Self-Care Advices

Try These First!

Sitz Bath

This involves soaking your anal and perineal area (where the pain, swelling, irritation or discomfort is located) under warm water for about 15-20 minutes each time, 3-4 times a day.
The warm water soothes the pain and discomfort, relaxes the anal muscles, improves blood circulation and gently cleanse the area.
Use tap water that is warm enough that you can comfortably soak in but not get burned. You do not need to put any Epsom salt. You can buy a sitz bath basin to use over the toilet (available in most pharmacy or online, cost anywhere between $10 to 30), or just sit in your clean bath tub with water filled up to your waist level.
The water should be slowly circulating and kept warm. If you use the bath tub, simply let some water go and add more warm water periodically. If you buy a sitz bath basin, get one that comes with a 1 to 2 liter solution bag and tubing to refill the water as the excess water drains out of the vent.

Things you can safely do and will help in most situations

Maintain air circulation to the anal area

Clean dry perianal skin feels good in general and is especially important when you have irritation or a wound in the area.
Wear cotton briefs and loose fitting clothes. Avoid clothes that has a seam that may rub directly against the area.
If you feel moisture in the anal area, you may tuck a piece of gauze loosely over the anal area so air circulates and you buttock is not “skin-to-skin” and trapping the moisture. You can change the gauze out as frequently as you need to.

Avoid suppository when you have anal pain or swelling

Sounds like common sense, but you may wonder why there are so many different kinds of suppository for anal conditions available over the counter?! Don’t try even if you’re desperate…
Inserting a solid suppository cause more pain and trauma to a painful and swollen anus. If your pain is mostly external or just inside the anal opening, the suppository (which tends to slip in deeper) will not help anyway.
You may use cream or ointment instead, apply with your finger tip (without long nail) is the safest. Wear a finger cot if you prefer but it’s not necessary, just wash you hands clean before and after you put the cream. If you need to put the cream inside the anus in the anal canal, you may use your finger or the applicator tip that comes with the tube of medication. You only need to insert about 1-2cm of your finger tip in the anal canal (where you feel a circular ring of muscle that hugs your finger) for the medication to reach and “sit” in the problematic area.

Use pain medications when you have real pain

Pain in the anal area can get really bad sometimes. The following over the counter pain medications are generally safe to use, especially when you are using it for a short time only. You may use all 3 at same time or alternate every few hours since they work through different mechanism and do not interact with each other:
Topical lidocaine 4% or 5% (cream, ointment, gel or spray) - these are the strongest strength over the counter. 4% is usually cheaper and not significantly different from 5% in terms of effectiveness. You may apply a small amount directly over the painful area at anal opening or on surrounding skin every 4-6 hours. It may sting initially. Applying deeper inside the anal canal is generally not recommended.
Oral ibuprofen (e.g. Motrin, Advil, Aleve, NSAIDs-type medication) - helps decrease pain and inflammation. OTC strength is 200mg. You may take 400mg to 600mg every 8 hours. Taking it for few days does not cause significantly more bleeding if you are not taking other anticoagulant or blood thinner medication.
Oral acetaminophen (Tylenol) - decreases pain, but no anti-inflammatory action. Can use in addition to ibuprofen for pain, or use in place of ibuprofen if you have intolerance of NSAIDs, concern for stomach problem or risk of excessive bleeding. May take 1000mg (2 extra-strength tabs) every 6-8 hours.

Correct the underlying cause of your problem

If you recognize or know what was the cause, such as constipation, diarrhea or poor toilet habit.
It may take some time, and often it’s easier said than done.

Hemorrhoids

Do: sitz bath, topical cream (see below section Over the counter topical cream and ointment).
May: push the hemorrhoid back in gently if you feel the hemorrhoid slides out from inside the anus (usually with bowel movement) and does not go back in on its own like it usually does.
Don’t: sit on toilet seat for long time or use donut-shape cushions - these makes hemorrhoids more swollen because they prevents blood from flowing away from the swollen hemorrhoidal blood vessels.

Additional self-care remedies for more specific conditions

Anal fissure

Do: use topical lidocaine for pain, sitz bath to relax anal muscles and improve blood flow for fissure healing.
Avoid: things that cause or aggravate the fissure, such as hard stool, loose stool, or trauma to anal area.
Unnecessary: no OTC cream or ointment are proven to heal fissure, hemorrhoid cream does not heal fissure, phenylephrine (an active ingredient in some hemorrhoid cream) may slow fissure healing, don’t waste your money.

