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BNSSG Adult Joint Formulary

1.9 Rectal and anal disorders

Last edited: 15-04-2024

1.9.1 Haemorrhoids

First line drugs Second line drugs Specialist drugs Secondary care drugs


Recommended: (TLS Green)

Anusol® cream & suppositories



Recommended: (TLS Green)

Anusol HC® ointment & suppositories

Scheriproct® ointment & suppositories


Rectal Sclerosants

Recommended: (TLS Green)

Oily Phenol Injection 5%


Management of Anal Fissures 

Recommended: (TLS Green)

Glyceryl trinitrate 0.4% rectal ointment (Rectogesic®)

Specific indication:

Diltiazem 2% ointment or cream (unlicensed) (TLS Blue)

  • If Glyceryl trinitrate 0.4% rectal ointment inappropriate or failed


Botulinum toxin type A (TLS Red)

  • For chronic anal fissure where topical treatments have failed

See Botulinum Toxin A Pathways page for more information


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