonoid fraction (MPFF) or as part of the ancient traditional medicine derivative of the Ginkgo tree, are used for relief of acute symptoms
- intervention
calcium dobisilate (used in diabetic retinopathy and chronic venous insufficiency), nitrates and nifedipine have also been effective and well tolerated in the medical treatment of haemorrhoids
- primaryOutcome
for control of bleeding and re-bleeding in all grades of haemorrhoids
- result
have also been effective and well tolerated in the medical treatment of haemorrhoids
- result
However, drug treatment is not aimed at curing haemorrhoids.
Drugs · PMID 16134260 · Read it on PubMed ↗
Dimitroulopoulos et al. 2005
Prospective, randomized, controlled, observer-blinded trial of combined infrared photocoagulation and micronized purified flavonoid fraction versus each alone for the treatment of hemorrhoidal disease
Combo treatment stopped bleeding better than either alone.Randomised trialModerate qualityRelated question
351 people90 days
74.8% of patients in the combined group had no bleeding after 5 days, versus 59.6% with MPFF alone and 55.6% with IRP alone
- Who was studied
- patients with grade I, II, and III acute internal hemorrhoids
- What they received
- combined infrared photocoagulation plus oral micronized purified flavonoid fraction (MPFF)
- Compared with
- MPFF alone or infrared photocoagulation (IRP) alone
- Main outcome
- whether bleeding stopped after 5 days of treatment
- Quality
- It was a fairly large randomized trial with blinded assessors, but only the observers (not patients) were blinded and the main result was measured after just 5 days.
- Limitations
- Single-blind design, short primary assessment period (5 days), and the treatments studied were oral medication and a laser-type procedure rather than a topical cream.
Taken word for word from the abstract
- n
A total of 351 patients (180 women, 171 men) were enrolled in the study.
- population
patients with grades I, II, and III acute internal hemorrhoids
- intervention
a treatment combining IRP and oral micronized purified flavonoid fraction (MPFF)
- comparator
versus each treatment used alone on bleeding cessation
- primaryOutcome
bleeding status was reported at day 0 (day of inclusion) and compared with that at day 5 after treatment
- result
The percentage of patients with no bleeding after 5 days of treatment was higher in the combined treatment group (74.8%) compared with MPFF alone (59.6%; P = 0.023) or with IRP alone (55.6%; P = 0.004).
Clin Ther · PMID 16117981 · Read it on PubMed ↗
Gioiella et al. 2004
[Clinical study on the pharmacological treatment of hemorrhoids with 0.25% oxethacaine chlorhydrate]
Symptoms improved, but no comparison group.Case seriesVery low quality
98 peoplethirty-six month treatment
reduction in itching, pain, blood and mucous loss, and elimination of urgency sensation in all patients; hemorrhoids reduced in 15 patients for 11 months
- Who was studied
- patients with Grade I-II and Grade III-IV hemorrhoids
- What they received
- rectal cream with 0.25% oxethacaine chlorhydrate (Emoren) applied twice daily for 10 days
- Main outcome
- symptoms including itching, bleeding, burning, urgency, and pain
- Quality
- There was no comparison group, so it's impossible to know if patients would have improved anyway without the cream.
- Limitations
- No control or placebo group was used; the abstract does not describe randomization or blinding.
Taken word for word from the abstract
- n
a total of 98 patients treated and observed
- population
thirty-six month treatment of Grades I and II haemorrhoids (pharmacological treatment) with a group of 75 patients (45 females and 30 males) and treatment for Grades III and IV haemorrhoids (Pharmacological and surgical treatment) on a second group of 23 patients
- intervention
a rectal cream containing 0.25% Oxethacaine chlorhydrate (Emoren, produced by Novasorel, srl) was used on all patients. The cream was applied intra-anally and on the external orifice twice a day, morning and evening, for ten days.
- primaryOutcome
the following symptoms were monitored: pruritus, ematochezia, burning, tenesmus, and pain
- result
A reduction in pruritus, pain, blood and mucous loss, Elimination of tenesmus, Absence of peri-anal eczema
- result
in 15 patients, haemorrhoids were reduced for 11 months
- followUp
thirty-six month treatment
Clin Ter · PMID 15702657 · Read it on PubMed ↗
Nicholson et al. 2004
Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing
Less pain, faster healing after hemorrhoid surgery.Randomised trialLow qualityRelated question
20 people28 days
less pain at 7 and 14 days after surgery, less swelling, and better wound healing compared with placebo
- Who was studied
- patients who had surgery to remove hemorrhoids (grade 3 or 4 hemorrhoids)
- What they received
- metronidazole 10% cream applied to the surgical wound after hemorrhoid removal
- Compared with
- placebo cream (inactive carrier) applied to the surgical wound
- Main outcome
- pain after surgery and how well the wound healed
- Quality
- Very small study (20 people) from one center, so the results may not hold up in a larger trial.
- Limitations
- Small sample size of only 20 patients; studies the use of cream after surgical removal of hemorrhoids, not as a treatment for shrinking existing hemorrhoids or stopping bleeding without surgery.
Taken word for word from the abstract
- n
Twenty patients were randomized in a prospective manner, ten to the topical 10 percent metronidazole group and ten to the placebo carrier group.
- population
Surgical indications included grade 3 or 4 internal or external hemorrhoidal disease, with or without a fissure-in-ano.
- intervention
The current study investigates the efficacy of topical metronidazole (10 percent) in reducing postoperative pain and promoting wound healing after Harmonic Scalpel hemorrhoidectomy.
- comparator
A prospective, randomized trial was conducted to compare posthemorrhoidectomy pain and wound healing with use of topical metronidazole (10 percent) vs. placebo carrier, applied to the surgical site.
