What Painkillers Can I Take for Hemorrhoids?

Most hemorrhoid pain responds well to a combination of over-the-counter oral painkillers and topical treatments you can pick up at any pharmacy. Ibuprofen and acetaminophen are the go-to oral options, while topical creams and ointments containing local anesthetics like lidocaine provide direct relief at the site. But the best approach depends on whether you’re dealing with a mild flare-up, a thrombosed external hemorrhoid, or post-surgical pain, and certain medications that seem obvious choices can actually make hemorrhoid symptoms worse.

Over-the-Counter Oral Painkillers

For most people with hemorrhoid pain, the first step is a standard anti-inflammatory painkiller like ibuprofen or naproxen. These work on two fronts: they reduce pain and they tamp down the swelling that causes much of the discomfort in the first place. Acetaminophen (paracetamol outside the US) is another option that handles pain but does not reduce inflammation, so it is less ideal as a standalone choice for swollen hemorrhoids.

The one oral painkiller you should think twice about is aspirin. While it does reduce pain and inflammation, aspirin thins the blood and can increase hemorrhoid bleeding. If your hemorrhoids are already bleeding, aspirin can turn a minor nuisance into something that stains your clothes and alarms you in the bathroom. The same caution applies to prescription blood thinners like clopidogrel, though those are not something you would stop on your own. A case report described a patient on both aspirin and clopidogrel who presented with bleeding hemorrhoids severe enough to require emergency laser treatment, precisely because stopping the medications was not an option given the patient’s cardiac history.¹

Opioid painkillers like codeine or oxycodone are generally a poor fit for hemorrhoid pain, even though they are potent. The reason is simple: opioids cause constipation. Hard stools and straining are exactly what made your hemorrhoids angry in the first place, so taking a painkiller that worsens the underlying problem creates a vicious cycle. Opioids are sometimes used briefly after hemorrhoid surgery under close supervision, but for everyday hemorrhoid flares they cause more trouble than they solve.

Topical Treatments That Work Directly on the Pain

Topical products are often more effective than oral painkillers for hemorrhoid pain because they deliver the active ingredient right where it hurts. The pharmacy shelf is full of options, and they are not all the same.

Lidocaine-based products are among the most effective topical choices. Lidocaine is a local anesthetic that numbs the tissue on contact. A multicenter trial found that a combination ointment containing lidocaine provided better pain control than an active control at six hours after hemorrhoid surgery and again at day seven.² You can find lidocaine in various over-the-counter hemorrhoid creams and ointments, though concentrations vary. Prescription-strength formulations contain higher concentrations.

Beyond anesthetics, many over-the-counter hemorrhoid products contain hydrocortisone, a mild steroid that reduces itching and swelling. These work well for short-term flares but should not be used for more than about a week at a time, as prolonged use of topical steroids can thin the skin in the anal area, which creates new problems. Other common ingredients include witch hazel (an astringent that can soothe irritation), zinc oxide (which forms a protective barrier), and phenylephrine (a vasoconstrictor that temporarily shrinks swollen tissue).

The choice between ointment and suppository is partly about location. External hemorrhoids sit outside or at the edge of the anal opening, so a cream or ointment applied with a finger works well. Internal hemorrhoids, which sit inside the rectum, are harder to reach with a surface cream, so suppositories can deliver medication deeper. A prospective observational study of sucralfate-based products found that both ointment and suppository forms significantly improved hemorrhoid symptoms, and about four out of five patients in each group reported satisfaction with the application method.³

Prescription Topical Options

When over-the-counter products are not cutting it, doctors sometimes prescribe topical medications that work by a different mechanism: relaxing the tight muscle around the anus. When hemorrhoids flare, the internal anal sphincter often goes into spasm, which increases pressure and pain. Two prescription options target this directly.

Nitroglycerin ointment (glyceryl trinitrate) relaxes smooth muscle and improves blood flow to the area. A study of patients who applied topical nitroglycerin for anal pain reported dramatic relief following application.⁴ A randomized controlled trial specifically looking at post-hemorrhoid-surgery pain found that topical glyceryl trinitrate ointment was effective at relieving pain and reducing the elevated resting pressure of the anal sphincter.⁵ The main side effect is headache, which makes sense given that the same drug is used to dilate blood vessels in heart patients.

