Xyloproct

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Xyloproct on Prescriptsy

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Xyloproct is a topical anorectal preparation containing four active ingredients: lidocaine 5% (local anaesthetic), hydrocortisone acetate 0.275% (corticosteroid), aluminium acetate 3.5% (astringent), and zinc oxide 18% (skin protectant).

It is prescribed for the symptomatic treatment of haemorrhoids (piles), anal fissures, and pruritus ani (anal itching), providing relief from pain, burning, itching, swelling, and inflammation.

Xyloproct is available as an ointment and suppositories, and it is a prescription-only medicine (POM) in the United Kingdom.

Haemorrhoids are one of the most common anorectal conditions, affecting an estimated 4 to 25% of the adult population in the UK at any given time, with the prevalence increasing with age.

They result from the pathological enlargement and downward displacement of the normal anal vascular cushions (specialised, highly vascularised submucosal tissue in the anal canal that contribute to anal continence).

Despite their prevalence, haemorrhoids cause significant physical discomfort and embarrassment, and many people delay seeking medical advice.

This page provides a comprehensive clinical guide to Xyloproct, covering its mechanism of action, how to use it, side effects, important warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about Xyloproct

Before reading further, note these essential safety points about Xyloproct.

• Do not use Xyloproct for longer than 7 days continuously without medical advice.
• Rectal bleeding should always be properly evaluated by a healthcare professional. Do not assume it is caused by haemorrhoids.
• Do not use Xyloproct if you have an untreated bacterial, fungal, or viral infection in the perianal area.
• Xyloproct is for rectal and perianal use only. Do not take by mouth or apply to other body areas.
• See your GP if symptoms persist, worsen, or recur frequently.

Understanding haemorrhoids

Haemorrhoids are classified as internal (arising above the dentate line, covered by columnar epithelium) or external (arising below the dentate line, covered by squamous epithelium).

Internal haemorrhoids are graded from I to IV. Grade I haemorrhoids bleed but do not prolapse. Grade II prolapse during straining but reduce spontaneously.

Grade III prolapse and require manual reduction. Grade IV are permanently prolapsed and cannot be reduced.

External haemorrhoids present as painful perianal lumps, particularly when thrombosed (containing a blood clot).

The pathophysiology involves deterioration and displacement of the normal anal cushion connective tissue (including smooth muscle fibres from the muscularis submucosae ani, also known as Treitz's muscle, and the elastic connective tissue framework).

Contributing factors include chronic constipation and straining at stool, prolonged sitting (particularly on the toilet), low-fibre diet, pregnancy (increased intra-abdominal pressure and pelvic venous congestion), ageing (degeneration of the supportive connective tissue), heavy lifting, obesity, and chronic diarrhoea.

A familial predisposition exists in some individuals.

Symptoms of haemorrhoids include painless bright red rectal bleeding (typically on the toilet paper or dripping into the pan after a bowel movement), perianal itching (pruritus ani), mucous discharge, a sensation of incomplete evacuation, and a palpable lump at the anus.

Pain is typically associated with external haemorrhoids, thrombosed haemorrhoids, and anal fissures rather than uncomplicated internal haemorrhoids.

How Xyloproct works

Xyloproct delivers four complementary active ingredients to the symptomatic site.

Lidocaine 5% provides rapid pain relief by blocking voltage-gated sodium channels in the sensory nerve endings of the perianal skin and anal canal mucosa.

Onset of anaesthesia occurs within 2 to 5 minutes of application, providing relief from the pain, burning, and itching that are the most distressing symptoms of haemorrhoids.

The local anaesthetic effect lasts approximately 30 to 60 minutes per application.

Hydrocortisone acetate 0.275% is a mild topical corticosteroid that suppresses the local inflammatory response.

It inhibits the release of pro-inflammatory mediators (prostaglandins, leukotrienes, cytokines) by binding to intracellular glucocorticoid receptors, reducing the oedema, erythema, and itching associated with inflamed haemorrhoidal tissue.

The low concentration (0.275%) is appropriate for the thin, sensitive perianal skin and limits the risk of local steroid side effects when used for short courses.

Aluminium acetate 3.5% acts as an astringent.

It causes mild precipitation of surface proteins on the inflamed mucosa, reducing exudation (mucous and serous discharge), forming a protective pellicle on the tissue surface, and providing a mild antiseptic effect.

This helps to keep the perianal area drier and reduces the maceration and irritation caused by chronic moisture exposure.

Zinc oxide 18% is a well-established skin protectant.

It forms a physical barrier on the perianal skin, protecting inflamed and excoriated tissue from contact with faecal matter, digestive enzymes, and moisture.

Zinc oxide also has mild astringent and antiseptic properties and promotes wound healing by providing a favourable environment for epithelial repair.

Management of haemorrhoids in the UK

NICE Clinical Knowledge Summaries (CKS) on haemorrhoids recommend a stepwise approach to management.

First-line treatment for all grades of haemorrhoids is lifestyle and dietary modification: increasing dietary fibre to 25 to 30 grams daily, drinking 6 to 8 glasses of water daily, avoiding straining at stool, responding promptly to the urge to defecate, and maintaining regular physical activity.