- primaryOutcome
Pain was assessed using a visual analog score (VAS) preoperatively and on postoperative days 1, 2, 7, 14, and 28.
- result
Patients in the topical metronidazole group experienced significantly less postoperative pain at day 7 (VAS +/- SEM, 3.4 +/- 0.4 vs. 6.3 +/- 0.5; P = 0.002) and day 14 (1.0 +/- 0.4 vs. 3.2 +/- 0.7, P = 0.02).
Dis Colon Rectum · PMID 15054681 · Read it on PubMed ↗
Hwang et al. 2003
Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemorrhoidectomy: results of a randomized, prospective, double-blind, placebo-controlled trial
Faster healing after hemorrhoid surgery.Randomised trialModerate qualityRelated question
110 peoplethree weeks
74.5% of nitroglycerin group had complete healing at three weeks versus 42% of placebo group, and pain scores were lower with nitroglycerin
- Who was studied
- patients with third or fourth degree hemorrhoids having surgery to remove three or more piles
- What they received
- 0.2% glyceryl trinitrate ointment applied to the surgical wound after hemorrhoid removal
- Compared with
- placebo ointment
- Main outcome
- complete wound healing at three weeks after surgery
- Quality
- it was a well-designed randomized double-blind placebo-controlled trial with a planned sample size, but it was done at a single center by one surgeon, which may limit how well it applies elsewhere.
- Limitations
- single surgeon performed all procedures; study measures wound healing after surgical removal of hemorrhoids, not effects on unremoved hemorrhoids
Taken word for word from the abstract
- population
patients with third-degree or fourth-degree hemorrhoids and patients undergoing hemorrhoidectomies for three or more piles
- intervention
0.2 percent glyceryl trinitrate ointment
- comparator
placebo ointment
- primaryOutcome
complete wound healing was checked at three weeks after the operation
- result
The wound healing rates at three weeks postoperative were 74.5 percent in the nitroglycerin group and 42 percent in the placebo group (P = 0.002).
- n
the first 110 patients to meet our criteria were selected, 55 in the nitroglycerin group and 55 in the placebo group
Dis Colon Rectum · PMID 12847372 · Read it on PubMed ↗
Wienert et al. 2002
Local treatment of hemorrhoidal disease and perianal eczema. Meta-analysis of the efficacy and safety of an Escherichia coli culture suspension alone or in combination with hydrocortisone
More symptom relief than placebo.Meta-analysisLow qualityRelated question
1,070 people2 weeks
BCS ointment and BCS plus hydrocortisone gave greater symptom relief than the ointment base, and BCS plus hydrocortisone was also better than hydrocortisone alone
- Who was studied
- patients with hemorrhoids and/or perianal eczema, mean age 50 years
- What they received
- ointment containing E. coli bacterial culture suspension (BCS), alone or combined with hydrocortisone
- Compared with
- ointment base (vehicle) or hydrocortisone ointment alone
- Main outcome
- overall efficacy rating and symptom scores for burning, itching, redness and soiling
- Quality
- Although it pools six short, double-blind randomized trials, treatment lasted only two weeks, mixed two different conditions together, and did not report measures like bleeding or hemorrhoid size.
- Limitations
- Treatment and follow-up were only 2 weeks; patients had either hemorrhoids or perianal eczema, not hemorrhoids specifically with bleeding as an endpoint; outcome measures were symptom scores and investigator ratings rather than hemorrhoid shrinkage or bleeding.
Taken word for word from the abstract
- n
Out of 1,070 patients (mean age 50 years), 273 received BCS and 229 BCS + HC; 568 patients were given the various controls.
- population
Patients with hemorrhoids and/or perianal eczema were included and treated over 2 weeks with weekly assessments.
- intervention
ointments containing either a bacterial culture suspension (BCS) from Escherichia coli or a combination of BCS with hydrocortisone
- comparator
against ointment base, and two trials using BCS + HC against hydrocortisone ointment alone
- primaryOutcome
Efficacy parameters included score changes for burning, itching, redness and soiling as well as the investigators' overall efficacy rating.
- result
BCS ointment was significantly superior to the ointment base in all three studies (p = 0.028, p = 0.016, and p = 0.045). Moreover, BCS + HC was superior to the ointment base (p < 0.001) and to hydrocortisone alone (p = 0.156 and p = 0.021)
- followUp
treated over 2 weeks with weekly assessments
Arzneimittelforschung · PMID 12189774 · Read it on PubMed ↗
Müller-Lobeck 2001
[Ambulatory hemorrhoid therapy]
No efficacy data reported for creams.Narrative reviewVery low qualityRelated question
size not given2001
the abstract states only that treatment with ointments can be managed by the patient without any problems, without giving data on whether it shrinks hemorrhoids or stops bleeding
- Who was studied
- people with hemorrhoid (anal) complaints
- What they received
- treatment with ointments, among other ambulatory options like sclerotherapy and rubber band ligation
- Compared with
- other ambulatory treatments (sclerotherapy, rubber band ligation, Doppler-guided artery ligation)
- Main outcome
- not clearly defined; the abstract discusses acceptance, risks and complications of treatment options rather than a specific efficacy outcome
- Quality
- this is a general narrative review that does not present actual study data or outcome measurements for ointment treatment specifically.
- Limitations
- no original data, sample size, or outcome measures are reported for ointment/cream treatment; it is a broad historical and descriptive review of multiple hemorrhoid therapies.