Perianal skin irritation

Do: use water to clean - water alone is enough and is the best! You may buy a small squirt bottle from pharmacy or dollar store and fill it with warm tap water to rinse anal area especailly after bowel movement, or just get into the shower.
Do: use a hair dryer at low setting to blow dry the area if it is too painful or irritating to wipe.
May: try cream or ointment with active ingredient that may help with your condition (see below Over the counter topical cream and ointment).
Avoid: wipes, strong cleaning agent such as alcohol, hydrogen peroxide, excessive cleaning. Cleaning too much may cause more irritation.

Open anal wound with drainage (post-surgical, fistula, abscess that opened and drained on its own...)

Do: use running tap water to clean, sitz bath, maintain air circulation and keep dry
Unnecessary: sterile gauze or bandage, antiseptic skin cleanser - an open anal wound does not get infected as long as it is able to drain well. There is always bacteria in the anal area no matter how well you clean it.

Rule of thumb:

Read the label and look for the active ingredient that may help you. More is not always better - so choose the product with the helpful ingredient.
Brand name or generic / drug-store brand should work the same as long as they have the active ingredient you need.
If you cannot find the one magic product that contains all the ingredients you need, you can get two different products. Use one product then wait 20 -30 mins for it to get absorbed before applying the other product.
Insurance do not cover products that are OTC (even if your doctor sends a prescription to the pharmacy), however many OTC products are FSA / HSA eligible nowadays.
Buy a small amount to try first if you’re not sure.

Over the counter (OTC) topical cream and ointment - what they do, which one to try and how to use

OTC "hemorrhoid cream"

Look for the ones with these active ingredients: lidocaine (4% or 5%) and phenylephrine 0.25%. Lidocaine relieves pain and is much stronger than pramoxine 1%, another analgesics commonly seen in hemorrhoid cream. Phenylephrine constricts blood vessels and thus helps temporarily decrease blood flow to and shrink the swollen hemorrhoid blood vessels. However, using phenylephrine for extended time will not shrink the hemorrhoid to nothing and is not safe. Thus, OTC hemorrhoid cream should only be used for no more than 1-2 weeks during a flare-up of your hemorrhoids. Phenylephrine should not be applied over fissure or healing anal wound, since good blood flow is needed to heal fissure and wounds.
Witch hazel - helps reduce irritation and discomfort and decrease inflammation in the anal area, but does not help shrink the hemorrhoids. You may buy the witch hazel solution or pads, and use them after they are chilled in the refrigerator for more cooling effect. Alternatively, you can take a small piece of ice from your freezer, wrap it in a gauze or paper towel and apply it over the painful area for 10-15 mins every few hours.
Other “active ingredient” that does not really help: glycerin, petroleum or mineral oil - these lubricate the area and act as a base for the cream or ointment.
Refer to above sub-section “Avoid suppository when you have anal pain or swelling” on how to apply the cream.

OTC cream or ointment for anal itch or skin irritation

You may or may not need a cream. If you do, put it on perianal skin after it is cleaned and dried, and after you put other topical medication which are meant to be absorbed. The OTC cream or ointment generally works as a skin barrier, it will prevent stool and bodily fluid from irritating your skin, but may also prevent the medication applied over it from being absorbed.
If the irritation is due to moisture (from diarrhea, fecal or urinary incontinence, ongoing drainage from fistula or wound - choose a cream with zinc oxide as the active ingredient (usually 20% zinc oxide is good enough). Zinc oxide is the active ingredient in most diaper rash cream, it gives the white color and pasty texture. You should apply enough cream to cover the irritated skin so it is shielded from the bodily fluid, and reapply each time it gets cleansed or wiped off.
If you feel itch or irritation but your anal skin is completely clean and dry and feels normal otherwise - it could be due to excessive cleaning and dryness, try Vitamin A & D ointment, apply over irritated skin 2-3 times a day (you’ll find it on the shelf with other diaper rash cream)

Rule of thumb:

Fiber supplement and stool softener are safest and should be first choice. They do not make you become “dependent” on them to move your bowel, and can be used safely during pregnancy.
Osmotic laxatives are generally safe when used at recommended dose, and may be added when fiber and stool softener are not effective.
Stimulant laxatives, suppository or enema should not be used regularly (use < 1 week duration).
It is okay to use a combination of 2 to 3 different types of product that work through different mechanisms at the same time (e.g fiber + stool softener; fiber + stool softener + laxative).

