ANSWER:  No, actually, I’m afraid you can’t

The use of over the counter creams, solutions, ointments are condemned by both the American FDA and by surgeons for use on internal hemorrhoids and prolapsed hemorrhoids.

The only time you should even considder applying a piles cream to an internal or prolapsed pile is when the doctor prescribes one. To be honest, most people may get by by using a piles cream if the manufacturer includes directions for internal use and provides an applicator for getting it inside. In this scenario, most people would assume the product is safe to use for internal and prolapsed piles.

However, as far as I can tell, all over the counter piles treatments are designed for use on external piles. External piles are by and far the most common type of pile for generating symptoms and external piles are the easiest things for such topical applications to be applied to. In fact the American FDA has not approved even one piles cream for use both internally AND externally.

Now here’s the problem, piles creams you buy over the counter are made for external piles ! So the FDA is basically saying it is unsafe to apply a pile cream internally.

In fact, in T.R.Koch, M.D., editor of the book Colonic Diseases, Humana Press Inc., 2003, presents a chapter written by two professors of professors of surgery: M.M.H.Kalan (MD, MS) and B.A.Orkin (MD, FACS, FASCRS) “Anorectal Disorders”. On page 537 these two professors condemn the use of pile creams. They also go on to state that steroid piles topical agents do not fix the problem – the piles – and that prolonged use of steroid based piles products leads to skin thinning and POOR healing in the longer run.

To be clear, the reasons there is such a problem between internal and external piles application of over the counter creams is because:

• 1.. There is a vast difference between the absorption rate of skin (external piles are covered with skin) and mucus membrane (which covers the internal piles – prolapsed or not) and

• 2… External piles creams may contiain ingredients that are toxic or harmful if used internally or on prolapsed hemorrhoids which are covered by the mucus membrane.

Concentration of ingredients in OTC piles creams are too strong

If a cream is formulated for external skin, as in an external pile, it may have 500 mg of medication in a dose but only 5 mg may make it to the bloodstream due to skin’s absorption rate.

However, if applied to mucus membrane, as in an internal or prolapsed pile, that same 500 mg dose may wind up delivering 450 mg straight to the bloodstream, which would be at that point a serious overdose, as only 5 mg was intended to be delivered at any one time.

You may be far better off if you are looking for immediate relief and something to help cure the pile to use a tablet like the Venapro pile treatment for symtom relief and to aid healing, while using your piles diet and exercise to help bring the internal and prolapsed piles under control over time.

Pharmacokinetics is the name of the field that deals with how medications are delivered to the bloodstream and act in the body and, it’s a very complicated field at that.

A prolapsed pile is still made up of mucus membrane, so whether it is outside of the body or not it will still have mucus membrane’s drug absorption rate, which can make a cream perfectly safe for external use into a recipe for overdose.

I checked, checked again, and double checked, and there is not a cream in existence that is used externally that is also rated for internal use. However, if the directions with the cream or solution say it can be used internally AND it comes with the manufacturers specific applicator for internal use, then it may be be safe enough.

Ingredients in OTC creams ointments etc may be dangerous when in contact with internal or prolapsed piles

The obvious problem is with steroid anti-inflammatories, such as those creams containing, for example, the very popular hydrocortisone. The ingredient easily damages mucus membranes and can make healing much more difficult to achieve.

Are there internal piles creams available?

Internal pile creams are only by prescription, and sometimes have to be hand-compounded by a fully licensed pharmacist.

Even when an external cream is used internally, the dosage has to be recalculated for mucus tissue’s absorption rate, and that calculation requires a math education that includes calculus and a good working knowledge of pharmacokinetics, which only your doctor or pjarmacist may know how to do.

In conclusion:

One should never apply an external pile cream to an internal pile, whether prolapsed or not, as none are approved by the FDA for such; the same holds true in Australia also and possibly all developed countries. It is just too risky to do so.