Taken word for word from the abstract
- population
the very common haemorrhoidal disease
- intervention
treatment with ointments
- comparator
regardless of how effective sclerotherapy and rubber band ligation are
- result
diet and behavioural methods, and also anal dilatation and treatment with ointments, can be managed by the patient without any problems
- primaryOutcome
discussed with reference to acceptance, inherent risks, and the possible complications
Chirurg · PMID 11469087 · Read it on PubMed ↗
Cavcić et al. 2001
Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis
Less effective than surgery.Randomised trialModerate qualityRelated question
150 peopleafter one year
excision gave better pain relief, fewer recurrences, and fewer skin tags than GTN ointment or incision
- Who was studied
- patients with perianal thrombosis
- What they received
- glyceryl trinitrate (GTN) ointment applied to the anal area
- Compared with
- incision or excision surgery
- Main outcome
- pain relief, recurrence rate, and skin tag formation
- Quality
- it is a randomized trial with a reasonable sample size, but it studies perianal thrombosis rather than ordinary hemorrhoids, limiting how directly it answers the question.
- Limitations
- abstract does not describe blinding or dropout details; condition studied is perianal thrombosis, not general hemorrhoids.
Taken word for word from the abstract
- population
treatment of perianal thrombosis
- n
A total of 150 patients were randomly divided into three groups of 50
- intervention
Topically applied 0.2% glyceryl trinitrate ointment to the anal region
- comparator
incision and excision were compared
- primaryOutcome
pain relief, number of recurrences and the appearance of anal skin tags
- result
Excision is a significantly better method of treatment of perianal thrombosis than incision or topically applied 0.2% glyceryl trinitrate ointment.
Dig Liver Dis · PMID 11432512 · Read it on PubMed ↗
Perrotti et al. 2001
Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine
Faster healing, less pain than lidocaine aloneRandomised trialModerate qualityRelated question
98 people14 days
more pain relief, less need for painkillers, and more resolution of hemorrhoids with nifedipine than with lidocaine alone
- Who was studied
- patients with acute thrombosed external hemorrhoids
- What they received
- topical nifedipine 0.3% with lidocaine ointment applied every 12 hours for two weeks
- Compared with
- topical lidocaine ointment alone
- Main outcome
- pain relief and resolution of the thrombosed hemorrhoids
- Quality
- it was a randomized trial but open-label (not blinded) and of modest size, which can bias results.
- Limitations
- open design (not blinded), so patients and doctors knew which treatment was given, which could affect reported pain and analgesic use
Taken word for word from the abstract
- n
Ninety-eight patients who gave their informed consent were recruited
- population
acute thrombosed external hemorrhoids
- intervention
Patients treated with nifedipine (n = 50) used topical 0.3 percent nifedipine and 1.5 percent lidocaine ointment every 12 hours for two weeks.
- comparator
The control group, consisting of 48 patients, received topical 1.5 percent lidocaine ointment during therapy.
- primaryOutcome
The aim was to test the efficacy of local application of nifedipine ointment in healing acute thrombosed external hemorrhoids.
- result
resolution of acute thrombosed external hemorrhoids was achieved after 14 days of therapy in 46 patients (92 percent) of the nifedipine-treated group, as opposed to 22 patients (45.8 percent) of the control group (P < 0.01)
Dis Colon Rectum · PMID 11289288 · Read it on PubMed ↗
Briel et al. 2000
Treatment of acute strangulated internal hemorrhoids by topical application of isosorbide dinitrate ointment
Pain eased, hemorrhoids became treatable.Case seriesVery low qualityRelated question
4 people2 weeks
pain relief within 1 day and hemorrhoids became reducible within 1 week, allowing later rubber band ligation
- Who was studied
- men with acute strangulated (prolapsed and trapped) internal hemorrhoids
- What they received
- isosorbide dinitrate ointment (1%) applied to the anal skin every 3 hours for 2 weeks
- Compared with
- no comparator group
- Main outcome
- pain relief and hemorrhoids becoming reducible so they could then be treated with rubber band ligation
- Quality
- Only 4 patients with no comparison group, so it's impossible to know if the cream itself caused the improvement.
- Limitations
- Very small number of patients (4), all male, no control group, and the condition studied (acute strangulated hemorrhoids) is a severe emergency situation rather than typical hemorrhoid symptoms like bleeding or mild shrinkage.
Taken word for word from the abstract
- n
Four male patients (median age 35 years, range 30-42)
- population
patients with acute strangulated internal hemorrhoids
- intervention
1% isosorbide dinitrate. The ointment was applied to the anoderm. This application was repeated every 3 h during daytime for 2 weeks.
- comparator
This study investigated the role of isosorbide dinitrate in the treatment of patients with acute strangulated internal hemorrhoids
- primaryOutcome
Significant pain relief was achieved within 1 day
- result
Within 1 week the hemorrhoids became reducible. Thereafter the hemorrhoids could be treated adequately by rubber band ligation.
Int J Colorectal Dis · PMID 11008728 · Read it on PubMed ↗
Espinosa 2000
[Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies]
High satisfaction reported, but no comparison group.Meta-analysisVery low quality
2,287 people2000
83.2% of patients were rated by doctors as having highly satisfactory results, and 82.2% of patients rated it the same way
- Who was studied
- patients with hemorrhoid problems, including external and internal hemorrhoids with bleeding, anal fissures, and other anal conditions
- What they received
- policresulene cream combined with a local anesthetic (cinchocaine), applied as ointment or suppositories
- Compared with
- none reported — no placebo or untreated comparison group was described
- Main outcome
- how satisfied doctors and patients were with symptom improvement
- Quality
- This pooled report of multiple centers had no comparison group, so it cannot show whether the cream itself caused the improvement.
- Limitations
- No control or placebo group was described, so improvement cannot be separated from natural healing; only investigator and patient satisfaction ratings were used, not objective shrinkage or bleeding measures.
