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RankingsWhat is the best treatment for piles?
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Hemorrhoids are one of those conditions most people would rather not talk about, yet roughly half of all adults over 50 will experience them at some point, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The swollen veins in and around the anus and lower rectum cause itching, pain, bleeding and general discomfort that can make sitting, walking and using the bathroom genuinely miserable.
The good news is that most mild to moderate hemorrhoids respond well to over-the-counter treatments. The less helpful news is that the drugstore aisle offers a confusing spread of creams, ointments, pads, suppositories and fiber supplements, each claiming to be the answer. Formulas range from vasoconstrictors that reduce swelling to local anesthetics that numb pain, with protectants, astringents and anti-itch agents somewhere in between.
We looked at the most widely available OTC hemorrhoid treatments in the US, verified every drug-facts label, read hundreds of buyer reviews, and scored each product on ingredients, ease of use, value and real-world feedback. Below, we explain how the main active ingredients work, what the evidence actually shows, and which seven products scored highest across different formats and needs.
Preparation H Maximum Strength Cream is the most complete OTC hemorrhoid treatment, combining four active ingredients in a single tube.
Our top pick is Preparation H – Maximum Strength Cream, a multi-action formula with a vasoconstrictor, a local anesthetic, and two protectants. For stronger numbing, consider RectiCare – Anorectal Cream with 5% lidocaine.
How to choose a treatment for piles
Know your active ingredients
OTC hemorrhoid treatments contain different categories of active ingredient, and understanding what each one does helps you pick the right product for your symptoms. The FDA’s anorectal drug monograph recognizes several classes:
- Vasoconstrictors (phenylephrine HCl 0.25%) temporarily shrink swollen tissue by constricting blood vessels. This reduces the feeling of fullness and pressure. They are found in Preparation H formulas.
- Local anesthetics (lidocaine, pramoxine HCl) numb the area to reduce pain and itching. Pramoxine at 1% is standard in many creams; lidocaine ranges from 4% to 5% in stronger formulas like Doctor Butler’s and RectiCare.
- Astringents (witch hazel, zinc oxide) create a protective barrier and have a mild drying effect that can reduce irritation. Witch hazel is the active ingredient in medicated pads like Tucks.
- Protectants (petrolatum, glycerin, lanolin) coat the skin to prevent further irritation from moisture and friction. Most ointments and creams include at least one protectant.
- Hydrocortisone (up to 1% OTC) reduces inflammation and itching. It should not be used for longer than 7 days without medical advice, as prolonged use can thin the skin.
Cream, ointment, pad or suppository?
The format matters as much as the formula. Creams absorb quickly and are less greasy, making them comfortable for daytime use. Ointments are thicker and stay in place longer, which suits overnight application. Medicated pads provide gentle cleansing and soothing after a bowel movement. Suppositories deliver active ingredients directly to internal hemorrhoids where topical products cannot reach. Many people find that combining formats, such as pads for cleaning and a cream for symptom relief, gives the best results.
Do not overlook fiber
A 2006 meta-analysis in the American Journal of Gastroenterology (Alonso-Coello et al.) pooled seven randomized controlled trials with 378 patients and found that fiber supplements reduced bleeding by 50% (RR 0.50, 95% CI 0.28-0.89) and persistent symptoms by 47% (RR 0.53, 95% CI 0.38-0.73). Both the American Academy of Family Physicians and the American Gastroenterological Association recommend fiber as a first-line treatment. A fiber supplement will not numb pain or shrink a swollen vein overnight, but it addresses the root cause of most hemorrhoids: hard stools and straining.
Most gastroenterologists recommend combining a fiber supplement with a topical treatment. The fiber softens stools and reduces straining over the longer term, while the cream or ointment manages acute symptoms like pain and swelling. Neither one alone does the full job.
How we scored
We evaluated each product on four criteria, weighted to reflect what matters most when choosing an OTC hemorrhoid treatment. Every specification was verified against the product’s drug-facts label, and every buyer quote comes from a named review platform.
- Ingredients (35%) – What active ingredients does the formula contain, and how well do they cover the main symptoms (pain, itching, swelling, skin protection)? Are the inactive ingredients reasonable?