Nifedipine ointment is another option that works by relaxing smooth muscle through a different pathway. It is a calcium channel blocker rather than a nitrate, and it tends to cause fewer headaches than nitroglycerin. Neither of these is available over the counter; they require a prescription and are most commonly used after hemorrhoid procedures or for particularly painful flares.

Flavonoid Supplements

One category of oral treatment that often surprises people is flavonoid supplements. These plant-derived compounds, sold under brand names in many countries, work by strengthening blood vessel walls and reducing inflammation in the hemorrhoidal tissue. They are not painkillers in the traditional sense, but they reduce the underlying process that causes the pain.

A randomized, triple-blind controlled trial of a flavonoid mixture (containing diosmin, troxerutin, and hesperidin) found that pain, bleeding, and the proportion of patients with persistent swelling and blood clots all decreased significantly after 12 days of treatment.⁶ A broader review of micronized purified flavonoid fraction (MPFF) confirmed that it can reduce multiple hemorrhoid symptoms including bleeding, pain, and anal discomfort in acute flares.⁷

Flavonoids are available without a prescription in most countries, though they are categorized differently depending on where you live. In some places they are sold as supplements, in others as over-the-counter medications. They are generally well tolerated and can be combined with standard painkillers. Evidence also supports their use after hemorrhoid surgery: a systematic review noted that combining flavonoids with oral metronidazole (an antibiotic) produced greater pain reduction after hemorrhoidectomy than either medication alone.⁸

Ice, Warm Water, and Other Non-Drug Approaches

Not all pain relief comes from a bottle. Sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes, have been a standard recommendation for hemorrhoid pain for decades. The warm water relaxes the sphincter muscles and improves blood flow, which can ease throbbing and discomfort. Most people find it soothing, and it costs nothing beyond the water.

Ice therapy is the less traditional option, but a head-to-head comparison after hemorrhoid surgery found that patients using ice experienced significantly lower pain scores than those using warm sitz baths at both 24 hours and 3 days post-surgery. The ice therapy group also used fewer painkillers in the first three days. However, the warm sitz bath group showed better wound healing in the later recovery phase.⁹ The practical takeaway: ice packs or cold compresses can be especially useful in the first couple of days when pain is at its worst, while switching to warm soaks later may help with healing.

Stool softeners deserve a mention here too, even though they are not painkillers. Softening the stool reduces straining, which reduces the pressure on already-inflamed hemorrhoidal tissue and prevents the sharp spike of pain that comes with passing a hard stool. Fiber supplements like psyllium husk work the same way over a longer timeline. These do not treat pain directly, but they remove one of its biggest triggers.

Managing Pain After Hemorrhoid Surgery

Hemorrhoidectomy, the surgical removal of hemorrhoids, is one of the more painful common surgeries. If you have been told you need one, you are right to be concerned about pain management afterward. The good news is that a multimodal approach, using several different types of pain control together, works well for most people.

A prospective study of 62 patients evaluated a protocol combining intravenous fentanyl during surgery, a local anesthetic injected around the surgical site, and an NSAID given rectally at the end of surgery and then orally for five days afterward. Despite the wide range of individual pain experiences, the average pain scores stayed low, and 95 percent of patients were satisfied with their pain management.¹⁰ The key takeaway from the post-surgical research is that no single drug class handles the pain alone. Combining an NSAID for baseline inflammation control, a local anesthetic for immediate relief, and a short course of stronger painkillers as needed tends to outperform any single agent.

Flavonoids and metronidazole added to that mix can further reduce pain, as noted by a systematic review of post-hemorrhoidectomy pain strategies.⁸ And topical nitroglycerin or nifedipine ointments, applied in the days following surgery, can help manage the sphincter spasm component of post-operative pain.

Thrombosed Hemorrhoids and When Painkillers Are Not Enough

A thrombosed external hemorrhoid, where a blood clot forms inside a hemorrhoid, produces sudden and severe pain. It is the situation most likely to send someone searching for the strongest painkiller they can find. Oral NSAIDs and topical anesthetics can take the edge off, but for many people with a thrombosed hemorrhoid, conservative treatment means enduring several days of significant pain while the clot slowly resolves on its own.

