Anusol vs Preparation H: Which Hemorrhoid Cream Is Better? (2026)

Last Updated: April 9, 2026 | Medically Reviewed by the HemRid Medical Team

Quick Answer: Anusol and Preparation H are both popular over-the-counter hemorrhoid treatments, but they contain different active ingredients and work differently. Anusol (with zinc oxide and pramoxine) is generally better for pain relief and skin protection, while Preparation H (with phenylephrine) is better for temporarily shrinking swollen tissue. Both are topical-only treatments with inherent limitations.

Anusol vs Preparation H: Key Differences at a Glance

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| Feature | Anusol | Preparation H | |---------|--------|---------------| | Primary active ingredient | Zinc oxide / Pramoxine HCl | Phenylephrine HCl | | Main mechanism | Skin protection + pain relief | Vasoconstriction (shrinks swelling) | | Best for | Pain, irritation, raw skin | Swelling, puffiness | | Available forms | Cream, ointment, suppositories | Cream, ointment, suppositories, wipes, gel | | Average price | $7–$12 | $8–$15 | | Available with hydrocortisone | Yes (Anusol-HC, prescription) | Yes (Preparation H with hydrocortisone, OTC) | | Widely available | Moderate (more popular in Canada/UK) | Very widely available (US dominant) |

Anusol Ingredients: What Is in It?

Anusol products vary by formulation and country, but the most common over-the-counter version contains:

Zinc Oxide (Primary Protectant)

Zinc oxide acts as a physical skin protectant. It creates a barrier over irritated hemorrhoid tissue, shielding it from moisture, friction, and contact with stool. This barrier function helps damaged tissue heal faster and reduces ongoing irritation.

Zinc oxide also has mild astringent and antiseptic properties, meaning it can help tighten tissue slightly and reduce the risk of minor infections in irritated areas.

Pramoxine Hydrochloride (Topical Anesthetic)

Pramoxine is a local anesthetic that works differently from lidocaine. It blocks nerve impulse conduction by decreasing the permeability of nerve cell membranes to sodium ions. The practical result: numbing of the affected area and relief from pain, itching, and burning.

Pramoxine is generally well-tolerated and has a lower incidence of allergic reactions compared to some other topical anesthetics (Yosipovitch & Maibach, Journal of the American Academy of Dermatology, 1997).

Mineral Oil (Emollient)

Mineral oil softens and lubricates the skin, reducing friction during bowel movements and making the experience less painful for hemorrhoid sufferers.

Anusol-HC (Prescription Variant)

Anusol-HC contains hydrocortisone acetate 2.5%, a topical corticosteroid that reduces inflammation, swelling, and itching. This is a prescription product and should not be used for more than 7–10 days without medical supervision, as prolonged steroid use can thin the delicate perianal skin.

Preparation H Ingredients: What Is in It?

Preparation H offers a wider range of products, each with different active ingredients:

Preparation H Ointment (Original)

• Phenylephrine HCl 0.25% — A sympathomimetic vasoconstrictor that temporarily shrinks swollen hemorrhoid tissue by constricting blood vessels. This is the same compound used in nasal decongestants.
• Petrolatum (71.9%) — Creates a thick protective barrier
• Mineral oil (14%) — Lubricates and softens
• Shark liver oil (3%) — Contains squalene, believed to promote tissue healing

Preparation H Cream

• Phenylephrine HCl 0.25% — Same vasoconstrictor as the ointment, in a lighter cream base

Preparation H Maximum Strength Pain Relief Cream

• Lidocaine 4% — A more potent topical anesthetic than pramoxine, providing stronger numbing for severe pain

Preparation H Anti-Itch Cream

• Hydrocortisone 1% — A mild OTC-strength corticosteroid for itch relief (should not be used more than 7 days)

Preparation H Medicated Wipes

• Witch Hazel 50% — A natural astringent that cleanses, soothes, and mildly tightens tissue

Which Is Better for Hemorrhoid Pain?

Winner: Anusol (with pramoxine) for mild-moderate pain; Preparation H Maximum Strength (with lidocaine) for severe pain.

Anusol's pramoxine provides reliable pain and itch relief with a lower risk of allergic reactions. For most everyday hemorrhoid discomfort, this is sufficient.

However, if pain is severe — such as from a thrombosed external hemorrhoid — Preparation H's lidocaine formulation delivers stronger numbing. Lidocaine is a more potent anesthetic than pramoxine.

For an alternative topical pain solution, Lidocaine Cream from HemRid provides targeted lidocaine-based relief designed specifically for hemorrhoid sufferers.

This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Which Is Better for Hemorrhoid Swelling?

Winner: Preparation H (with phenylephrine).

Phenylephrine is the only vasoconstrictor available in OTC hemorrhoid preparations in the United States. It actively shrinks swollen blood vessels at the application site, providing temporary reduction in hemorrhoid size and puffiness.

Anusol does not contain a vasoconstrictor. Its zinc oxide provides protection and mild astringent tightening, but it does not actively constrict blood vessels the way phenylephrine does.

If reducing visible swelling is your primary goal, Preparation H's original formula has the edge.

Which Is Better for Hemorrhoid Itching?

Tie — with caveats.

Both products can relieve itching, but through different mechanisms:

• Anusol: Pramoxine numbs the itch, zinc oxide protects the irritated area
• Preparation H Anti-Itch: Hydrocortisone directly suppresses the inflammatory response causing the itch
• Preparation H Wipes: Witch hazel provides soothing, cooling relief

For short-term itch relief (less than 7 days), Preparation H's hydrocortisone formula may be more effective. For ongoing itch management, Anusol's non-steroidal approach is safer for extended use.

