Anesthetic, Local (Rectal)

Patients who suffer from hemorrhoids (or piles) can use rectal anesthetics to relieve the itching and pain of this uncomfortable condition.

Overview

Rectal anesthetics can be provided as a cream, foam or suppository, and are sometimes used for other medication conditions such as itching or swelling. The medication is applied locally, directly to the location being treated.

Rectal anesthetic is available either with or without a prescription. For severe problems, a doctor may prescribe a higher, more potent dosage. In addition, a doctor may provide additional instructions for use to treat the condition.

A patient with bleeding hemorrhoids, which may occur after a bowel movement, should talk to their doctor first before using this medication. The appearance of bleeding may indicate that there is an additional or more severe problem that needs to be treated.

If the patient finds that the condition being treated does not improve within 7 days, they should seek the advice of their doctor. Some of the side effects of taking rectal anesthetic are redness, swelling, hives or itching beyond the condition being treated, and should be discussed with the physician right away.

Follow the proper procedures for the use of this medication:

  • Read and follow all directions provided for the rectal anesthetic, including directions provided by the doctor. For questions about using this product, patients can also ask their pharmacist.
  • Patients should not use more of this drug, use it more frequently, or use it for a longer time than is recommended by the instructions. Because this medication is absorbed into the body, incorrect use can cause unwanted side effects.

Because of the risk of side effects, it's important that this medication only be used for the prescribed medical conditions, either as directed by a doctor or as recommended on the packaging. For patients who have other co-occurring infections or illnesses, it's best to seek a doctor's advice about whether this medication can safely be used.

Conditions Treated

  • Hemorrhoids (piles)
  • Rectal itching

Type of Medicine

  • Benzocaine
  • Dibucaine
  • Tetracaine
  • Pramoxine

Side Effects

This form of rectal anesthetic may cause some unwanted side effects, along with treating the condition it has been prescribed for. Not every patient will experience these side effects, but if any of them should occur, it is recommended that the patient seek medical attention.

Certain side effects listed below can result from taking too much anesthetic. A patient should stop taking the anesthetic and get emergency care immediately if they experience any of the following side effects:

  • Blurred or double vision
  • Dizziness, lightheadedness
  • Confusion
  • Convulsions or seizures
  • Drowsiness
  • Feeling hot, cold or numb
  • Trembling or shivering
  • Sweating more than usual
  • Buzzing or ringing in either ear or both
  • A slow or irregular heartbeat
  • A feeling of unusual anxiety, nervousness, excitement or restlessness
  • Turning pale

There are some less common side effects that are not as severe. If the patient experiences any of the following side effects, they should see their doctor as soon as possible:

  • A burning or stinging feeling, or swelling or tenderness that did not appear prior to taking the treatment
  • Redness, itching, hives or other skin rash appearing around the place where the medication is applied.

It's possible that some other side effects may be reported by patients. For patients who experience any other side effects, they should contact their doctor for further advice and instructions.

Patients may also report side effects to the FDA at 1-800-FDA-1088.

Dosage

Different patients who have been prescribed rectal anesthetic will have different dosages, depending on their specific condition and how severe it is. Patients should follow their doctor's orders carefully, or follow the directions on the label. The dosage information that appears below is only intended to show the average doses that are given for this medication. Patients should take whatever dose their doctor prescribes, and should not make any changes unless instructed by their doctor.

How much rectal anesthetic a doctor prescribes will depend on the strength of the medicine. How many doses, how much time should elapse between doses, and how long a patient will continue treatment will all depend on how severe the medical problem is for which it is being prescribed. A doctor will make this determination depending on the specific needs of the patient.

Dosage for this medication will depend on the type being used. Check packaging for precise directions, or seek the advice of a doctor. Adult patients using benzocaine for treatment can use a small amount of ointment up to six times a day. For children, the dose should be determined by the doctor. If the medication contains dibucaine, adults can use it up to three or four times per day. For medications which contain pramoxine, adults can apply the cream or ointment form to their rectum up to five times per day, and if using foam, up to six times per day. Patients using tetracaine can also apply this medication up to six times per day, either inserted into the rectum or applied around the rectal area.

It's recommended that medication be applied once in the morning, once in the evening, and after a bowel movement, up to the maximum daily doses. This medication is not recommended for use in children without the direction of a doctor.

For any missed doses of this medicine, patients should take it as soon they are able. If it's too close to the time for the next dose, however, then the patient should leave the missed dose and take the next scheduled dose as normal. Patients should not take two doses.

For the cream form of rectal anesthetic, it should be applied around the rectum as follows:

  • Wash the rectal area well with water and soap. Rinse and dry gently without rough wiping, using a soft cloth or tissue.
  • Apply the recommended small amount of anesthetic to the sore area using gauze or tissue.