A systematic review and meta-analysis comparing surgery to conservative management for thrombosed external hemorrhoids found that both approaches eventually resolve the problem, with no significant difference in bleeding risk. However, surgical excision was associated with roughly half the risk of recurrence compared to conservative treatment.¹¹ A study of thrombosed hemorrhoids during pregnancy found a similar pattern: both surgical and conservative treatment improved pain, but the surgical group had a significantly earlier reduction in pain by day three.¹²

Another trial comparing surgical excision to conservative treatment in pregnant patients reported that the surgical group had lower pain scores at both 1 and 7 days after treatment, returned to normal activities in about half the time (roughly 6.5 days versus 13.5 days), and had a much lower recurrence rate.¹³ If you are dealing with a thrombosed hemorrhoid and the pain is severe, it is worth asking your doctor about excision rather than waiting it out on painkillers alone, especially if the clot developed within the last 48 to 72 hours, when the procedure is most straightforward.

Hemorrhoid Pain During Pregnancy

Pregnancy makes hemorrhoids more common because of increased pressure on the pelvic veins, higher blood volume, and the constipation that hormonal changes promote. Managing pain during pregnancy carries extra considerations because many medications have not been thoroughly studied in pregnant people.

Acetaminophen is generally considered the safest oral painkiller during pregnancy and remains the first-line recommendation. Ibuprofen and other NSAIDs are typically avoided, especially in the third trimester, because of potential effects on the fetal cardiovascular system. Aspirin, with its blood-thinning effects, is similarly limited to specific medical indications during pregnancy.

Topical hemorrhoid treatments are generally considered safe in the third trimester. Although none of the commonly used topical antihemorrhoidal agents have been formally assessed for safety in pregnancy, the constituent ingredients, including local anesthetics, corticosteroids, and anti-inflammatory agents, are unlikely to harm the infant at that stage.¹⁴ That said, topical steroids should still be used sparingly and for short durations. Sitz baths, ice packs, and fiber supplements are all safe during pregnancy and should be the foundation of any pain management plan.

As noted in the section on thrombosed hemorrhoids, even surgical excision of a thrombosed hemorrhoid during pregnancy has been shown to be safe and effective when the pain is severe enough to warrant it.

Blood Thinners and Other Drug Interactions

If you are on blood-thinning medications, hemorrhoid pain management gets more complicated in a couple of ways. First, you need to be cautious about adding NSAIDs like ibuprofen, because these also thin the blood and increase bleeding risk. The combination of a prescription blood thinner with an over-the-counter NSAID can turn minor hemorrhoid bleeding into something more significant. Acetaminophen becomes the safer oral option for pain in this situation.

Second, if your hemorrhoids need procedural treatment, the blood thinners create a surgical dilemma. Stopping the blood thinner to allow safe surgery may expose you to the cardiovascular risk the medication was preventing. Continuing the medication raises the risk of bleeding during and after the procedure. The case of a patient on aspirin and clopidogrel who required emergency laser treatment for bleeding hemorrhoids illustrates this tension: the surgical team chose a minimally invasive laser technique specifically because it could be performed without stopping the patient’s medications.¹ If you are on blood thinners and have hemorrhoid problems, your doctor needs to know about both conditions so they can choose the right pain management and treatment approach.

Building a Pain Management Plan That Actually Works

The research consistently shows that combining approaches works better than relying on a single painkiller. For a typical hemorrhoid flare, a reasonable starting point looks like this:

Oral NSAID: Ibuprofen or naproxen taken on a regular schedule for a few days to control both pain and inflammation, rather than waiting until the pain becomes unbearable.
Topical anesthetic: A lidocaine-containing cream or ointment applied directly to the area, particularly before and after bowel movements when pain tends to spike.
Sitz baths or ice: Ice packs wrapped in a cloth for the first day or two when swelling is worst, transitioning to warm sitz baths as the acute pain subsides.
Stool softener or fiber: Starting a fiber supplement or stool softener immediately to prevent hard stools from aggravating the problem further.

For more severe cases, adding a flavonoid supplement may provide additional benefit beyond what standard painkillers offer. And for thrombosed hemorrhoids that are causing extreme pain, early excision within the first two to three days is worth discussing with your doctor, since the evidence favors faster relief and lower recurrence rates compared to riding it out with painkillers alone. The worst thing you can do is suffer in silence assuming nothing can help. Hemorrhoid pain is very treatable, and the range of effective options is wider than most people realize.