Price Comparison: Anusol vs Preparation H

| Product | Typical Price | Size | |---------|--------------|------| | Anusol Cream | $7–$10 | 1 oz | | Anusol Suppositories | $8–$12 | 12–24 count | | Preparation H Ointment | $8–$12 | 1–2 oz | | Preparation H Cream | $8–$13 | 0.9–1.8 oz | | Preparation H Suppositories | $9–$14 | 12–24 count | | Preparation H Wipes | $5–$10 | 48 count | | Preparation H Maximum Strength | $10–$15 | 0.9 oz |

Prices are comparable, with Preparation H generally costing slightly more due to its wider product range and brand premium. Both are affordable on a per-unit basis, but costs accumulate over months and years of ongoing use — a point worth considering for chronic hemorrhoid sufferers.

Availability: Where to Buy Each Product

Preparation H is ubiquitous in the United States. You can find it at virtually every pharmacy, grocery store, and big-box retailer. It is also widely available online.

Anusol has more variable availability. It is extremely popular in Canada and the United Kingdom, where it is often the first-choice OTC hemorrhoid treatment. In the United States, Anusol is available but less prominently stocked. You may need to look in the pharmacy section specifically or order online.

Cream vs Ointment vs Suppository: Which Form Is Best?

Both Anusol and Preparation H are available in multiple forms. Here is when to use each:

Creams

• Lighter texture, absorbs faster
• Less greasy, better for daytime use
• Best for external hemorrhoids
• Easier to apply precisely

Ointments

• Thicker, longer-lasting barrier
• Better moisture protection
• Best for nighttime use or severely irritated skin
• Can feel greasy

Suppositories

• Designed for internal hemorrhoids
• Deliver active ingredients directly inside the rectum
• Dissolve slowly for extended relief
• Best when symptoms are primarily internal

Wipes (Preparation H Only)

• Convenient for on-the-go use
• Good for gentle cleansing after bowel movements
• Mild relief — best as a complement to other products
• Can replace irritating dry toilet paper

User Reviews: What People Say About Each

Anusol Reviews Summary

• Positive: Soothing, good for sensitive skin, effective for raw and irritated areas, gentler formula
• Negative: Does not shrink hemorrhoids, harder to find in US stores, limited product range

Preparation H Reviews Summary

• Positive: Reduces swelling visibly, widely available, trusted brand, multiple product options
• Negative: Greasy texture (ointment), temporary relief only, symptoms return quickly, phenylephrine can cause sensitivity in some users

The Fundamental Limitation Both Products Share

Here is the critical point that applies equally to Anusol and Preparation H: both are topical-only treatments that address symptoms on the surface without targeting the underlying vascular cause of hemorrhoids.

Hemorrhoids are swollen veins — a vascular condition. Topical creams can numb pain, temporarily shrink tissue, and protect irritated skin, but they cannot:

• Strengthen weakened vein walls
• Improve venous tone and blood flow
• Reduce the vascular inflammation driving hemorrhoid development
• Prevent future hemorrhoid recurrence

This is why many chronic hemorrhoid sufferers find themselves in an endless cycle of cream application — temporary relief followed by symptom return, repeating indefinitely.

A More Comprehensive Approach

For lasting hemorrhoid management, the HemRid Medical Team recommends combining topical relief with internal support:

1. Internal vein support: HemRid Max delivers clinically studied flavonoids (diosmin, hesperidin) that support vein health from the inside — addressing the root vascular cause that topical creams cannot reach.

2. Topical relief as needed: Use Lidocaine Cream, Anusol, or Preparation H for acute symptom relief during flare-ups.

3. Digestive support: Fiber Gummies promote the soft, easy-to-pass stools that prevent the straining which worsens hemorrhoids.

This three-pronged approach addresses hemorrhoids from every angle — vascular health, symptom relief, and prevention — rather than relying solely on topical management.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Frequently Asked Questions

Can I use Anusol and Preparation H together?

It is generally not recommended to layer multiple topical hemorrhoid products simultaneously, as this can cause irritation and makes it difficult to identify which product is helping. Choose one topical product at a time.

Is Anusol safer than Preparation H?

Both have strong safety profiles for short-term use. Anusol may have a slight edge for sensitive individuals because pramoxine has a lower allergy risk than phenylephrine. Neither should be used for extended periods without medical guidance if the formulation contains hydrocortisone.

Which is better after hemorrhoid surgery?

Post-surgical product choices should be made in consultation with your surgeon. Many surgeons recommend plain petroleum-based ointments for wound protection, with pain-relieving products as needed.

Are there natural alternatives to both?

Witch hazel, aloe vera, and coconut oil are commonly used natural alternatives for topical relief. For internal support, HemRid Max provides a supplement-based approach using naturally derived flavonoids and botanical extracts.

The Bottom Line: Anusol vs Preparation H

Both Anusol and Preparation H are credible, widely used OTC hemorrhoid treatments. Choose Anusol if your primary concerns are pain, itching, and skin protection. Choose Preparation H if you need temporary swelling reduction or want the widest product selection.

But remember: no topical cream alone can fully resolve chronic hemorrhoids. For comprehensive management, pair your chosen topical product with internal vein support from HemRid Max, digestive regularity from Fiber Gummies, and the dietary and lifestyle changes that address the root causes of hemorrhoid disease.