Taken word for word from the abstract
- n
2287 patients with hemorrhoid pathology
- population
2287 patients with hemorrhoid pathology
- intervention
policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations
- comparator
Seven centres investigated the therapeutic efficacy and tolerability of policresulene associated to cinchocaine administered locally as ointment, suppositories or both formulations in 2287 patients with hemorrhoid pathology.
- primaryOutcome
with the same score criteria for rating efficacy and tolerability according to the physicians and the patients
- result
Highly satisfactory results were achieved in 1904 patients (83.2%) according to the investigators criteria. Patients rated the outcome most satisfactory for 1881 cases (82.2%).
Acta Gastroenterol Latinoam · PMID 10975023 · Read it on PubMed ↗
Janicke et al. 1996
Anorectal disorders
Doesn't test hemorrhoid cream at allNarrative reviewVery low qualityRelated question
size not given1996
the abstract does not report a specific outcome or result for hemorrhoid cream; it only states treatment depends on severity and most cases can be treated conservatively
- Who was studied
- people with anorectal disorders including hemorrhoids seen in the emergency department
- What they received
- conservative medical treatment such as dietary changes and sitz baths, or nonsurgical procedures like rubber band ligation and infrared coagulation
- Quality
- This is a general narrative review describing treatment categories, not a study testing a specific cream against an outcome, so it cannot show whether cream works.
- Limitations
- This is a broad review of anorectal disorders overall, not a study evaluating hemorrhoid cream specifically, and reports no data, numbers, or outcomes for any cream.
Taken word for word from the abstract
- population
Anorectal disorders are commonly encountered in the practice of emergency medicine.
- intervention
Most cases can be treated by conservative medical treatment (e.g., dietary changes, sitz baths) or nonsurgical procedures (e.g., rubber band liagation, infrared coagulation).
- result
Treatment is dependent on the degree of hemorrhoid prolapse and symptoms.
Emerg Med Clin North Am · PMID 8921768 · Read it on PubMed ↗
Marsicano et al. 1995
[Effectiveness and innocuousness of the association of calcium dobesilate, dexamethasone acetate and lidocaine versus prednisolone capronate with dibucaine clorohydrate in the treatment of hemorrhoids-]
Both creams improved symptoms similarly.Randomised trialLow quality
40 people1995
No significant difference between the two creams; both produced important improvement in symptoms and hemorrhoid grade, with physician-rated success of 88% and 85.7% respectively
- Who was studied
- patients with internal hemorrhoids grade 1 or 2
- What they received
- calcium dobesilate with dexamethasone acetate and lidocaine applied topically twice a day
- Compared with
- prednisolone capronate with dibucaine chlorohydrate applied topically twice a day
- Main outcome
- change in hemorrhoid symptom score and hemorrhoid grade from start to end of treatment
- Quality
- Very small study (40 patients) comparing two active creams without a placebo group, so it cannot show whether either cream helped more than no treatment.
- Limitations
- No placebo or untreated comparison group; small sample size; subjective symptom scoring
Taken word for word from the abstract
- n
They were included 40 patient with diagnosis of internal hemorrhoids grade 1 or 2
- population
40 patient with diagnosis of internal hemorrhoids grade 1 or 2
- intervention
A = dobesilate of calcium with acetato of dexamethasone and lidocaine
- comparator
B = Capronato of Prednisolone with Clorhidrato of dibucaina, applied twice a day
- primaryOutcome
As for the evaluation of the punctuation of symptoms and of the grade of Hemorrhoids, comparing beginning and final
- result
they didn't show significant difference interproduct confirming the effectiveness and similar inocuity
- result
the treatment A (88%) and B (85.7%) the got successful outputs
G E N · PMID 8762660 · Read it on PubMed ↗
Cospite 1994
Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids
Oral pill eased symptoms faster, not cream.Randomised trialModerate qualityRelated question
100 people1994
symptoms improved faster and more with the drug than with placebo, with less need for analgesics and topical treatments
- Who was studied
- patients having an acute hemorrhoid flare-up with a history of hemorrhoid disease
- What they received
- oral Daflon 500 mg tablets (a vein-support drug, not a cream)
- Compared with
- placebo tablets
- Main outcome
- overall improvement of hemorrhoid symptoms like bleeding, discomfort, pain, and discharge
- Quality
- it was a properly randomized, double-blind, placebo-controlled trial, but it was small, short, and single-study, and it tested a swallowed drug rather than a cream applied to the skin.
- Limitations
- small sample size, short treatment period, and no information on long-term outcomes or recurrence
Taken word for word from the abstract
- n
One hundred patients with a history of hemorrhoidal disease
- population
patients with a history of hemorrhoidal disease and suffering from an acute hemorrhoidal attack
- intervention
treated with Daflon 500 mg* (D500)
- comparator
placebo (PL) under double-blind conditions
- primaryOutcome
Overall improvement of symptoms was greater in the D500 group than in the PL group
- result
treatment with D500 resulted in a quicker and more pronounced relief of signs and symptoms of acute hemorrhoids than with the placebo
Angiology · PMID 8203789 · Read it on PubMed ↗
Dressler et al. 1992
[Local therapy of grade 1 and 2 hemorrhoids. Effectiveness of a combination preparation with standardized blood leech extract]
Faster symptom relief than placeboRandomised trialLow quality
80 peopleone week
symptoms and signs improved significantly more rapidly with the active cream than placebo
- Who was studied
- patients with first and second degree hemorrhoids
- What they received
- topical combination preparation containing standardized leech extract, polidocanol and allantoin
- Compared with
- placebo cream
- Main outcome
- improvement in subjective and objective symptoms and signs of hemorrhoids
- Quality
- small, short one-week trial with few details on how symptoms were measured or on long-term outcomes like bleeding or shrinkage
- Limitations
- Only 80 patients, one week duration, abstract gives no numeric effect sizes and does not report bleeding or hemorrhoid size specifically.
