Topical haemorrhoidal preparation Pregnancy: Do not use in pregnancy or breast-feeding — inadequate evidence of safety in human pregnancy; there may be a very small risk of cleft palate and intrauterine growth retardation as well as suppression of the neonatal HPA axis, and there is evidence of harmful effects in animals.

Benzyl benzoate with bismuth oxide, bismuth subgallate, hydrocortisone acetate, Peru balsam and zinc oxide

Brand names: Anusol HC, Proctosedyl

Used in: Anaphylaxis & Allergy

This is a compound topical preparation for the symptomatic relief of haemorrhoids and perianal irritation, combining benzyl benzoate, bismuth salts, hydrocortisone acetate, Peru balsam and zinc oxide.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Apply ointment to the affected area

Route: Anal application (topical; rectal nozzle provided for internal conditions). Not to be taken orally

Frequency: At night, in the morning and after each evacuation

Max: Maximum of 4 applications a day; use for a maximum period of one week

Thoroughly cleanse the affected area, dry, and apply the ointment on a gauze dressing. For internal conditions use the rectal nozzle provided — remove the nozzle cap and clean the nozzle after each use. Do not use for more than 7 days unless under the direction of a doctor; prolonged or excessive use may produce systemic corticosteroid effects. Elderly (over 65 years): as for adults. Children: not recommended. Following symptomatic relief a definitive diagnosis should be established; patients with rectal bleeding or blood in the stool should speak to their doctor before use. Source SPC is for Anusol HC Ointment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Tubercular, fungal and most viral lesions including herpes simplex, vaccinia and varicella
Hypersensitivity to the active substances or to any of the excipients
Pregnancy and breast-feeding

Side effects

Hypersensitivity (rare)
Application site reactions including burn, erythema, exfoliation, irritation, pain, pruritus, rash and urticaria (frequency not known)
Blurred vision (frequency not known)
Skin sensitisation reactions and systemic contact dermatitis attributed to Balsam Peru (reported in published literature)
Systemic corticosteroid effects with prolonged or excessive use

Interactions

Concurrent use with other corticosteroid preparations, either topically or orally, may increase the likelihood of systemic effects
CYP3A inhibitors, including cobicistat-containing products — expected to increase the risk of systemic corticosteroid effects; avoid the combination unless benefit outweighs risk, with monitoring

Clinical monograph

How it works

It combines a mild topical corticosteroid (hydrocortisone acetate) to reduce inflammation with astringent and soothing/protectant components (bismuth salts, zinc oxide) and Peru balsam.

Prescribing in practice

Because it contains a corticosteroid, limit to short-term use, as prolonged perianal application can cause skin thinning; exclude infection first.
Peru balsam and other constituents may cause local sensitisation, so discontinue if irritation or an allergic reaction develops.
It is intended for short courses of symptomatic relief rather than ongoing treatment.

Monitoring

No laboratory monitoring is required; review symptoms and stop if there is no improvement or if local reactions occur.

Counselling the patient

Use for short periods only and seek review if symptoms persist, recur or worsen.
Stop and seek advice if rectal bleeding occurs or the area becomes more irritated.
Attention to fibre, fluids and avoiding straining helps the underlying problem.

Evidence & guidelines

Compound corticosteroid-containing haemorrhoidal preparations are recommended for short-term symptomatic relief in line with standard UK practice.

Reference: NICE CKS Haemorrhoids; ACPGBI; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways