Anusol vs Preparation H: Ingredients, Differences, and Which to Use
Preparation H and Anusol are not interchangeable. In the US, Preparation H is an over-the-counter line built mostly around phenylephrine, a numbing agent, and skin protectants. Anusol-HC is a prescription hydrocortisone steroid. That difference in ingredients, and in access, is what separates them.
This guide compares the ingredients, explains what each is designed to do, and shows when over-the-counter relief stops being enough. For the full range of options, see our guide to best hemorrhoid cream.
Quick comparison
| Preparation H (phenylephrine and numbing versions) | Preparation H Anti-Itch Cream | Anusol-HC | |
| Availability | Over the counter | Over the counter | Prescription only |
| Main active ingredients | Phenylephrine 0.25% in most, plus pramoxine 1% or lidocaine 5% in numbing versions, with glycerin and petrolatum as protectants | Hydrocortisone 1% | Hydrocortisone acetate 2.5% (cream) or 25 mg (suppository) |
| Steroid | No | Yes | Yes |
| Shrinks swollen tissue (vasoconstrictor) | Yes | Not an active ingredient | No |
| Numbing agent | Yes, in pramoxine and lidocaine versions | Not an active ingredient | No |
| Best known for | Swelling, pain, itching, and protection | Itching and inflammation | Inflammation, itching, and redness |
Formulas change, so always check the label on the product you are buying.
What’s in Preparation H
Preparation H is a brand with many versions, and the ingredients differ from product to product. According to the brand’s own comparison chart:
- Multi-Symptom Cream: glycerin 14.4%, phenylephrine HCl 0.25%, pramoxine HCl 1%, white petrolatum 15%
- Rapid Relief with Lidocaine Cream: glycerin 14.4%, lidocaine 5%, phenylephrine HCl 0.25%, white petrolatum 15%
- Suppositories: cocoa butter 88.44% and phenylephrine HCl 0.25%
- Cooling Gel: phenylephrine HCl 0.25% and witch hazel 50%
Phenylephrine is a vasoconstrictor, so it temporarily narrows blood vessels and can reduce swelling and the feeling of pressure. Pramoxine and lidocaine numb pain and itching. Glycerin and petrolatum coat and protect irritated skin. A separate Preparation H anti-itch cream uses hydrocortisone 1% instead. For a full ingredient breakdown, see what’s in Preparation H.
What Anusol-HC is
In the US, Anusol-HC is a prescription hydrocortisone acetate 2.5% rectal cream or a 25 mg suppository, and generic versions are available. Hydrocortisone is a steroid that reduces inflammation, so Anusol-HC targets itching, redness, and swelling rather than pain or tissue size. It contains no numbing agent and no vasoconstrictor.
Because it is a prescription product, you cannot pick it up from the pharmacy shelf. A provider decides whether it fits your symptoms.
If you are outside the US, note that Anusol is sold over the counter in some countries, including the UK, Canada, and Australia, with different formulas built mainly on zinc oxide and balsam of Peru. Those products are not the same as Anusol-HC.
Anusol-HC vs Preparation H
The closest Preparation H comparison to Anusol-HC is its over-the-counter anti-itch cream with hydrocortisone 1%. Both are steroids, so the practical difference is strength and access: 2.5% requires a prescription and 1% does not. The other Preparation H products, built on phenylephrine, pramoxine, or lidocaine, contain no steroid and do a different job.
Steroid creams at this strength are meant for short-term use. Long continuous use can thin the skin around the anus, so follow the label or your prescriber’s directions.
Which one fits your symptoms
- Swelling and pressure after bowel movements: a phenylephrine product such as Preparation H cream or suppositories.
- Pain or burning: a numbing version, with pramoxine or lidocaine.
- Itching and inflammation: hydrocortisone, either the 1% over-the-counter cream or prescription Anusol-HC.
- Symptoms inside the rectum: a suppository, since a cream or ointment applied outside may not reach internal tissue.
Layering several products can duplicate ingredients, such as two numbing agents, so check labels or ask a pharmacist before combining them.
Preparation H labeling includes precautions for people with high blood pressure, heart disease, diabetes, or thyroid disease. Standard guidance for these products is to stop and see a provider if symptoms do not improve in about 7 days, get worse, or involve rectal bleeding.
When neither is enough
Both are built for temporary symptom relief. Neither treats the muscle spasm behind many fissures or the recurring cause of hemorrhoid flares. Sharp pain during bowel movements that lingers afterward often points to a fissure rather than a hemorrhoid, and a numbing or steroid cream will not heal it. See our guide to hemorrhoids vs anal fissures to tell them apart. If symptoms last more than a week, keep coming back, or involve bleeding, it is time to see a provider.
Bummed offers prescription treatment online. Our compounded creams combine a sphincter-relaxing ingredient (diltiazem, nitroglycerin, or nifedipine) with lidocaine, bupivacaine, and hydrocortisone after a clinician reviews your intake. For the full range, see our guides to best hemorrhoid cream, best hemorrhoid medicine, and anal fissure cream. Compounded medications are not FDA-approved.
Frequently asked questions
Is Anusol the same as Preparation H?
No. In the US, Preparation H is an over-the-counter line mostly built on phenylephrine plus a numbing agent and protectants, while Anusol-HC is a prescription hydrocortisone steroid.
Do I need a prescription for Anusol?
In the US, yes. Anusol-HC requires a prescription, while Preparation H is available over the counter. Some other countries sell a non-steroid Anusol over the counter, but that is a different product.
Which is stronger, Anusol-HC or Preparation H?
They work differently, so “stronger” depends on the symptom. Anusol-HC is a 2.5% hydrocortisone steroid for inflammation and itching. Preparation H’s phenylephrine and numbing products target swelling and pain and contain no steroid. Its hydrocortisone cream is 1%.
Can I use Anusol and Preparation H together?
Layering products can duplicate ingredients, such as two numbing agents, and steroid products have limits on how long they should be used. Check the labels and ask a pharmacist or provider before combining them.
Can these treat an anal fissure?
They are formulated for hemorrhoid symptoms. Numbing agents and steroids can ease fissure discomfort temporarily, but they do not relax the sphincter spasm that keeps a fissure from healing. See our guide to anal fissure cream.
This article is for general education and isn’t a substitute for medical advice about your individual situation. Prescription products require an online consultation with a physician who will determine if a prescription is appropriate.