Over the counter product or medication for constipation

Fiber supplement

Depending on the formula or brand, the active ingredient is usually one of the following: psyllium, methylcellulose, wheat dextrin or inulin.
Fiber is a bulking agent - it remains undigested and binds with water to keep stool soft and increase stool bulk, which then stimulates bowel to move.
You need to drink enough fluid, preferably water (1.5 to 2 Liter per day) for the fiber to work!
Fiber supplement in powder form is generally the most effective (and least expensive). The less processed (more coarse) the powder, the more effective it will be to help move your bowel. Some powder has added sugar or flavor, some thickens the fluid more than others.
Choose a product that contains both insoluble and soluble fiber. Other available forms include capsules, chewable tablets or gummies.
Some formula causes more gas or bloating. If one product or brand does not work well with you, just try another one. Start with a lower dose may help.
The dose recommended on the package may not be enough especially if your diet is lack of fiber in general. You may gradually increase to 1 Tbsp powder (or 4 caps), take with 8 oz of fluid, 2 times a day. Fiber supplement can be taken anytime during the day, on its own or mixed in with your food or beverage.
It is best to consume natural fiber that are present in all fruits and vegetables (which also contain water naturally), oat bran, barley, ground flax seed, many legumes, nuts and seeds.

Stool softener

Active ingredient is docusate (generic), typically sold as 100mg capsule to be taken 2-3 times a day, also available in liquid form.
Works by allowing water to penetrate into stool so stool will be softer and easier to pass.
Works in 1-3 days, less effective than fiber or laxatives in general.
Safe to use in all patients including during pregnancy.

Osmotic laxatives

There are 3 main types of osmotic laxatives over the counter, each contain one of these active ingredients:
- Polyethylene glycol 3350 - sold as a powder that you should mix in 8 oz of water or beverage to drink, dissolves colorless and tasteless;
- Magnesium hydroxide, a.k.a. milk of magnesia - sold as a milky liquid with or without added flavor, usual dose is 15 to 30 mL each time;
- Magnesium citrate - sold as a bottle of clear solution with or without added flavor, usual effective dose is 10 oz but you may use less, this is the strongest of the OTC osmotic laxatives, and should not be used more than once every few weeks.
They all work by drawing water into the bowel so stool will become more loose. Typically work in few hours.
May use 1 to 2 doses a day as directed on the package.
While you may choose a product based on how much volume you can tolerate drinking, it is advisable to drink additional water with it to prevent getting dehydrated from having loose stool or diarrhea.

Stimulant laxatives

There are 2 main types of stimulant laxatives over the counter, each contain one of these active ingredients:
- Bisacodyl - sold as 5mg oral tab or 10mg suppository
- Senna or sennosides - extract derived from the Senna plant, sold as 8.6mg oral tab, as laxative tea with each tea bag containing about 15mg Senna, or as laxative chocolate with each tiny square containing 15mg Senna.
They work by stimulating the bowel to contract (peristalsis) and move the waste through - the faster the stool passes through your colon, the less water get reabsorbed and hence the more soft or loose stool.
Works in few hours, may take at bedtime for bowel movement in the morning.
May cause abdominal cramps (related to intestinal contraction). Do not use if pregnant (risk of uterine contraction).

Suppository and enema

All suppository and enema have the general action of stimulating the anus and rectum directly (which then causes a reflex stimulating the colon upstream) to evacuate the stool. Suppository is a soft solid, enema is a liquid, both are to be inserted through the anus into the rectum.
The active ingredient of the suppository or enema may exert more specific action:
- Glycerin, sold as suppository or liquid small-volume enema - an osmotic laxative
- Sodium phosphate, sold as saline enema - an osmotic laxative
- Bisacodyl, sold as suppository - a stimulant laxative
- Mineral oil, sold as enema - a lubricant
Typically work in less than 15 minutes.

Self-Care Advices

Skip to:

Try These First!

Things you can safely do and will help in most situations

Additional self-care remedies for more specific conditions

Rule of thumb:

Over the counter (OTC) topical cream and ointment - what they do, which one to try and how to use

Rule of thumb:

Over the counter product or medication for constipation