Haemorrhoids (haemorrhoids), also known as piles, is a common condition that causes rectal symptoms. Today I will review the best haemorrhoids treatment in the UK. I will discuss the best haemorrhoids treatment over the counter in the UK (part one) and prescription-only options to treat piles (part 2).
- What are haemorrhoids?
- Symptoms of haemorrhoids
- Causes and risk factors for haemorrhoids
- How to prevent piles?
- Do I need to see my GP?
- How to treat constipation associated with haemorrhoids?
- What is the recommended treatment of haemorrhoids?
- The best haemorrhoids treatment in the UK
- The best haemorrhoids treatment over the counter the UK (part 1)
- The best haemorrhoids treatment – prescription-only options (part 2)
- What is the best haemorrhoid treatment (UK) in pregnancy?
What are haemorrhoids?
Haemorrhoids are defined as enlarged supportive tissues (vascular mucosal cushions) present along the anal canal. Although haemorrhoids are present in all people, the definition is primarily associated with the unpleasant symptoms caused by swollen vascular mucosal cushions (Sandler & Peery, 2019), which are usually typical supportive structures in the anal canal. Haemorrhoids can prolapse outside the anus (external haemorrhoids) or project inside the anal canal (internal haemorrhoids). Additionally, piles can also be classified according to how far they prolapse from the anus.
Symtoms of haemmorhoids
The most common symptom caused by haemorrhoids is blood connected with bowel movements (Lohsiriwat, 2012). The blood is usually bright red and may be present on the stool’s surface or around the toilet. Other common symptoms may include:
- Itchiness and irritation around the anal area
- Rectal pain and discomfort. The presence of pain during bowel movements may be a symptom of another condition, for example, anal fissure, which is a small tear of the tissue around the anus. Sharp pain is the most common symptom of anal fissure.
- Presence of piles around the anus
It is essential to recognise any ongoing or presence of other symptoms. The above symptoms may be caused by other conditions, including some cancers and anal fissure, which I already briefly mentioned.
Causes and risk factors for haemorrhoids
Certain factors may contribute to the development of haemorrhoids, including (NICE, 2016):
- Prolonged straining
- Heavy lifting
- Pregnancy and childbirth
- Chronic cough
How to prevent piles?
Maintaining a good diet (high in fibre) and drinking plenty of fluids is the main recommendations to minimise the episodes of constipation and possible development of piles. A high fibre diet includes eating fruit and vegetables, whole grain foods (for example, cereal, porridge, oats, pasta). Individuals who fail to increase their fibre from the diet may consider fibre-containing laxatives or other gentle laxatives available over the counter.
When possible, painkillers containing codeine should be avoided. Co-codamol and codeine are some of the most commonly prescribed medication in the UK. Co-codamol is also available over the counter (see over the counter co-codamol and 20 most popular painkillers in the UK).
Do I need to see my GP?
NHS recommends seeing your GP if symptoms do not improve after seven days of self-treatment at home or if individuals get haemorrhoids regularly.
What is the recommended treatment of haemorrhoids?
Management of haemorrhoids includes lifestyle changes (increasing fibre in the diet) and possible use of laxatives (prescribed or over the counter laxatives) to ensure that stools are soft and comfortable to pass and avoidance of straining.
Simple analgesics such as paracetamol can be used to manage the pain. Codeine and co-codamol should be avoided as these can cause constipation. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should not be taken if bleeding is present (NICE, 2021).
How to treat constipation associated with haemorrhoids?
Constipation experienced during an episode of haemorrhoids can be treated with over the counter medicines. Read more about the best laxatives overt the counter in the UK. Bulk-forming laxatives, for example, Fybogel or osmotic laxatives, for example, Lactulose, are suitable as a gentle laxative. Read product information leaflet before use.
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The best haemorrhoids treatment in the UK
The treatment aims to control the main symptoms caused by haemorrhoids, including itchiness and rectal discomfort. Most over the counter haemorrhoids treatments are available off the shelf in pharmacies and supermarkets. Not all pack sizes may be marketed, with some products being restricted to pharmacy-only sales.
The best haemorrhoids treatment UK – over the counter options (part 1)
1. Anusol Soothing Relief Ointment for haemorrhoids
Anusol Soothing Relief Ointment can be called the best haemorrhoid treatment (UK) over the counter. Anusol Soothing Relief Ointment is available over the counter in most supermarkets and pharmacies.