- Texture and ease of use (25%) – Is the product comfortable to apply? Does the packaging include an applicator or finger cots? Is the dosing schedule practical for daily life?
- Value (20%) – How much product do you get per tube or pack? How does it compare to competitors on a per-application basis?
- Buyer feedback (20%) – What do verified buyers say on Amazon, Walmart and other platforms, weighted toward comments about hemorrhoid-specific symptom relief?
Scores run from 0 to 10, rounded to one decimal place, and decrease strictly from our top pick to our seventh. Full methodology: how we rank products.
Our ranking at a glance
| Rank | Product | Key active | Score | |
|---|---|---|---|---|
| #1Best overall | Preparation H - Maximum Strength Cream | Cream Phenylephrine 0.25% + Pramoxine 1% + Glycerin 14.4% + Petrolatum 15% | 8.8/10 | Check price |
| #2Best for pain & fissures | Doctor Butler's - Hemorrhoid & Fissure Ointment | Ointment Lidocaine 4% + Zinc oxide 5% + Glycerin 37.5% + Lanolin 12.5% | 8.5/10 | Check price |
| #3Strongest OTC numbing | RectiCare - Anorectal Cream | Cream Lidocaine 5% | 8.2/10 | Check price |
| #4Best medicated pads | Tucks - Medicated Cooling Pads | Medicated pad Witch hazel 50% | 8.0/10 | Check price |
| #5Best suppository | Preparation H - Suppositories | Suppository Phenylephrine 0.25% | 7.7/10 | Check price |
| #6Best fiber supplement | Metamucil - Psyllium Fiber Supplement | Powder Psyllium husk (3.4 g per serving) | 7.4/10 | Check price |
| #7Best budget option | Ma Ying Long - Musk Hemorrhoids Ointment | Ointment Zinc oxide + Petrolatum 78.5% | 7.1/10 | Check price |
Our picks reviewed
Preparation H - Maximum Strength Cream
Four active ingredients in one tube, covering vasoconstriction, local anesthesia, and dual skin protection.
- ActiveGlycerin 14.4%, Phenylephrine HCl 0.25%, Pramoxine HCl 1%, White petrolatum 15%
- Formatcream with applicator tip
- Size1.8 oz (51 g)
- Useup to 4 times daily or after each bowel movement
- you want the most complete multi-symptom OTC formula
- you deal with both pain and swelling and prefer a single product
- you are sensitive to phenylephrine or have high blood pressure (consult your doctor)
- you need something for internal hemorrhoids only (a suppository may be better)
Preparation H Maximum Strength Cream is the most comprehensive OTC hemorrhoid formula on the US market. It combines a vasoconstrictor (phenylephrine HCl 0.25%) to reduce swelling, a local anesthetic (pramoxine HCl 1%) to numb pain and itching, and two protectants (glycerin 14.4% and white petrolatum 15%) to shield irritated skin. Few competitors pack all four categories into a single tube.
On Amazon, verified buyers rate it 4.6 out of 5 across more than 40,000 ratings. On Walmart, it holds a 4.7 out of 5 from nearly 5,500 reviews. "Works well for relief" (Pam, Walmart) sums up the general sentiment. The cream consistency absorbs reasonably quickly without leaving a heavy residue, though it is greasier than a lotion. The main limitation is that phenylephrine is a vasoconstrictor, and people with certain cardiovascular conditions should check with a doctor before using it. This is noted on the drug-facts label.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Doctor Butler's - Hemorrhoid & Fissure Ointment
A 4% lidocaine ointment with zinc oxide and botanical extracts, formulated for both hemorrhoids and anal fissures.
- ActiveGlycerin 37.5%, Lanolin 12.5%, Lidocaine 4%, Zinc oxide 5%
- Notable inactivehorse chestnut extract, calendula, chamomile, turmeric, hydrocortisone
- Formatointment
- Size2 oz (56 g)
- Useup to 6 times daily
- you have both hemorrhoids and a fissure and want one product for both
- you need strong numbing from lidocaine rather than pramoxine
- you prefer a lighter cream consistency over a thick ointment
- you want to avoid lanolin (present in the formula)
Doctor Butler's is formulated by a proctologist and targets both hemorrhoids and anal fissures, which often occur together. The 4% lidocaine provides stronger numbing than the 1% pramoxine found in Preparation H, while zinc oxide (5%) acts as an astringent and skin protectant. The formula also includes glycerin (37.5%) and lanolin (12.5%) as additional protectants.
