1.7.1 Soothing haemorrhoidal preparations


Choice	Drug	Dosage
Encourage self-care with OTC products as appropriate			Encourage self-care with OTC products as appropriate	Encourage self-care with OTC products as appropriate
1st choice	Anusol® cream, ointment or suppositories	Doses: Anusol® cream or ointment: apply to the affected area at night, in the morning and after defaecation until the condition is controlled. For internal conditions, use rectal nozzle provided Anusol® suppositories: insert one suppository at night, in the morning and after defaecation
2nd choice	Xyloproct® ointment (contains lidocaine 5%)	Dose: Apply several times daily when necessary; short-term use only

Topical haemorrhoidal products are widely used despite lacking evidence. There are some reported benefits to their use and the general opinion is that they may provide short-term symptomatic relief.
Local anaesthetic ointments can be absorbed through the rectal mucosa therefore excessive application should be avoided.
Preparations containing local anaesthetics should be used for short periods only (no longer than a few days) since they may cause sensitisation of the anal skin.
Patients with pruritus ani (itching around the anal canal)/excoriation should avoid applying creams and ointments where possible as this often causes additional irritation. They should be advised to reduce their caffeine intake, clean with water and avoid soaps/wipes/baby wipes and excessive rubbing with toilet paper. If this fails they can be prescribed Perinal^® spray (hydrocortisone with lidocaine) on a when required basis.