Anusol ointment can also be prescribed. The prescription-only version of Anusol ointment is known as Anusol HC ointment. Anusol HC does not differ from Anusol ointment, which is available over the counter.
Anusol Soothing Relief Ointment aims to control the symptoms of piles by:
- Shrinking haemorrhoids
- Reliving the itchiness
- Reliving discomfort
- Reduction of inflammation
What makes Anusol Soothing Relief Ointment my prefered recommendation is the addition of hydrocortisone in the formulation. Hydrocortisone is a drug classified as a steroid. Steroids are effective in reducing itchiness, local inflammation and swelling.
Other ingredients found in Anusol Soothing Relief Ointment and their role:
- Zinck oxide and bismuth oxide: relieve itchiness.
- Bismuth subgallate: relieve itchiness, have protective and some antiseptic properties.
- Balsam Peru: used as antiseptic and for healing properties.
Anusol Soothing Relief Ointment should be used for a maximum of 7 days.
Can you use Anusol Soothing Relief ointment in pregnancy or breastfeeding?
Anusol Soothing Relief ointment should not be used in pregnancy or breastfeeding.
Where can you buy Anusol Soothing Relief ointment?
Anusol Soothing Relief ointment can be purchased over the counter in most supermarkets, pharmacies and online.
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2. Anusol Soothing Relief Suppositories
Anusol Soothing Relief Suppositories contain the same active ingredients as previously discussed Anusol Soothing Relief Ointment. Anusol suppositories contain a higher amount of active ingredients per suppository than Anusol Soothing Relief Ointment, making them possibly more effective treatment of haemorrhoids. There is some evidence that suggests that suppositories may provide ‘marginally greater’ relief of pain and itchiness than suppositories (study included different brand of suppositories).
Treatment with suppositories, therefore ay be advantages over the treatment with ointment or cream for haemorrhoids.
Can you use Anusol suppositories in pregnancy or breastfeeding?
Anusol Soothing Relief Suppositories should not be used in pregnancy or breastfeeding.
Where can you buy Anusol Soothing suppositories?
Anusol Soothing suppositories are usually available behind the pharmacy counter.
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3. Germoloids Hemorrhoid Treatment & Piles Treatment Ointment
Germoloids ointment for haemorrhoids is another popular option for the treatment of piles. Germoloids ointment is advertised as a triple-action product, which reliefs Itchiness and pain associated with haemorrhoids. Additionally, it protects and lubricates the area.
Two main active ingredients found in Germoloids ointment are zinc oxide and lidocaine.
- Lidocaine is classified as a local anaesthetic, which helps with the pain and reliefs itchiness.
- Zinc Oxide: is used for its anti-itch properties.
Can you use Germoloids Hemorrhoid ointment in pregnancy or breastfeeding?
Germoloids Hemorrhoid ointment is not contra-indicated in pregnancy or breastfeeding. However, the manufacturer of the product advices to speak to the doctor before using this ointment.
Where can you buy Germoloids ointment?
Germoloids ointment can be purchased over the counter in pharmacies, supermarkets and online.
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Germoloids ointment can be used for the treatment of external and internal piles. Although very popular, the lack of steroid in the formulation of Germoloid ointment put this product behind Anusol ointment or suppositories.
4. Germoloids HC Spray
Germoloids HC spray contains two active ingredients, hydrocortisone and lidocaine. Germoloids HC spray offers a formulation alternative to previously discussed ointments or suppositories.
The role of both active ingredients was discussed in previous products.
- Hydrocortisone (steroid) helps with itchiness, reduces inflammation.
- Lidocaine (a local anaesthetic) relieve pain and also helps to control itchiness.
Spray formulation may ease the application for some individuals. The main question (which I cannot answer) is how much of the active ingredient can be delivered from the droplets expelled from the spray?
Where can you buy Germoloids HC spray for the treatment of haemorrhoids?
As with all other products discussed so far, Germoloids HC is a general sale item, which means it can be purchased over the counter in supermarket and pharmacies. Some pharmacies or supermarkets may restrict the sale of this item from behind the pharmacy counter.