What sets this product apart is its blend of botanical inactive ingredients: horse chestnut extract, calendula, chamomile and turmeric, alongside a small amount of hydrocortisone. On Walmart, one buyer wrote "Numb that bum so you can heal" (Samantha, Walmart), while another noted it "relieved pain in no time!" (Debi, Walmart). The ointment consistency is thicker than a cream, which helps it stay in place but can feel heavy. The smaller review base compared to Preparation H keeps it in second position, but for anyone dealing with fissure-related pain alongside hemorrhoids, it is a strong choice.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
RectiCare - Anorectal Cream
The highest lidocaine concentration available without a prescription, at 5%, with finger cots included for hygienic application.
- ActiveLidocaine 5%
- Notable inactivebenzyl alcohol, carbomer 940, cholesterol, isopropyl myristate, lecithin
- Formatcream with finger cots
- Size1.5 oz (42.5 g)
- Useup to 6 times daily
- you need the strongest OTC numbing available for severe pain
- you want a cream that includes applicator finger cots for hygienic use
- you need a product that also reduces swelling (this contains no vasoconstrictor)
- you are allergic to lidocaine or other amide-type anesthetics
RectiCare delivers 5% lidocaine, the maximum concentration allowed in an OTC anorectal product. For people whose primary concern is pain rather than swelling or bleeding, that single-minded focus on numbing is its biggest strength. The formula is a cream rather than an ointment, so it absorbs quickly and feels lighter on the skin.
The packaging includes disposable finger cots, a practical touch that makes application more hygienic and comfortable. The inactive ingredient list is short and clinical: benzyl alcohol, carbomer 940, cholesterol, lecithin and a few others. Because the formula contains only lidocaine as the active ingredient, it does not address swelling or provide the multi-symptom coverage of Preparation H. Think of RectiCare as a targeted tool for pain management rather than an all-in-one solution. For anyone recovering from a procedure or dealing with an acute flare-up where pain is the dominant symptom, it fills a gap that milder formulas do not.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Tucks - Medicated Cooling Pads
Witch hazel-soaked pads that clean and soothe after a bowel movement, with a 4.8-star average on Walmart.
- ActiveWitch hazel 50%
- Formatpre-soaked medicated pad
- Pack100 pads per tub
- Useup to 6 times daily or after each bowel movement
- you want a gentle cleansing pad to use after bowel movements
- you prefer a non-greasy, mess-free format
- you need strong pain relief (witch hazel is mild)
- you need treatment for internal hemorrhoids
Tucks pads are soaked in 50% witch hazel, a natural astringent recognized by the FDA for temporary relief of anorectal itching and irritation. They are not designed to numb pain or shrink swollen tissue. What they do well is provide gentle cleansing and a cooling sensation after a bowel movement, when the area is most irritated. Many people use them as a complement to a cream or ointment rather than a standalone treatment.
On Walmart, Tucks holds a 4.8 out of 5 from more than 2,800 ratings. One buyer wrote "They work exceptionally well" (Christopher, Walmart), and another called them "Perfect for postpartum care" (Makala, Walmart). The 100-pad tub is good value and lasts several weeks at typical use. The main limitation is that witch hazel provides mild symptom relief at best. For anyone with moderate to severe pain, a cream with lidocaine or pramoxine will do more. But as a daily comfort product for mild hemorrhoids or as part of a treatment routine, Tucks is hard to fault.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Preparation H - Suppositories
Delivers phenylephrine directly to internal hemorrhoids via a cocoa-butter base that melts at body temperature.
