NHS Dudley Health Economy Medicines Formulary
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1.7 Local preparations for anal and rectal disorders

General Guidance

  • The majority of piles will settle with conservative measures. However, those with significant local symptoms, bleeding, or anaemia should be referred for further investigation.
  • Anal and perianal pruritus, soreness, and excoriation are best treated by application of bland ointments and suppositories.
  • Careful attention to local toilet hygiene with attention to any minor faecal soiling, adjustment of the diet to avoid hard stools, the use of bulk-forming materials such as bran, and a high residue diet are helpful in those suffering from haemorrhoids, fistules and proctitis.
  • Warm salt baths and ice packs may also give symptomatic relief from haemorrhoids.
  • There is little evidence to support the use of local anaesthetic preparations in haemorrhoids and pruritus ani. However, they can be helpful to reduce pain prior to bowel emptying in anal fissure.
  • Idiopathic or other proctitis may require treatment with local steroids e.g. prednisolone enemas or mesalazine suppositories.
  • Preparations containing corticosteroids should be used for a short period only – long-term use may lead to atrophy of anal skin.

Recommended drugs

1st line - Bran in diet

2nd line - Ispaghula Husk

3rd line - Anusol cream or Anusol HC ointment


Pruritus ani

Anusol cream

Anusol HC ointment

Anusol suppositories



1st line - Bran in diet

2nd line - Ispaghula Husk

3rd line - Xyloproct

Prednisolone suppositories

Mesalazine suppositories


Management of anal fissures

Glyceryl Trinitrate 0.4% rectal ointment (Rectogesic)


Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary


Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

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