RectiCare vs Preparation H: Which Hemorrhoid Cream Should You Use?

RectiCare vs Preparation H: Which Hemorrhoid Cream Should You Use?

RectiCare and Preparation H are two of the most widely recommended hemorrhoid creams, but they solve fundamentally different problems. RectiCare is a pain management product. Preparation H is a swelling reduction product. Choosing the wrong one means treating a symptom the product was not designed for.

This guide breaks down the active ingredients, intended use cases, limitations, and practical differences so you can pick the right cream — or decide whether you need both.

How They Work: Different Ingredients, Different Jobs

RectiCare: Maximum-Strength Pain Relief

RectiCare Anorectal Cream contains 5% lidocaine, the highest concentration available without a prescription. Lidocaine is a local anesthetic that blocks nerve signals in the tissue where it is applied.

What it does:

• Numbs the affected area within 5–10 minutes
• Provides 1–2 hours of pain relief per application
• Effective for both hemorrhoid pain and anal fissure pain

What it does not do:

• Does not shrink swollen hemorrhoid tissue
• Does not reduce inflammation
• Does not address the underlying cause of hemorrhoids

RectiCare is a single-ingredient product by design. It does one thing — block pain — and it does it more effectively than any other OTC hemorrhoid cream on the market.

Preparation H Maximum Strength: Shrink and Soothe

Preparation H Maximum Strength takes a multi-ingredient approach. Its active ingredients include:

• Phenylephrine HCl (0.25%) — a vasoconstrictor that narrows blood vessels, physically shrinking swollen hemorrhoid tissue
• Pramoxine HCl (1%) — a local anesthetic that provides moderate pain relief
• Glycerin and petrolatum — skin protectants that form a barrier against further irritation

What it does:

• Reduces the size of swollen hemorrhoids within 15–30 minutes
• Provides moderate pain relief (less intense than RectiCare)
• Protects irritated tissue from friction and moisture

What it does not do:

• Does not provide the intense numbing that severe pain requires
• Does not treat the root cause (straining, constipation, prolonged sitting)

Head-to-Head Comparison

When to Use RectiCare

RectiCare is the right choice when pain is your primary problem and swelling is secondary or manageable:

• Thrombosed hemorrhoids — A blood clot inside a hemorrhoid causes intense, sharp pain. RectiCare's 5% lidocaine provides the strongest OTC numbing available for this situation. If the pain is severe enough to interfere with daily activities and the clot is less than 72 hours old, see a doctor — they can drain it for immediate relief. Learn more about thrombosed hemorrhoid emergencies.
• Anal fissures — Small tears in the anal lining cause burning pain during and after bowel movements. RectiCare was originally developed for anorectal pain broadly, not just hemorrhoids, making it effective for this overlapping condition.
• Post-procedure pain — After rubber band ligation or other office procedures, the treated area can be very sore. RectiCare provides targeted numbing during the recovery period.
• Breakthrough pain — If you are already using Preparation H for swelling but experience pain spikes that pramoxine cannot manage, RectiCare can be applied as a supplemental pain reliever.

When to Use Preparation H

Preparation H is the right choice when swelling is your primary problem and you need the hemorrhoid to physically shrink:

• External hemorrhoids with visible swelling — Phenylephrine constricts the blood vessels feeding the hemorrhoid, reducing its size. This is the most common use case and where Preparation H excels.
• Itching and irritation — The protective barrier formed by glycerin and petrolatum reduces friction and moisture contact, addressing two major itch triggers.
• Daily management — For routine hemorrhoid flare-ups with moderate symptoms, Preparation H's combination of shrinking, mild pain relief, and tissue protection covers the most common needs in one product.
• First-time hemorrhoid sufferers — If you have not had hemorrhoids before and symptoms are uncomfortable but not severe, Preparation H is the standard starting point recommended by most pharmacists.

When to Use Both

These products target different mechanisms and can be used together when symptoms warrant it:

1. Apply RectiCare first for immediate pain relief 2. Wait 15–20 minutes for the numbing to take full effect 3. Apply Preparation H over the same area for swelling reduction

This combination approach is most useful for:

• Thrombosed hemorrhoids where both pain and swelling are significant
• Severe flare-ups where single-product treatment is insufficient
• The first 48–72 hours of an acute episode, after which single-product treatment is usually adequate

Important: Using two topical products increases the total amount of active ingredients absorbed through the skin. While both products are considered safe for short-term OTC use, do not exceed the recommended application frequency for either product. If you need this combination for more than 7 days, consult a healthcare provider.

When to Avoid Each Product

Avoid RectiCare if:

• Your primary issue is swelling rather than pain — RectiCare will not reduce hemorrhoid size
• You have a known allergy or sensitivity to lidocaine or other local anesthetics
• You are using other lidocaine-containing products (risk of exceeding safe total lidocaine exposure)

Avoid Preparation H (with phenylephrine) if:

• You have uncontrolled high blood pressure — phenylephrine is a vasoconstrictor that can theoretically affect blood pressure, though systemic absorption from topical application is minimal
• You have thyroid disease or diabetes — consult your physician before use
• You are pregnant — the safety of topical phenylephrine during pregnancy is not well established. See our pregnancy-safe hemorrhoid treatment guide for alternatives that are considered safer during pregnancy

Price and Value Comparison

RectiCare costs approximately $18 for a 30g tube. At the recommended application amount, this provides roughly 20 applications — about $0.90 per use.

Preparation H Maximum Strength costs approximately $11 for a 1.8 oz (51g) tube. With similar application amounts, this provides roughly 35 applications — about $0.30 per use.

Preparation H offers better per-application value, but the comparison is not entirely fair because the products serve different functions. If you need strong numbing, Preparation H's milder pramoxine will not substitute for RectiCare's lidocaine regardless of price. If you need shrinkage, RectiCare offers no shrinking action at any price.

What About Doctor Butler's?

Doctor Butler's Hemorrhoid & Fissure Ointment is worth mentioning because it bridges the gap between these two products. It contains both lidocaine (4%) and phenylephrine, providing both numbing and shrinking in a single product. At approximately $25 for a 1 oz tube, it is the most expensive option per application but eliminates the need for two separate products.

The trade-off: Doctor Butler's lidocaine concentration (4%) is slightly lower than RectiCare's (5%), so for the most severe pain, RectiCare still provides stronger numbing. But for most users, the difference between 4% and 5% lidocaine is not clinically significant.

For a broader comparison of all topical options, see our best hemorrhoid cream guide.

The Verdict

Choose RectiCare if pain is severe and swelling is secondary. It is the strongest OTC pain reliever for hemorrhoids.

Choose Preparation H if swelling, itching, and general discomfort are your main concerns. It is the most well-rounded daily hemorrhoid treatment.

Use both during acute flare-ups where pain and swelling are both significant, but limit combination use to 7 days.

Neither product treats the root cause of hemorrhoids. Pair either cream with a fiber supplement to soften stools, a sitz bath for healing, and a hemorrhoid cushion for sitting comfort. Addressing the cause alongside the symptoms produces the fastest and most lasting relief.

You can compare all products side by side to see how these creams stack up against other treatment categories.