- ActivePhenylephrine HCl 0.25%
- Inactivecocoa butter, corn starch, methylparaben, propylparaben
- Formatsuppository
- Pack24 or 48 count
- Useup to 4 times daily or after each bowel movement
- you have internal hemorrhoids that topical creams cannot reach
- you want a vasoconstrictor delivered directly to the affected area
- you are uncomfortable with the suppository format
- you need strong pain relief (this does not contain a local anesthetic)
Topical creams and ointments work well on external hemorrhoids, but they cannot easily reach internal hemorrhoids inside the rectal canal. That is where suppositories fill a gap. Preparation H Suppositories contain phenylephrine HCl 0.25% in a cocoa-butter base that melts at body temperature, delivering the vasoconstrictor directly where it is needed.
On Walmart, verified buyers rate these 4.5 out of 5 from 183 ratings. One reviewer described them as "Always works great!" (Sid, Walmart), and another found them "quite soothing" (Niki9, Walmart). The format is less convenient than a cream, and some people find suppositories uncomfortable to use. The formula also lacks a local anesthetic, so it addresses swelling more than pain. For people whose main issue is internal pressure and swelling rather than external soreness, these are a practical option that complements a topical product used on the outside.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Metamucil - Psyllium Fiber Supplement
Backed by the strongest clinical evidence on this list: a meta-analysis showed fiber reduces hemorrhoid bleeding by 50%.
- ActivePsyllium husk (3.4 g per serving)
- Formatpowder (mix with water) or capsule
- Use1-3 servings daily, with at least 240 ml of liquid per serving
- EvidenceAlonso-Coello et al. (2006), 7 RCTs, 378 patients
- you want to address the root cause of hemorrhoids (hard stools and straining)
- you are looking for a long-term strategy rather than quick symptom relief
- you need immediate pain or itch relief (fiber works over days to weeks)
- you dislike mixing powder drinks or prefer not to take a daily supplement
Metamucil is not a hemorrhoid cream, and it will not numb pain or reduce swelling overnight. What it does is tackle the underlying cause of most hemorrhoids: constipation and straining. Psyllium husk is a soluble fiber that absorbs water in the gut, forming a soft gel that makes stools easier to pass. Less straining means less pressure on the veins around the anus.
The clinical evidence for fiber and hemorrhoids is stronger than for any topical OTC treatment. A 2006 meta-analysis (Alonso-Coello et al., American Journal of Gastroenterology) pooled seven randomized controlled trials with 378 patients. Bleeding was reduced by 50% (RR 0.50, 95% CI 0.28-0.89) and persistent symptoms by 47% (RR 0.53, 95% CI 0.38-0.73). The AAFP and the American Gastroenterological Association both recommend fiber as first-line treatment. On Drugs.com, Metamucil for hemorrhoids holds a 7.3 out of 10 from 101 reviews. The texture and taste of the powder format put some people off, but capsule versions are available for those who prefer them.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Ma Ying Long - Musk Hemorrhoids Ointment
A traditional Chinese medicine formula with zinc oxide, petrolatum and distinctive herbal ingredients, available in multi-packs.
- ActiveZinc oxide, Petrolatum 78.5%
- Inactivemusk ketone, pearl, borneol, sodium borate, lanolin
- Formatointment
- Size10 g per tube (often sold in 3-packs)
- Useapply externally 1-2 times daily
- you want a budget-friendly option and do not mind a smaller tube
- you are interested in a traditional formula alongside conventional active ingredients
- you need strong pain relief (this has no local anesthetic)
- you prefer a well-known US brand with a large review base
Ma Ying Long is a traditional Chinese medicine hemorrhoid ointment that has been manufactured in China for decades and has built a dedicated following in the US, particularly online. The FDA-recognized active ingredients are zinc oxide (an astringent and skin protectant) and petrolatum at 78.5% (a protectant). The inactive ingredients are more unusual: musk ketone, pearl, borneol, sodium borate and lanolin, reflecting its traditional formulation.
The tubes are small (10 g each, roughly the size of a lip balm), but the product is typically sold in 3-packs that bring the per-tube cost down. On Walmart, the 3-pack holds a 4.3 out of 5 from 24 reviews. The ointment has a distinctive herbal scent that some reviewers find strong. The review base is much smaller than Preparation H, and the formula lacks any local anesthetic or vasoconstrictor. It is best suited as a budget-friendly protectant for mild symptoms, not as a primary treatment for significant pain or swelling.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
When to see a doctor
OTC treatments work well for mild to moderate external hemorrhoids, but they have limits. Some situations call for medical evaluation rather than another tube of cream.