To insert a rectal ointment or cream into the rectum, follow these steps:

  • Patients should only use products that are sold with applicators that are already filled with cream or that come packaged with a tube designed to insert the cream into the rectum.
  • To use a rectal tube with cream or ointment, remove the cap from the product and attach it to the insertion tube. Squeeze a small amount of the medication into the tube until it comes out of the tip, and spread some of the medication on the inserter. Insert the tube into the rectum and squeeze until the medication has been inserted into the rectum. Withdraw the inserter, put the cap on the tube of cream, and carefully clean the applicator.
  • For products that are sold in a pre-filled applicator, follow the directions on the packaging that explain how to use the applicator to insert the medication into the rectum. These applicators are for single use, and can be disposed of after use.
  • For rectal insertion of an anesthetic aerosol foam, an applicator is provided with the product. Shake the can well, and insert the tip into the provided foam applicator. Push the top of the can until the foam has filled the applicator to the indicated level. Take the can out of the end of the applicator. Put a small amount of the medication on the insertion end of the applicator, and put the applicator into the rectum. Press the handle of the applicator as far as it will go, and when finished, take the applicator out and wash and dry thoroughly before storing.

Major Drug Interactions

Taking more than one medication can cause unwanted interactions and side effects. While some medications should never be taken together, others may be used together even if that can cause side effects, in order to get the best result. In some cases, a doctor may determine that a change in dose or other precaution can allow the patient to take both medications together.

All patients should provide a complete medical history to their doctor prior to treatment. For the patient taking rectal anesthetic, it is very important to inform the doctor if he or she is taking any one or more of the medications listed below. These are the most likely to cause interactions, but are not intended to be an all-inclusive list.

While the use of rectal anesthetic with these medications is normally not recommended, the patient's doctor will make a determination and change either the dose or the frequency of the rectal anesthetic. The following medications fall into this category:

  • Acecainide
  • Bretylium
  • Dofetilide
  • Amiodarone
  • Sotalol
  • Ibutilide

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Warnings

For patients using rectal anesthetic who are also suffering with other medical problems, their use of this medication may be affected. To avoid the possibility of unwanted side effects, patients should tell their doctor about the following medical issues if they are present:

  • Any infection that appears at or close to the place of treatment
  • Broken skin, sores or any severe injury appearing at or close to the place of treatment.

Patients using rectal anesthetic should check with their doctor as soon as possible if any of the following occur:

  • The condition being treated does not improve after the patient has been using this medicine for seven days, or if it gets worse during that time.
  • The patient experiences any bleeding from the rectum.
  • The patient experiences a rash, redness, swelling or irritation that did not occur prior to taking this medicine.

Certain patients using either benzocaine or tetracaine treatments may be at risk of getting false tests on some necessary lab tests they may undergo for other conditions. This test is given to patients who are having testing done on their pancreas. The bezocaine or tetracaine may react with the medicine used for the test, called bentiromide. For patients who need this test, they should avoid taking any kind of anesthetic product containing benzocaine or tetracaine for at least 72 hours or three days prior to taking the pancreas test.

Patients should inform their doctor if they have had any unusual or allergic reaction to rectal anesthetic medicines, as well as allergies to other products such as foods dyes, preservatives, or animals.

Generally, this medication is not recommended for use in children without the direction of a doctor or health professional. Children and seniors may be particularly sensitive to the application of local anesthetics, which may result in causing an increased potential for side effects. Care should be taken to watch for potential reactions over the course of treatment, and parents of children or elderly patients should contact their doctor right away if they experience side effects.

For women who are pregnant or seeking to become pregnant, or who are nursing babies, there are no reported side effects, birth defects or other problems reported with taking this medication.

Storage

This medication should be kept in a container that is closed, and kept at room temperature, and should not be kept where there is excessive heat, moisture, or direct light. This medication should not be frozen. This medication should also not be left outside or in a car, as it could be exposed to extremely hot or cold temperatures. Patients should avoid damaging or making holes in the canister containing this medication, and should be kept away from fire, even when empty.

As with all medications, rectal anesthetic should be kept out of the reach of children. Any medication that is no longer in use or which has passed the expiration date should be disposed of properly. For proper disposal of this and other medications, check with a health or law enforcement professional.

Summary

Rectal anesthetics can provide relief for the pain and itching of hemorrhoids (piles) or other types of itching and irritation in the rectal area. These types of anesthetics are sold over the counter without a prescription, but can also be prescribed by a doctor if the patient has other medical conditions or has a more severe form of hemorrhoids.

Rectal anesthetics come in several forms: cream, suppository or foam, and packaging includes applicators as needed. The medication is applied to the outside of the rectal area, or inserted into the rectum. However, for patients that have hemorrhoids that are bleeding, especially after a bowel movement, it's important to discuss with a doctor prior to applying any of these medications. Rectal bleeding may be a sign that there is a more serious condition present.

Patients can also obtain information about the use of these medications from a pharmacist. This medication should not be taken by children without direction of a doctor or health professional.

While there are few severe side effects, there are reports of additional redness, itching or swelling in the rectal area by some patients. It is also not recommended to take more of this medication than is recommended by the doctor or the manufacturer, at the risk of suffering from unwanted side effects. If any of these occur, patients should seek medical advice. In addition, if the medication is not working to reduce the pain and itching over the course of seven days, there may be another medical issue present, and medical advice should be sought.

By taking this medication as directed, patients can get relief from the common pain and irritation of hemorrhoids.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 02, 2018