Doctor Butler's Hemorrhoid & Fissure Ointment

Doctor Butler's was formulated by a board-certified proctologist, which is reflected in the ingredient selection. Rather than relying on a single active mechanism, it combines pharmaceutical-grade actives with botanical ingredients. Here's what each one does.

Lidocaine 4%

Lidocaine is an amide-type local anesthetic that blocks sodium channels in nerve fibers, preventing pain signal transmission. At 4%, Doctor Butler's delivers stronger numbing than pramoxine-based creams (like Preparation H at 1% pramoxine) but slightly less than RectiCare's 5% lidocaine. Onset is 3–5 minutes with duration of 1–3 hours. The 4% concentration hits a practical sweet spot: strong enough for meaningful pain relief while reducing the risk of lidocaine sensitivity reactions that increase at higher concentrations with repeated use.

Phenylephrine HCl

The same vasoconstrictor found in Preparation H. It narrows blood vessels feeding the hemorrhoid, reducing swelling. This makes Doctor Butler's one of only two topical products in our review set that both numbs and shrinks — the other being Preparation H Maximum Strength. The key difference: Doctor Butler's pairs the vasoconstrictor with the stronger lidocaine rather than the milder pramoxine.

Botanical Ingredients

The formula includes aloe vera, cocoa butter, and amino acids. While these are not active pharmaceutical ingredients under the FDA monograph, they contribute to skin conditioning and moisture retention. The cocoa butter base creates a smoother application texture than petrolatum-heavy formulas. For a full breakdown of how natural ingredients compare to pharmaceuticals, see our natural remedies evidence guide.

Best Candidates

• External hemorrhoids with significant pain. The 4% lidocaine delivers fast, strong numbing that most users feel within minutes.
• Anal fissures alongside hemorrhoids. Doctor Butler's is explicitly marketed for both conditions. The lidocaine numbs fissure pain while the vasoconstrictor reduces surrounding swelling.
• Recurring flare-up patients who know their symptoms and want a higher-potency product to shorten episodes. The dual-action formula addresses both the pain and swelling components simultaneously.
• Users who prefer a proctologist-designed formula. The credential is genuine — the formulating physician is named and verifiable — which provides an additional layer of confidence for a sensitive health product.

Not Ideal For

• Budget-conscious buyers. At $24.95 for 1 oz, this is the most expensive cream per ounce in our review set. Preparation H provides similar dual-action at less than half the per-ounce cost.
• Internal hemorrhoid treatment. Like all external creams, this product is designed for surface application. Learn more about the difference between internal and external hemorrhoids.
• Users with known lidocaine sensitivity. Repeated lidocaine use can cause contact sensitization. If previous lidocaine products caused increased redness or rash, switch to a pramoxine-based product.

Medical Cautions

Lidocaine should not be used longer than 7 consecutive days without medical guidance. The phenylephrine component carries the same cardiovascular caution as Preparation H — consult a physician if you have uncontrolled blood pressure, heart disease, or take MAOIs. Pregnant or nursing women should discuss options with their OB before use.

Application Method

• Clean and gently pat dry the affected area before applying.
• Apply a small amount (pea-sized) directly to external hemorrhoids or fissures.
• Use up to 4 times daily, including after each bowel movement.
• The ointment base is thicker than cream formulas — a little goes further. Apply sparingly and spread gently.
• Wash hands thoroughly after application to avoid numbing unintended areas.

Expected Timeline

Numbing begins within 3–5 minutes. Swelling reduction from phenylephrine starts within 15–30 minutes. Most mild-to-moderate external hemorrhoids show meaningful improvement within 5–7 days of consistent use. For context on typical hemorrhoid healing timelines, expect mild cases to resolve within 1–2 weeks and moderate cases within 2–4 weeks with treatment.

Side Effects

• Common: Mild tingling or burning at the application site during the first 1–2 minutes as the lidocaine takes effect. This is normal and resolves as numbing sets in.
• Uncommon: Contact dermatitis — rash, increased redness, or itching that worsens with each application rather than improving. Discontinue if this pattern emerges.
• Rare: Systemic lidocaine effects (dizziness, metallic taste) are extremely unlikely at topical OTC concentrations but possible if applied to large areas of broken skin.

How It Compares

• Preparation H Maximum Strength — Same vasoconstrictor, weaker anesthetic (1% pramoxine vs 4% lidocaine). Half the price per ounce. Best for moderate pain where maximum numbing isn't needed.
• RectiCare 5% Lidocaine — Stronger numbing but no vasoconstrictor. Pure pain management without the shrinking component. Best for users whose sole complaint is pain.
• Tucks Medicated Pads — Witch hazel only. Gentlest option, best for mild symptoms or as a complement to a cream. Much less potent but safe for indefinite use.

Price and Value

At $24.95 for 1 oz, Doctor Butler's is premium-priced. The tube provides approximately 20–25 applications. That's roughly $1.00–1.25 per application — 2–3× the cost of Preparation H. The premium buys you stronger lidocaine numbing and the botanical additions. Whether that justifies the price depends on your pain severity. For a full price comparison, see our cream buying guide.

Our Assessment

Doctor Butler's is the strongest dual-action (numb + shrink) OTC hemorrhoid ointment available. The proctologist pedigree is genuine, and the 4% lidocaine delivers noticeably stronger pain relief than pramoxine-based alternatives. Its 25,000+ Amazon ratings at 4.3 stars are solid, though the lower star average (compared to simpler products) partly reflects the price sensitivity and smaller tube size.

The primary trade-off is cost. If your pain is moderate, Preparation H gives you similar dual-action at much lower cost. If your pain is severe and you want maximum numbing, RectiCare's 5% lidocaine is stronger (but lacks the vasoconstrictor). Doctor Butler's fills the niche between them: strong numbing plus tissue shrinking for users willing to pay the premium.