Rectal bleeding does not stop after a week of home treatment, or you see blood in the toilet for the first time. Pain is severe enough to interfere with daily activities, sitting or sleeping. A hard, painful lump near the anus does not improve after several days (this may be a thrombosed hemorrhoid that needs medical attention). Symptoms return frequently despite dietary changes and OTC treatment. You are over 50 and have not had a recent colorectal screening, or you have a family history of colorectal cancer. You have used hydrocortisone-containing products for more than 7 consecutive days.
Rectal bleeding has many possible causes, and hemorrhoids are only one of them. The NIDDK notes that a doctor should evaluate rectal bleeding to rule out more serious conditions, including colorectal polyps or cancer. This is especially important for people over 45, which is when the US Preventive Services Task Force recommends beginning routine screening.
For hemorrhoids that do not respond to OTC treatment, a doctor may recommend office-based procedures such as rubber band ligation, infrared coagulation or sclerotherapy. These are typically quick, performed in a clinic, and effective for grade II-III internal hemorrhoids. Surgery (hemorrhoidectomy) is reserved for the most severe cases.
Common questions about hemorrhoid treatments
What is the fastest way to get rid of hemorrhoids
There is no overnight cure. OTC creams and ointments with a local anesthetic (lidocaine or pramoxine) can reduce pain within minutes of application. Reducing swelling typically takes several days of consistent treatment. Adding a fiber supplement and plenty of water softens stools and reduces straining, which helps hemorrhoids heal. The NIDDK recommends warm sitz baths (sitting in a few inches of warm water for 10-15 minutes, 2-3 times daily) as an additional comfort measure.
Can I use hemorrhoid cream and suppositories at the same time
Yes, many people use both. A cream or ointment treats external hemorrhoids on the outside, while a suppository delivers active ingredients to internal hemorrhoids inside the rectal canal. Check the drug-facts labels to make sure you are not exceeding the maximum daily applications for any single active ingredient, particularly phenylephrine.
How long should I use OTC hemorrhoid treatments
Most OTC anorectal products recommend use for no longer than 7 consecutive days without consulting a doctor. Products containing hydrocortisone carry a stricter 7-day limit because prolonged use can thin the skin. If your symptoms persist beyond a week, see your doctor rather than continuing to self-treat.
Is fiber really helpful for hemorrhoids
Yes, and the evidence is strong. A 2006 meta-analysis of seven RCTs found that fiber supplements reduced hemorrhoid bleeding by 50% and persistent symptoms by 47%. Psyllium (the type in Metamucil) is the best-studied fiber for this purpose. The AAFP recommends fiber as first-line treatment for symptomatic hemorrhoids.
What is the difference between hemorrhoids and piles
They are the same condition. "Piles" is the informal term, used more commonly in British English, while "hemorrhoids" is the medical term used in American English and clinical settings. Both refer to swollen veins in and around the anus and lower rectum.
The bottom line
Most hemorrhoids improve with a combination of the right OTC product and basic lifestyle changes: more fiber, more water, less straining. Preparation H Maximum Strength Cream remains the most complete multi-symptom formula on the US market, covering swelling, pain, itching and skin protection in a single tube. For anyone dealing with fissures alongside hemorrhoids, Doctor Butler’s lidocaine-based ointment is purpose-built for that overlap. And a daily fiber supplement like Metamucil, while less glamorous than a cream, has the strongest clinical evidence of anything on this list.
If symptoms persist beyond a week of OTC treatment, or if you notice rectal bleeding for the first time, see your doctor. Hemorrhoids are common and treatable, but the symptoms overlap with conditions that need professional evaluation.
Preparation H - Maximum Strength Cream
- Four active ingredients: vasoconstrictor, anesthetic, and dual protectants
- 4.6/5 across 40,000+ ratings on Amazon
- The most widely available hemorrhoid cream in the US
Independent guides to natural remedies and supplements, checked against NHS and EFSA references.