Hemorrhoids
Clinical basis & sources
- Primary source
- OCP Minor Ailments Prescribing
Sources used
- Ontario Regulation 256/24: GeneralGovernment of Ontario · 2026
- Minor Ailments: Drug Classes and Specified DrugsOntario College of Pharmacists · 2026
- Executive Officer Notice: Update to Funding for Minor Ailment Services in Ontario Pharmacies (Effective July 1, 2026)Government of Ontario · 2026-05-19
- Hemorrhoids: Diagnosis and Treatment OptionsAmerican Family Physician · 2018
- Clinical Practice Guidelines for the Management of HemorrhoidsAmerican Society of Colon and Rectal Surgeons · 2024
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Allowable drugs under Schedule 4 (7)
Drugs an Ontario pharmacist may prescribe for Hemorrhoids under O. Reg. 256/24, Schedule 4. Choice still depends on the assessment, contraindications, allergies, and product availability — this is the eligible list, not a recommendation.
- Dibucaine (Cinchocaine)
- Esculin (Aesculin)
- Framycetin (Neomycin B)
- Hydrocortisone
- Phenylephrine
- Pramoxine
- Zinc sulfate
Symptoms this assessment screens
- Small-volume bright red blood with bowel movements
- Anal itching, irritation, burning, or soiling
- Soft swelling, lump, or reducible prolapse
- Mild anorectal discomfort, worse with bowel movements or sitting
- Constipation, straining, low-fiber diet, diarrhea, pregnancy, or prolonged toilet sitting trigger
- Short duration and previously responsive to self-care
Red flags — any positive means refer
- Rectal bleeding age over 40, heavy/persistent bleeding, black or tarry stool, anemia symptoms, or high bleeding risk
- Unexplained weight loss, abdominal pain, fever, change in bowel habits, personal/family colorectal cancer or polyps, or inflammatory bowel disease risk
- Severe anal pain, sudden painful lump, or suspected thrombosed external hemorrhoid
- Fever, pus, purulent drainage, rapidly worsening pain, or suspected perianal abscess
- Rectal mass, prolapse that cannot be reduced, fecal incontinence, or diagnostic uncertainty
- Child, immunocompromised patient, complex pregnancy/postpartum concern, anticoagulation, or significant comorbidity
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