Taken word for word from the abstract
- n
double-blind study in 80 patients with first and second degree hemorrhoids
- population
80 patients with first and second degree hemorrhoids
- intervention
a topical combination preparation containing standardized leech extract, polidocanol and allantoin
- comparator
Placebo-controlled, double-blind study
- primaryOutcome
Both the subjective and objective symptoms and signs improved during the one week of treatment
- result
improved during the one week of treatment statistically significantly more rapidly under the test preparation as compared with placebo
Fortschr Med · PMID 1634173 · Read it on PubMed ↗
Knoch et al. 1992
[Ointment treatment of 1st degree hemorrhoids. Comparison of the effectiveness of a phytogenic preparation with two new ointments containing synthetic drugs]
All creams worked equally well.Randomised trialLow quality
90 people21 days
all three ointments worked well with no major differences between groups, slight trend favoring the herbal one
- Who was studied
- patients with first-degree hemorrhoids
- What they received
- plant-based (herbal) hemorrhoid ointment
- Compared with
- two synthetic ointments, one containing a corticoid
- Main outcome
- symptom improvement: itching, bleeding, burning, soreness
- Quality
- small three-armed trial of only 90 patients over three weeks, limiting confidence in finding true differences between treatments.
- Limitations
- Small sample size split across three groups and short 21-day duration.
Taken word for word from the abstract
- n
Treatment of 90 patients with first-degree hemorrhoids
- population
patients with first-degree hemorrhoids
- intervention
a vegetable-based hemorrhoid ointment
- comparator
two other ointments containing synthetic substances, one of which additionally contained corticoid
- primaryOutcome
Four typical symptoms--pruritus, bleeding, burning sensation, sore sensation--graded by both physician and patient
- result
All three ointments proved highly effective. Both during the course of treatment and at the final examination carried out on the 21st day, no major differences were to be found between the three treatment groups.
Fortschr Med · PMID 1582642 · Read it on PubMed ↗
Xie et al. 1992
Effects of 2-camphanone on canine portal vein blood flow and rat smooth muscle
Increased vein blood flow in animals.Animal studyVery low qualityRelated question
size not given1992
2-camphanone increased blood flow velocity and reduced vein muscle contractions in animals
- Who was studied
- anesthetized dogs and rats used to test portal vein blood flow
- What they received
- 2-camphanone applied transdermally or intravenously
- Compared with
- vehicle-treated animals
- Main outcome
- portal venous blood flow velocity and vein muscle contractions
- Quality
- This was an animal and isolated-tissue experiment, not a study of people with hemorrhoids, so it cannot show whether hemorrhoids actually shrink or stop bleeding.
- Limitations
- Study was conducted in dogs and rats, not in humans with hemorrhoids, and did not measure hemorrhoid symptoms directly.
Taken word for word from the abstract
- population
administration of 2-camphanone to dogs anesthetized with pentobarbital sodium
- intervention
Both intravenous (0.06, 0.2, and 0.6 mg/kg) and transdermal (6 mg/dog on the thigh) administration of 2-camphanone
- comparator
compared with vehicle-treated animals
- primaryOutcome
The effects of 2-camphanone on canine portal venous blood flow were investigated using pulsed Doppler flow techniques and on the spontaneous contractions of the isolated rat portal vein.
- result
increased portal venous flow velocity by 20%-30% without affecting femoral arterial blood flow, heart rate, or arterial blood pressure
Gastroenterology · PMID 1732110 · Read it on PubMed ↗
Mínguez et al. 1992
[Pressure of the anal canal in patients with hemorrhoids or with anal fissure. Effect of the topical application of an anesthetic gel]
Eased pain, lowered canal pressure.Prospective cohortVery low qualityRelated question
19 people1992
gel lowered anal pressure in hemorrhoid patients and eased pain in some patients, but pain relief did not match pressure changes
- Who was studied
- patients with hemorrhoids or with posterior anal fissure
- What they received
- anesthetic gel containing tetracaine applied inside the anal canal
- Compared with
- measurements before gel application and a healthy control group of same age and sex
- Main outcome
- anal canal pressure and pain sensation
- Quality
- Very small, uncontrolled study measuring pressure and pain, not actual hemorrhoid size or bleeding.
- Limitations
- Very small sample, no blinding or placebo comparison, measures pressure/pain rather than bleeding or hemorrhoid size.
Taken word for word from the abstract
- n
11 patients with hemorrhoids and 8 patients with posterior and fissure
- population
11 patients with hemorrhoids and 8 patients with posterior and fissure
- intervention
topical administration of an anesthetic gel containing tetracaine in the anal canal
- comparator
comparison with a control group of the same age and sex
- primaryOutcome
pressure measurements and clinical sensation
- result
The anesthetic gel produced a significant decrease of the maximal basal pressure in subjects with hemorrhoids, as well as a lessening of pain in 37% of patients with anal fissure and in 55% of those with hemorrhoids. This symptomatic improvement was not correlated with changes in pressure.
Rev Esp Enferm Dig · PMID 1567701 · Read it on PubMed ↗
Wright et al. 1991
A prospective crossover trial of direct current electrotherapy in symptomatic hemorrhoidal disease
No added benefit from electrotherapy device.Randomised trialLow qualityRelated question
16 people16 weeks
no statistically significant difference in symptom improvement between direct current electrotherapy and sham therapy
- Who was studied
- patients referred for treatment of symptomatic hemorrhoids
- What they received
- direct current electrotherapy plus standard medical therapy (sitz baths, hydrocortisone suppositories, topical preparations, high fiber diet)
- Compared with
- sham electrotherapy plus the same standard medical therapy
- Main outcome
- improvement in hemorrhoid symptoms
- Quality
- Very small crossover trial of only 16 patients comparing an electrical device, not the cream itself, to a sham version with both arms also receiving topical treatment.
- Limitations
- Only 16 patients; both groups received topical/medical therapy so the cream's own effect is not isolated; crossover design; no mention of blinding success.
Taken word for word from the abstract
- n
Sixteen patients referred for treatment of symptomatic hemorrhoids underwent a 16-week treatment protocol.
- population
Sixteen patients referred for treatment of symptomatic hemorrhoids underwent a 16-week treatment protocol.
- intervention
medical therapy with active direct current electrotherapy at 4-week intervals
- comparator
medical therapy with a sham therapy
- primaryOutcome
Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups.
- result
Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups.
Gastrointest Endosc · PMID 1661696 · Read it on PubMed ↗
Neiger et al. 1990
[The symptomatic therapy of hemorrhoids and anal eczema--a report of experiences from proctology practice]
Mostly rated effective, but no control group.Case seriesVery low qualityRelated question
92 people1990
treatment judged good or very good in 92% of cases, well tolerated in all cases
- Who was studied
- patients with hemorrhoid disease and related conditions
- What they received
- suppositories or cream containing a steroid (fluocortolone pivalate), local anesthetic (lidocaine), and in the cream also an antiseptic (chlorquinaldol)
- Compared with
- no comparison group
- Main outcome
- how well the treatment worked, judged by doctors/patients
- Quality
- This was an uncontrolled study of patients all given the treatment, with no placebo or comparison group, so it can't show whether the cream itself caused the improvement.
- Limitations
- No control group, no blinding, and outcome judged subjectively as 'good or very good' without objective measures of hemorrhoid size or bleeding.
Taken word for word from the abstract
- n
were tested in 92 patients with hemorrhoidal diseases
- population
92 patients with hemorrhoidal diseases and their concomitant conditions
- intervention
suppositories with the corticoid fluocortolone-21-pivalate and the local anesthetic lidocaine hydrochloride as well as a cream with the same substances and in addition, chlorquinaldol
- comparator
were tested in 92 patients with hemorrhoidal diseases and their concomitant conditions
- primaryOutcome
efficacy of the preparations proved to be good or very good
- result
In 92% of the cases efficacy of the preparations proved to be good or very good, and in all cases they were well tolerated.
Schweiz Rundsch Med Prax · PMID 2392628 · Read it on PubMed ↗
Nishiki et al. 1988
[Neriproct: its anti-inflammatory effect on an experimentally induced hemorrhoid model in the rat]
Reduced inflammation in rat hemorrhoids.Animal studyVery low qualityRelated question
size not given1988
Neriproct reduced inflammation, tissue destruction and swelling more effectively than the other tested anti-hemorrhoid drugs in rats
- Who was studied
- rats with chemically induced hemorrhoids (croton-oil or abrasive irritation models)
- What they received
- Neriproct cream (steroid diflucortolone valerate combined with lidocaine)
- Compared with
- other anti-hemorrhoid creams (Scheriproct, Proctosedyl, Posterisan forte, Borraginol N, Posterisan, Borraza G) and other steroids (prednisolone, hydrocortisone caproate, hydrocortisone)
- Main outcome
- reduction of inflammation and tissue damage in the hemorrhoid model
- Quality
- This is an animal study using artificially induced hemorrhoids in rats, not a human trial, so it cannot show whether the cream works for people.
- Limitations
- Animal model only, no human data, and higher doses of the steroid suppressed wound healing.
Taken word for word from the abstract
- population
croton-oil-induced hemorrhoid rat
- intervention
The effect of DFV was not affected by combination with lidocaine.
- comparator
efficacy of Neriproct was superior to that of the other drugs such as Scheriproct, Proctosedyl, Posterisan forte, Borraginol N, Posterisan and Borraza G
- primaryOutcome
DFV was found to suppress inflammation most effectively
- result
In both models, efficacy of Neriproct was superior to that of the other drugs such as Scheriproct, Proctosedyl, Posterisan forte, Borraginol N, Posterisan and Borraza G.
Nihon Yakurigaku Zasshi · PMID 3243509 · Read it on PubMed ↗
Tajana et al. 1988
[Results of the use of topical diosmin (venosmine) in the treatment of acute hemorrhoid pathology]
Less swelling and redness, uncontrolled study.Case seriesVery low quality
50 peoplethree consecutive weekly visits
swelling and redness improved by about 75% and 73% over three weekly visits
- Who was studied
- patients with grade 1-4 hemorrhoids with strangulation and thrombosis
- What they received
- topical diosmin (venosmine) cream
- Compared with
- none (no control group)
- Main outcome
- severity of hemorrhoid symptoms (bleeding, swelling, redness, pain, itching) scored over visits
- Quality
- This was a small uncontrolled study with no comparison group, so improvement cannot be separated from natural healing over time.
- Limitations
- No control group; patients who had prior treatment were excluded, and the study was not randomized or blinded.
Taken word for word from the abstract
- n
topical treatment with Diosmina ointment was used on 50 patients (33 males, 17 females)
- population
50 patients (33 males, 17 females) with grade 1, 2, 3 or 4 haemorrhoids featuring strangulation and thrombosis
- intervention
topical treatment with Diosmina ointment
- comparator
Patients who had previously been given other treatment were excluded from the study.
- primaryOutcome
scoring (0-3) the major symptoms of the condition (bleeding, oedema, erythema, pain, itching) according to severity
- result
The drug was most effective on oedema and erythema, producing 75% and 73% improvements as assessed in three consecutive weekly visits.