Bulk-forming laxatives (ispaghula husk, sterculia) or stool softeners (docusate sodium) may be added if dietary measures alone are insufficient to produce soft, well-formed stools.

Topical preparations are used for symptomatic relief while lifestyle modifications take effect.

Options include simple soothing preparations (bland ointments and suppositories containing protectants such as zinc oxide, bismuth subgallate, and Peru balsam), local anaesthetic-containing preparations (lidocaine-based products), and corticosteroid-containing preparations (for short-term use when inflammation is prominent).

Xyloproct combines all three approaches in a single product, making it a comprehensive topical treatment option.

If symptoms persist despite conservative management, procedural interventions may be recommended.

Grade I and II haemorrhoids may be treated with rubber band ligation (the most commonly performed office-based procedure in the UK, with success rates of 60 to 80%), injection sclerotherapy, or infrared coagulation.

Grade III and IV haemorrhoids, or those failing office-based treatments, may require surgical haemorrhoidectomy (excisional or stapled), haemorrhoidal artery ligation (HALO/THD procedure), or other specialist procedures.

Dosage and administration

Xyloproct Ointment: apply a small amount to the affected external area up to 3 times daily and after each bowel movement.

For internal haemorrhoids, use the applicator nozzle to insert ointment into the rectum. Clean the perianal area gently with warm water and pat dry before application.

Wash hands before and after use. Clean the applicator nozzle after each use.

Xyloproct Suppositories: insert 1 suppository into the rectum up to 3 times daily, preferably after a bowel movement.

Remove the wrapper and moisten the tip with water if needed for easier insertion. Insert pointed end first. Wash hands before and after insertion.

Use for the shortest duration necessary. Do not exceed 7 days of continuous use without medical review. If symptoms have not improved after 7 days, consult your prescriber for reassessment and consideration of alternative diagnoses or treatments.

Side effects of Xyloproct

Common side effects

Local burning, stinging, or itching at the application site is the most frequently reported side effect.

This occurs particularly on first application or when the preparation is applied to broken or excoriated skin.

It usually resolves within a few minutes and does not require stopping treatment.

Uncommon side effects

Allergic contact dermatitis to one or more components can develop, presenting as worsening redness, itching, or a new rash at the application site.

If the perianal area worsens during treatment, stop Xyloproct and consult your prescriber. Sensitisation to the lidocaine component is rare.

Localised dryness or skin irritation from the astringent components (aluminium acetate, zinc oxide) may occur.

Risks of prolonged use

Using Xyloproct for longer than the recommended 7 days increases the risk of local corticosteroid side effects.

The perianal skin is thin and susceptible to skin thinning (atrophy), stretch marks (striae), and telangiectasia. These changes may be irreversible.

Prolonged corticosteroid use also risks masking symptoms of perianal infection, which could worsen untreated.

Systemic absorption of both lidocaine and hydrocortisone from anorectal application at recommended doses is minimal. Clinically significant systemic effects are not expected with short-term use. Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk.

Warnings and precautions

Diagnostic considerations

Rectal bleeding should never be assumed to be caused by haemorrhoids without proper assessment.

Colorectal cancer, inflammatory bowel disease (Crohn's disease, ulcerative colitis), anal fissure, perianal abscess, anal fistula, and sexually transmitted infections can present with similar symptoms.

NICE referral guidelines (NG12: suspected cancer) recommend urgent 2-week-wait referral for patients aged 40 or over with unexplained rectal bleeding combined with a change in bowel habit, abdominal pain, or weight loss.

Any patient with persistent rectal bleeding should be evaluated by their GP.

Contraindications

Xyloproct should not be used in patients with untreated perianal infections (bacterial, fungal, or viral), including perianal herpes simplex, perianal warts (condylomata), and perianal candidiasis.

The corticosteroid component can suppress the local immune response and worsen infection. It is contraindicated in patients with known allergy to lidocaine or hydrocortisone.

Pregnancy and breastfeeding

Haemorrhoids are particularly common during pregnancy (affecting up to 35% of pregnant women) and the postpartum period.

The safety of Xyloproct in pregnancy has not been established in formal studies.

Low-dose topical hydrocortisone applied to a limited area for a short course is generally considered low risk, but use should be discussed with the prescriber or midwife.

First-line management of haemorrhoids in pregnancy is dietary fibre, adequate hydration, and avoidance of straining.

How to get Xyloproct in the UK

Xyloproct is available on NHS prescription from your GP or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

The standard NHS prescription charge in England is 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Over-the-counter alternatives for mild haemorrhoidal symptoms include Anusol, Germoloids, and Preparation H, available from pharmacies without prescription.

If these prove inadequate, your GP can prescribe Xyloproct or refer you for specialist assessment if needed.

Sources

• Xyloproct Ointment, Summary of Product Characteristics (EMC)
• Haemorrhoids, Treatment Summary, British National Formulary (BNF)
• Haemorrhoids, NICE CKS
• Piles (haemorrhoids), NHS
• MHRA Yellow Card Scheme