Preparation H contains a mix of protectants that coat irritated tissue and active drugs that reduce swelling and numb pain. The exact formula depends on which version you pick, since the brand sells ointments, creams, gels, suppositories, and medicated wipes, each with a slightly different ingredient list. Here’s what’s in each one and what those ingredients actually do.
The Standard Ointment
The original Preparation H ointment is mostly protectants. Petrolatum makes up 71.9% of the formula, mineral oil adds another 14%, and shark liver oil contributes 3%. Together, these create a thick, greasy barrier over inflamed skin. That coating shields the tissue from further irritation, especially during bowel movements, and helps lock in moisture so the area can heal.
The only drug in the ointment is phenylephrine HCl at 0.25%. Phenylephrine works by tightening blood vessels in the tissue it touches. Hemorrhoids are essentially swollen blood vessels, so when phenylephrine constricts them, the swelling temporarily goes down. It’s the same compound used in nasal decongestant sprays for the same basic reason: shrink swollen tissue by narrowing blood vessels.
The Cream Formula
The cream version swaps out some of those heavy protectants for a lighter base and adds ingredients the ointment doesn’t have. Its active ingredients are glycerin (14.4%) and white petrolatum (15%) as protectants, phenylephrine HCl (0.25%) to reduce swelling, and pramoxine HCl (1%) as a local anesthetic. Pramoxine is the key addition here. It numbs the skin on contact, which helps with the itching and stinging that hemorrhoids cause. If pain relief is your priority, the cream offers more than the basic ointment.
Rapid Relief and Maximum Strength
For the strongest numbing effect, the Rapid Relief cream contains lidocaine at 5%, a significantly more potent anesthetic than pramoxine. It also includes glycerin and petrolatum as protectants and phenylephrine at 0.25% for swelling. Lidocaine blocks nerve signals in the tissue it touches, which can make a noticeable difference if you’re dealing with sharp or throbbing pain. This is the formula to look for if over-the-counter pain relief is the main goal.
Cooling Gel
The gel version takes a different approach. Its two active ingredients are phenylephrine HCl (0.25%) and witch hazel (50%). Witch hazel is a plant-based astringent, meaning it tightens and dries tissue. At 50% concentration, it does most of the work in this formula, providing a cooling sensation while helping reduce minor swelling and irritation. The gel base absorbs quickly and doesn’t leave the greasy residue that the ointment does.
Medicated Wipes
The wipes are the simplest product in the lineup. Their only active ingredient is witch hazel at 50%. The inactive ingredients include aloe vera juice, glycerin, and purified water. These are designed for gentle cleanup rather than heavy-duty treatment. They work well as a less irritating alternative to dry toilet paper, and the witch hazel provides mild soothing and astringent effects.
Suppositories
The suppository form is designed for internal hemorrhoids. It contains cocoa butter at 88.44%, which serves as both the base that holds the suppository together and the protectant that coats internal tissue. The remaining active ingredient is phenylephrine HCl at 0.25%. Once inserted, the cocoa butter melts at body temperature, spreading the phenylephrine across the affected area and leaving a protective layer over inflamed tissue.
How Each Ingredient Works
- Phenylephrine HCl (0.25%): Constricts blood vessels to temporarily reduce swelling. Present in every Preparation H product except the wipes.
- Petrolatum / mineral oil / cocoa butter / glycerin: Protectants that form a physical barrier over irritated skin, reducing friction and contact with stool or moisture.
- Shark liver oil (3%): An additional protectant found only in the original ointment. It coats tissue in a similar way to petrolatum.
- Pramoxine HCl (1%): A mild topical anesthetic in the standard cream that numbs itching and surface pain.
- Lidocaine (5%): A stronger anesthetic in the Rapid Relief formula for more significant pain.
- Witch hazel (50%): A plant-based astringent in the gel and wipes that cools, tightens, and mildly dries swollen tissue.
Precautions Worth Knowing
Because phenylephrine constricts blood vessels, it can raise blood pressure in small amounts. The product label warns people with heart disease or high blood pressure to check with a doctor before using it. The same applies if you take prescription medication for blood pressure or depression, since phenylephrine can interact with those drugs.
Any Preparation H product can be applied up to four times daily, typically in the morning, at night, and after bowel movements. If your symptoms haven’t improved within seven days, that’s the signal to stop and get a medical evaluation. Hemorrhoids that don’t respond to over-the-counter treatment may need a different approach.