Minerva Med · PMID 3287228 · Read it on PubMed ↗
Smith et al. 1988
Comparative efficacy and tolerability of two ointment and suppository preparations ('Uniroid' and 'Proctosedyl') in the treatment of second degree haemorrhoids in general practice
Symptoms improved, but no placebo comparison.Randomised trialLow qualityRelated question
89 people3 weeks
symptoms improved in all groups, with over 90% control after 3 weeks and no significant differences between treatments
- Who was studied
- patients with second degree hemorrhoids in general practice
- What they received
- antibiotic-corticosteroid ointment or suppository ('Uniroid' or 'Proctosedyl')
- Compared with
- the other antibiotic-corticosteroid formulation (ointment vs suppository, Uniroid vs Proctosedyl)
- Main outcome
- control of symptoms including pain, itching, bleeding, and anal discharge
- Quality
- this was an open (not blinded) study comparing two active treatments without a placebo group, so it cannot show whether the creams work better than no treatment at all.
- Limitations
- open study design (not blinded), no placebo or untreated comparison group, so benefit could be due to natural resolution over time.
Taken word for word from the abstract
- n
89 patients with second degree haemorrhoids
- population
89 patients with second degree haemorrhoids
- intervention
two antibiotic-corticosteroid combinations ('Uniroid' and 'Proctosedyl') in ointment and suppository formulations
- comparator
Patients were allocated at random into 4 groups and received treatment with one of the trial preparations for 1, 2 or 3 weeks
- primaryOutcome
control of symptoms was achieved from Week 2 onwards
- result
Significant improvement occurred in all groups during treatment.
- result
building up to levels in excess of 90% after 3 weeks of therapy
- result
No statistically significant differences between the two ointment and the two suppository formulations were identified in this study
Curr Med Res Opin · PMID 2838221 · Read it on PubMed ↗
Libeskind 1987
[Non-surgical treatment of hemorrhoids]
No real evidence given either way.Narrative reviewVery low qualityRelated question
size not given1987
The abstract says these treatments often give interesting results but does not provide data on effectiveness
- Who was studied
- people with hemorrhoids
- What they received
- non-surgical treatments (creams, medications, and office procedures)
- Compared with
- surgery or no treatment
- Main outcome
- symptom relief from hemorrhoids
- Quality
- This is a general narrative overview describing available treatments without presenting any study data or outcomes to judge effectiveness.
- Limitations
- No data, numbers, or specific outcomes are given; it is a descriptive overview of available treatment options, not a study of effectiveness.
Taken word for word from the abstract
- population
The treatment of hemorrhoids includes a vast array of medical and instrumental means.
- intervention
phlebotonics, local topical agents, anti-infectious and anti-inflammatory agents, myorelaxants, transit regulators
- comparator
some of which were offered as a substitute to surgery
- primaryOutcome
there are numerous products in order to act on the symptoms or one of the factors of the hemorrhoidal complex
- result
All these treatments, some of which were offered as a substitute to surgery, often give interesting results, but are not devoid of danger.
Ann Gastroenterol Hepatol (Paris) · PMID 3662418 · Read it on PubMed ↗
Schussman et al. 1986
Outpatient management of hemorrhoids
No evidence reported either way.Narrative reviewVery low qualityRelated question
size not given1986
- Who was studied
- people with hemorrhoids
- What they received
- dietary changes, stool softeners, and local hydrocortisone creams
- Quality
- This is a general review article with no study data, just recommendations, so it cannot show whether the cream works.
- Limitations
- No data, outcomes, or comparisons are reported; it is a general management review, not a study of cream effectiveness.
Taken word for word from the abstract
- population
Hemorrhoids are a common medical problem
- intervention
managed conservatively with dietary changes, stool softeners, and local hydrocortisone creams
Prim Care · PMID 3538088 · Read it on PubMed ↗
Neiger 1980
[Pathogenesis, clinical aspects and conservative therapy of hemorrhoids]
No efficacy data for creams.Narrative reviewVery low qualityRelated question
size not given1980
the abstract states ointments/suppositories are tried first, with no data on how well they worked, and that sclerosing injections, infrared coagulation or banding were used if this failed
- Who was studied
- people diagnosed with hemorrhoids after examination
- What they received
- ointments and suppositories applied to the anal area
- Compared with
- other treatments such as sclerosing injections, infrared coagulation, and rubber band ligation
- Main outcome
- whether symptomatic treatment relieved hemorrhoid symptoms
- Quality
- This is a general overview of hemorrhoid treatments with no study data, numbers, or comparison results reported for creams.
- Limitations
- No patient numbers, no measured outcomes, no comparison data for ointment/suppository treatment specifically; it is a descriptive overview rather than a study.
Taken word for word from the abstract
- intervention
Local use of ointment and suppositories follows.
- comparator
If this symptomatic treatment fails, sclerosing injections are recommended.
- comparator
coagulation by infrared radiation using a special probe has been developed and found to be at least as successful as injection treatment
- comparator
For prolapsing piles, however, rubber band ligature appears to be the most effective method.
- population
Hemorrhoids are readily diagnosed by proctoscopy.
- primaryOutcome
Once the diagnosis is established, instruction in anal hygiene should first be given.
- result
Local use of ointment and suppositories follows. If this symptomatic treatment fails, sclerosing injections are recommended.