5. Germoloids Hemorrhoid Treatment suppositories
Germoloids suppositories represent the same combination of active ingredients as Germoloid ointments. Germoloids suppositories for haemorrhoids can be used on their own or in combination with the ointment.
Can you use Germoloids Hemorrhoid Treatment suppositories in pregnancy or breastfeeding?
The same advice applies to the use of Germoloids Hemorrhoid Treatment suppositories. Medical advice from a doctor should be sought before using Germoloids Hemorrhoid Treatment suppositories in pregnancy.
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6. Preparation H Clear Gel for haemorrhoids
Preparation H comes in the form of a gel, which is advertised as a cooling product. Additionally, as with previous products, Preparation H aims to moisture and soothe the skin.
Preparation H contains ‘natural ingredients’, of which Witch hazel is most known.
Can you use Preparation H in pregnancy or breastfeeding?
Preparation H can be used in pregnancy and breastfeeding.
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7. AnuSol wipes
It is worth recommending soothing and cleansing wipes for the symptomatic management of piles. AnuSol wipes combine different ingredients such as Witch Hazel, Aloe Vera, and chamomile, aiming to provide gentle care of the affected area.
AnuSol wipes can be used with other AnuSol product during the treatment of haemorrhoids.
Can you use AnuSol wipes in pregnancy or breastfeeding?
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The best haemorrhoids treatment UK – prescription-only options (part 2)
Prescription-only treatment of haemorrhoid usually involves the use of ointments or suppositories or a combination of both products. The main active ingredients found in combination products are local anaesthetics (for example, lidocaine, benzocaine, cinchocaine or pramocaine)
8. Anusol HC suppositories and Anusol Plus HC Ointment
Both Anusol HC suppositories and HC Ointment are the same medicines as previously discussed over the counter Anusol Soothing Relief products. Both contain the same amounts of active ingredients, which are no different from one another.
9. Proctosedyl suppositories and ointment
Proctosedyl Contains two active ingredients cinchocaine (a local anaesthetic) and hydrocortisone (steroid). Each suppository/1g of ointment contains 5mg of hydrocortisone and 5mg of cinchocaine.
A similar combination of drugs is included in over the counter Germoloids HC Spray, which also has hydrocortisone as the main ingredient, but with a different local anaesthetic (lidocaine) and significantly lower amounts of both drugs.
10. Scheriproct suppositories and ointment
Both prescription-only Scheriproct suppositories and ointment contain cinchocaine and a steroid drug called prednisolone. There is a slight difference in terms of quantitive composition (the amount of active ingredients) of both products.
What is the best haemorrhoid treatment (UK) in pregnancy?
None of the topical medicated products listed above is licensed as a treatment of haemorrhoids in the pregnancy. Doctors can prescribe medicines off their license. Products that reduce irritation and soothe the area are usually prefered to treat haemorrhoids in the pregnancy. Local anaesthetics and steroids should preferably be avoided.
What is the best haemorrhoid treatment in the UK?
Most over the counter preparations contain the same/very similar active ingredients. No evidence suggests that one product is better than the other.
Topical ointments or gels are usually recommended to treat external haemorrhoids, whereas suppositories for internal haemorrhoids.
Products containing astringent agents, such as zinc oxide, may help to manage irritation; however, they can cause skin sensitisation.
The local aesthetic can also cause sensitisation of the anal skin, but they may help manage pain, itching, and irritation.
Products containing steroids may help to reduce pain and inflammation. Products containing steroid should not be used for longer than seven days (unless advised otherwise by a doctor). They may cause adverse side effect s on the skin, for example, skin atrophy and dermatitis.
Lohsiriwat V. (2012) Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-2017. doi:10.3748/wjg.v18.i17.2009 Available at: https://dx.doi.org/10.3748%2Fwjg.v18.i17.2009 Accessed on 18/02/2021
NICE (2016). Haemorrhoids. Available at: https://cks.nice.org.uk/topics/haemorrhoids/ Accessed on 20/02/2021
NICE (2021). Haemorrhoids. Available at: Accessed on 20/02/2021
Sandler RS, Peery AF (2019). Rethinking What We Know About Hemorrhoids. Clin Gastroenterol Hepatol. 2019;17(1):8-15. doi:10.1016/j.cgh.2018.03.020 Available at: https://dx.doi.org/10.1016%2Fj.cgh.2018.03.020 Accessed on 19/02/2021