RectiCare and Preparation H relieve hemorrhoid symptoms in two different ways. RectiCare numbs pain and itching with 5 percent lidocaine, while the classic Preparation H ointment uses phenylephrine to help temporarily shrink swollen hemorrhoidal tissue, so the better pick depends on whether pain or swelling is bothering you more.
Both are legitimate over the counter options, and neither one cures hemorrhoids. They manage symptoms while your body heals and while you fix the habits that caused the flare in the first place. Here is how the two products compare, ingredient by ingredient, and how to decide which one belongs in your medicine cabinet.
RectiCare Advanced Anorectal Cream is built around one job: numbing. Its active ingredient is lidocaine 5 percent, the strongest concentration of this local anesthetic you can buy without a prescription for anorectal use. Lidocaine works by blocking the nerve signals in the skin that register pain, burning, and itching. Most people feel it start working within a few minutes of applying it.
What RectiCare does not do is act on the hemorrhoid itself. There is no vasoconstrictor in the 5 percent lidocaine cream, so it will not help reduce the swelling. Think of it as fast, strong symptom control for the moments when a hemorrhoid hurts too much to sit, walk, or have a bowel movement comfortably.
Preparation H is not one product but a family of them. The original ointment pairs phenylephrine HCl 0.25 percent, a vasoconstrictor that narrows the blood vessels feeding the swollen tissue, with protectants such as petrolatum and mineral oil that shield irritated skin while it calms down. That is the formula behind the brand's best known claim: it helps temporarily shrink swollen hemorrhoidal tissue and relieves burning and itching.
Other versions change the recipe. The maximum strength cream adds pramoxine, a milder numbing agent, there is a rapid relief cream that includes lidocaine, and the suppositories deliver phenylephrine internally with a cocoa butter base. If you grab a box of Preparation H, read the Drug Facts panel, because two boxes that look nearly identical can contain different actives.
If your main complaint is pain, RectiCare has the edge. Lidocaine 5 percent is the most effective OTC option for numbing the area quickly, which is why it also shows up in postpartum care and in prescription strength fissure treatments at higher concentrations. Phenylephrine does nothing for pain directly; the original Preparation H ointment relies on its protectants to reduce friction and irritation, which helps, but it will not switch off a throbbing external hemorrhoid the way a true anesthetic can. We compared the strongest OTC numbing options in more detail in our guide to the strongest numbing cream for hemorrhoids.
Here Preparation H wins. Phenylephrine constricts the dilated blood vessels inside hemorrhoidal tissue, which is what the phrase "helps temporarily shrink swollen hemorrhoidal tissue" on the label refers to. If your hemorrhoid feels like a swollen, heavy lump but is more uncomfortable than painful, a phenylephrine product addresses the actual swelling in a way plain lidocaine cannot. Just remember the effect is temporary: once you stop using it, the swelling can return unless constipation, straining, and long toilet sits have been dealt with.
Yes, and for many people this is the practical answer to the whole debate. Some hemorrhoid creams combine maximum strength lidocaine with phenylephrine so you get fast numbing and temporary shrinking of swollen tissue from a single application. Revivol-XR Advanced Hemorrhoid Cream takes this approach, pairing 5 percent lidocaine with 0.25 percent phenylephrine, the same strengths discussed above, in one tube. If numbing alone is all you want, a dedicated 5 percent lidocaine numbing cream keeps it simple.
For a comparison of phenylephrine against a steroid based option, see our breakdown of Preparation H vs hydrocortisone.
If you are pregnant or breastfeeding, ask your OB or midwife before using RectiCare, Preparation H, or any topical hemorrhoid product.
Stop self treating and get examined if you have rectal bleeding, if pain is severe or getting worse, if a lump feels hard and extremely tender, or if a week of consistent OTC care has not improved things. Both product labels carry the same 7 day rule for a reason. Bleeding in particular should never be assumed to be hemorrhoids until a clinician has confirmed it, a point the American Society of Colon and Rectal Surgeons stresses in its patient guidance, because other conditions can cause identical symptoms.
This article is for general information only and is not medical advice. Talk with your doctor or pharmacist about what is right for your situation.