Lidocaine for Piles

1. Introduction

Lidocaine is a local anaesthetic commonly used to relieve pain, discomfort, and itching associated with piles (haemorrhoids) and anal itching. It works by blocking sodium channels in nerve endings, providing rapid and temporary numbness in the affected area.

2. Indications

  • Approved Indications:
    • Pain and itching associated with haemorrhoids.
    • Anal fissures.
    • Post-anal surgery pain relief.
  • Off-Label Uses:
    • Pruritus ani (chronic itching of the anal area).

3. Dosage

  • Adults and Elderly:
    • Creams or Gels (e.g., 5%): Apply a small amount (pea-sized) to the affected area 2–4 times daily as needed.
    • Ointments or Suppositories: Insert 1 suppository into the rectum up to 3 times daily for internal piles.
  • Children (≥12 years):
    • Use with caution and in the lowest effective dose. Apply as directed by a healthcare professional.

4. Administration

  • External Application: Clean the area with mild soap and water, pat dry, and apply a thin layer of cream or gel to the affected area.
  • Internal Application: Use a suitable applicator for ointments or suppositories, and avoid excessive use.

5. Forms Available

  • Cream: 2%, 5%.
  • Ointment: 5%.
  • Suppositories: 5%.

6. Side Effects

6.1. Common Side Effects

  • Temporary numbness or tingling at the application site.
  • Mild irritation or redness.

6.2. Less Common Side Effects

  • Dryness or peeling of the skin.
  • Sensitivity reactions, such as mild itching or burning.

6.3. Rare but Serious Side Effects

  • Allergic reactions (e.g., rash, swelling).
  • Systemic toxicity if large amounts are applied (e.g., confusion, drowsiness, seizures).

7. Warnings

  • Systemic Absorption: Excessive application, especially to broken skin or mucous membranes, may lead to systemic toxicity.
  • Prolonged Use: Avoid prolonged use (more than 7 days) without medical supervision.
  • Allergy Risk: Rare allergic reactions may occur; discontinue use if symptoms develop.

8. Precautions

  • Avoid application to large areas or broken skin to reduce the risk of systemic absorption.
  • Use sparingly to prevent irritation or sensitivity.
  • Avoid using in children under 12 years unless directed by a healthcare professional.

9. Interactions

  • Drug-Drug Interactions:
    • Beta-blockers: May increase the risk of lidocaine toxicity.
    • CYP3A4 inhibitors (e.g., erythromycin, ketoconazole): May increase lidocaine levels.
  • Drug-Food Interactions:
    • None significant.

10. Monitoring Parameters

  • Relief of pain and itching symptoms.
  • Signs of local irritation or allergic reactions.
  • Symptoms of systemic toxicity if excessive amounts are used.

11. Use in Children

  • Use cautiously in children ≥12 years, as excessive application can lead to toxicity.

12. Use in Pregnancy

  • Category B: Safe for short-term use in pregnancy under medical supervision. Avoid excessive application.

13. Use in Elderly

  • Safe for use, but start with the lowest effective dose due to increased sensitivity in older adults.

14. Use in Kidney Disease

  • No specific dose adjustments are required with topical use. Monitor for systemic toxicity in severe renal impairment.

15. Use in Liver Disease

  • Use cautiously in severe liver impairment, as lidocaine is metabolised in the liver.

16. Patient Counselling Points

  • Clean and dry the area before application to ensure effectiveness.
  • Apply only a thin layer to the affected area to minimise the risk of irritation or systemic effects.
  • Avoid prolonged use beyond 7 days without consulting a doctor.
  • Report any signs of persistent irritation, rash, or numbness extending beyond the treated area.
  • For internal piles, use suppositories or ointments with the applicator provided.
  • Keep the product out of reach of children to prevent accidental ingestion or misuse.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
Xyloproct (Ointment)AstraZeneca$20–40 (30 g, 5%)
Anamantle HC (Cream)Various manufacturers$10–20 (30 g, 5%)
Lidocaine SuppositoriesVarious manufacturers$15–30 (10 suppositories, 5%)

18. FAQs (15 Questions)

  1. What is lidocaine used for in piles?
    It is used to relieve pain, itching, and discomfort caused by piles and anal fissures.
  2. How does lidocaine work?
    It numbs the area by blocking nerve signals, providing temporary relief.
  3. How often can I apply lidocaine for piles?
    You can apply it 2–4 times daily, as directed by your doctor.
  4. Can lidocaine treat piles permanently?
    No, it provides symptom relief but does not treat the underlying condition.
  5. How long does the numbing effect of lidocaine last?
    The numbing effect typically lasts 30–60 minutes.
  6. Is lidocaine safe for children?
    Use cautiously in children ≥12 years; avoid excessive application.
  7. Can I use lidocaine while pregnant?
    Yes, it is generally safe for short-term use during pregnancy under medical supervision.
  8. What are the common side effects of lidocaine?
    Common side effects include temporary numbness, mild irritation, or tingling.
  9. Can lidocaine cause allergic reactions?
    Rarely, but symptoms like rash, swelling, or difficulty breathing require immediate medical attention.
  10. What should I do if I apply too much lidocaine?
    Seek medical attention if symptoms of toxicity (e.g., dizziness, confusion, irregular heartbeat) occur.
  11. How long can I use lidocaine for piles?
    Do not use for more than 7 days without consulting a doctor.
  12. Can lidocaine be used with other haemorrhoid treatments?
    Yes, but consult your doctor to avoid overuse or interactions.
  13. Is lidocaine effective for anal fissures?
    Yes, it provides temporary pain relief for anal fissures.
  14. Can I use lidocaine after anal surgery?
    Yes, it is commonly used to manage post-operative pain and discomfort.
  15. How should lidocaine be stored?
    Store at room temperature, away from light and moisture.