Schweiz Med Wochenschr · PMID 7423174 · Read it on PubMed ↗
Neiger 1978
[Hemorrhoids: recognition and current therapeutic possibilities]
No evidence reported either way.Narrative reviewVery low quality
size not given1978
the abstract does not report any outcome data for creams or suppositories, only that they are used after hygiene advice and before injection treatment if hygiene fails
- Who was studied
- people with hemorrhoids or anal/rectal complaints seen by a general practitioner
- What they received
- creams or suppositories applied symptomatically
- Compared with
- anal hygiene instruction alone, or other treatments like injections, infrared coagulation, or banding
- Main outcome
- symptom relief and resolution of hemorrhoids
- Quality
- this is a general narrative review describing treatment approaches without presenting any study data or outcomes for creams specifically.
- Limitations
- no numerical data, no comparison groups, no outcome measures reported for cream/suppository treatment; purely descriptive review of management strategies
Taken word for word from the abstract
- intervention
symptomatic application of creams or suppositories
- population
Up to 5% of the patients of a general practitioner have terminal bowel disease, most frequently hemorrhoids.
- comparator
If these symptomatic measures fail, treatment by injections is indicated.
- result
The treatment of hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or suppositories.
- primaryOutcome
The treatment of hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or suppositories.
Schweiz Med Wochenschr · PMID 345437 · Read it on PubMed ↗
Arnold et al. 1976
[Multicenter clinical study of a novel steroid-free preparation in proctology]
Most patients improved, but no control group.Case seriesVery low qualityRelated question
585 people1976
Highly satisfactory results were achieved in 486 patients (83.1%)
- Who was studied
- patients with various anal and rectal (proctological) conditions, including bleeding internal hemorrhoids
- What they received
- Faktu suppositories and ointment (containing Albothyl, a steroid-free acidic compound)
- Compared with
- none reported
- Main outcome
- therapeutic efficacy and tolerance as judged by treating physicians
- Quality
- This was an uncontrolled multicenter observation with no comparison group or randomization, so improvement can't be separated from natural healing or placebo effect.
- Limitations
- No control group, no randomization, outcome based on physician-judged satisfaction rather than objective measures, and population included many different anal conditions beyond hemorrhoids.
Taken word for word from the abstract
- n
585 patients with proctological affections
- population
585 patients with proctological affections
- intervention
Faktu suppositories and ointment (containing the active principle of Albothyl, a condensation product of m-cresolsulfonic acid and formaldehyde)
- comparator
15 physicians investigated the therapeutic efficacy and tolerance of Faktu suppositories and ointment
- primaryOutcome
the therapeutic efficacy and tolerance of Faktu suppositories and ointment
- result
Highly satisfactory results were achieved in 486 patients (83.1%).
Arzneimittelforschung · PMID 132941 · Read it on PubMed ↗
How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.
- Searched
- PubMed · ClinicalTrials.gov · Crossref on 2026-10-05
- The exact search — paste this into PubMed to repeat it
("Hemorrhoids/drug therapy"[Mesh] OR hemorrhoid*[tiab]) AND (cream*[tiab] OR ointment*[tiab] OR topical[tiab] OR "Administration, Topical"[Mesh]) AND (bleeding[tiab] OR shrink*[tiab] OR symptom*[tiab] OR efficacy[tiab] OR "treatment outcome"[Mesh])- PubMed expanded that to:
("hemorrhoids/drug therapy"[MeSH Terms] OR "hemorrhoid*"[Title/Abstract]) AND ("cream*"[Title/Abstract] OR "ointment*"[Title/Abstract] OR "topical"[Title/Abstract] OR "administration, topical"[MeSH Terms]) AND ("bleeding"[Title/Abstract] OR "shrink*"[Title/Abstract] OR "symptom*"[Title/Abstract] OR "efficacy"[Title/Abstract] OR "treatment outcome"[MeSH Terms]) - What came back
- 195 records found · 195 read · 96 answered the question
- Included
- Human, animal or laboratory studies reporting an outcome relevant to the question
- Excluded
- Records about a different condition or intervention
- Records reporting no outcome
- Retracted publications, which are listed but excluded from every count
- Limits
- Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
- Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
- Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.
Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.
- 195records came back from the search
- 195were read
- 96actually answered the question
Why people try thisThe reasoning behind the question — not a claim that it works.
- Creams are sold over the counter, so they feel like an easy first step before seeing a doctor.
- Packaging promises fast relief from itching, pain, and swelling.
- Hemorrhoids feel embarrassing to many people, who prefer a private, do-it-yourself fix.
- Herbal or 'natural' versions feel lower-risk than medication or a doctor's procedure.
Common questionsShort answers, drawn from the same studies.
- Should I stop using hemorrhoid cream?
- You don't have to. No study found serious injury from typical over-the-counter hemorrhoid cream, and some trials found it eased itching, pain, or bleeding for a few weeks. Just don't expect it to shrink hemorrhoids or stop bleeding for good, and see a doctor if bleeding doesn't settle quickly.
- Will hemorrhoid cream make my hemorrhoids go away?
- The studies don't show this clearly. Most trials measured symptom relief, not whether the hemorrhoid itself shrank, and the few that did look at hemorrhoid size gave mixed or low-quality results.
- What worked better than cream in these studies?
- A warm salt-water soak healed more pregnant women's hemorrhoids than cream did, and an injectable clot-dissolving suppository stopped bleeding and shrank hemorrhoids better than a standard hydrocortisone suppository. If bleeding continues, ask a doctor about these or office procedures.
- Is it safe to use hemorrhoid cream during pregnancy?
- Several small studies in pregnant women used topical creams without reporting serious problems, but the quality of this evidence is very low. Check with your obstetrician before starting any cream.
- How long should I try cream before seeing a doctor?
- Studies that found a benefit usually saw it within 1 to 4 weeks. If your symptoms — especially bleeding — haven't improved by then, or if bleeding is new or heavy, see a doctor instead of continuing on your own.
This is information, not advice
This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.
Contact the officeAutomated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.