Is Preparation H safe during pregnancy?

What does the evidence say about preparation H during pregnancy?

1. Preparation H Maximum Strength cream lists four actives: glycerin 14.4 percent as a protectant, phenylephrine HCl 0.25 percent as a vasoconstrictor, pramoxine HCl 1 percent as a local anesthetic, and white petrolatum 15 percent as a protectant, applied externally or in the lower portion of the anal canal only, up to 4 times daily. 1
2. The label directs users to ask a doctor before use if they have heart disease or high blood pressure, and to ask a health professional before use if pregnant or breastfeeding. It is marked for external use only. 1
3. Applying over-the-counter hemorrhoid creams, ointments or suppositories may relieve mild pain, swelling and itching of external hemorrhoids, and doctors most often recommend using over-the-counter products for 1 week. Follow up if symptoms are not relieved after a week or if the product causes dry skin around the anus or a rash. 2
4. Estimates of hemorrhoid disease in pregnant women range as high as 35 percent, and first-line conservative care is increased dietary fiber, stool softeners and increased water intake, with fiber needing adequate water so that stool is soft rather than merely bulky. 3
5. On the vasoconstrictor ingredient, MotherToBaby reports that studies involving more than 1,500 women who took phenylephrine in the first trimester did not show an increased chance of birth defects, and notes that taking phenylephrine could raise blood pressure. 4

Is preparation H safe in each trimester?

• First trimester. Hemorrhoids are uncommon this early, so if they have arrived already, the cause worth chasing is constipation rather than the cream aisle. StatPearls puts hemorrhoid disease in pregnancy as high as 35 percent overall, with fiber, fluids and stool softeners as first-line conservative care.
• Second trimester. This is where straining starts to build, and where the product line difference matters. The vasoconstrictor version carries a label instruction to ask a doctor before use if you have heart disease or high blood pressure, which is worth reading rather than assuming a hemorrhoid cream is inert.
• Third trimester. Peak hemorrhoid season, and peak temptation to use a cream indefinitely. NIDDK's guidance is that doctors most often recommend using over-the-counter products for 1 week, and to follow up if symptoms are not relieved after that week or if the product causes dry skin or a rash.