Suppository vs Cream for Hemorrhoids: Which Preparation H Format to Use, and When

This is the axis that decides, and it is anatomy rather than chemistry. The anal canal is short, and the line that matters runs across it: hemorrhoids above that line are internal, in the lower rectum, covered by lining rather than skin, and usually painless even when they bleed or prolapse; hemorrhoids below it are external, at or outside the opening, covered by skin, and the ones that itch, burn and swell where you can feel them. A cream is applied to skin. Even with the applicator tip, which the label permits for use just inside the opening, it does not travel up to where an internal hemorrhoid sits. A suppository is inserted past the opening and melts against the rectal lining, which is exactly where an internal hemorrhoid is and exactly where a cream is not.

So the rule is short. Internal, or symptoms you cannot point to on the skin: the suppository. External, or symptoms on the skin around the anus: the cream. Both at once, which is common: both, the suppository inside and the cream outside, each on its own label directions. The reader who cannot tell which they have is the reader who should ask a clinician before buying either, because a suppository does nothing for external skin and a cream does nothing for the rectum, and a week of the wrong one is a week wasted against the label's own 7 day line.

Everything, nearly. Both Drug Facts panels list phenylephrine HCl as a vasoconstrictor. The suppository pairs it with cocoa butter as the protectant and base; the cream pairs it with glycerin and petrolatum. Both carry the same Uses line: temporary relief of the itching, burning and discomfort of hemorrhoids, and temporary shrinking of swollen hemorrhoidal tissue. Both direct adults up to 4 times daily, especially at night, in the morning and after each bowel movement, and both send children under 12 to a doctor. Neither is stronger than the other, and neither title states a percentage, so there is no strength comparison to make from the listings.

The cream takes seconds: cleanse, dry, apply to the skin, wash hands. It absorbs, it does not leak, and it can be reapplied after the next bowel movement without ceremony. The suppository takes a minute and some planning: unwrap, insert with a clean or gloved finger past the opening, and lie down for a few minutes while the cocoa butter melts, because standing up immediately lets it slide back and standing up later lets it leak. Owners consistently report both that the melt can leak and that inserting one on clean skin, after a wipe, is more comfortable than on skin that has not been cleansed. A suppository is also lost if a bowel movement follows soon after insertion, which is why the label's after-each-bowel-movement timing is the practical one: go, cleanse, then insert.

Storage differs. The cream lives in a drawer. The suppository's cocoa butter base softens in a warm bathroom and can arrive soft in summer; keep the box cool and chill a soft suppository in its wrapper before use, as what to do when a suppository has melted describes. For the mechanics of insertion in plain language, how to use a rectal suppository. None of this changes the first axis: convenience is not a reason to use a cream on an internal hemorrhoid.

All prices verified via the Amazon Creators API on September 5, 2026; cost per use computed only where the listing title states the count or size.

A suppository episode at the label's ceiling, 4 a day for 7 days, is 28 suppositories, so the two-pack covers one episode and most of a second at about $21 per episode. A cream episode at the same ceiling uses a fraction of a 2 oz tube; a tube covers several episodes for $12.48. The cream is cheaper per episode by a wide margin, and that is irrelevant if the hemorrhoid is internal. The lidocaine cream is in a different price class and buys a different thing, pain relief; it is ranked in the best lidocaine hemorrhoid creams.

• Internal hemorrhoid, or symptoms inside you cannot point to on skin: Preparation H Suppositories, 12 count, pack of 2.
• External hemorrhoid, itching and swelling on the skin: Preparation H Cream, 2 oz.
• Both: both, each per its own label; the suppository inside after a bowel movement, the cream outside after cleansing.
• Want a film that stays on the skin rather than a cream that absorbs: the Preparation H Ointment, same label, petrolatum base.
• Pain is the main symptom: neither; the cream with lidocaine or the lidocaine field.
• Irritation only, no swelling, nothing internal: Preparation H Wipes or Tucks.
• Any phenylephrine ask-a-doctor condition applies, or pregnant or breastfeeding: a clinician first; Calmol 4 and witch hazel are the phenylephrine-free formats in the meantime.
• Bleeding, or more than 7 days: neither. Stop and ask a doctor, per both labels.