The short answer: Coat the skin around your anus before the first dose, then clean gently and reapply after each bowel movement. Use alcohol-free, fragrance-free wipes. Ask before using suppositories, and call about rectal bleeding. The 2025 US Multi-Society Task Force guidance favors split-dose prep, so plan for two rounds.

Why does prep hurt more with hemorrhoids?

Prep works by causing many watery bowel movements in a short time. That means repeated wiping and long spells on the toilet. The GOLYTELY label lists anal irritation among its adverse reactions, so soreness is a known effect of the prep itself.

Hemorrhoids make that skin more likely to complain. The NIDDK describes external hemorrhoids as tender lumps that can itch or ache, and internal hemorrhoids as a source of bright red blood. One Arizona GI practice warns its patients that a flare of hemorrhoid inflammation can happen during prep.

You are in common company. The NIDDK says hemorrhoids affect about 1 in 20 Americans and about half of adults older than 50.

Hemorrhoids are not a reason to cut the prep short. The task force recommends a split-dose regimen, and a poor clean-out can hide what the doctor needs to see. For taste and drinking tricks, see our colonoscopy prep tips. This page covers the skin.

What protects sore skin during prep?

These are the measures backed by a source we read. Most come from hospital prep sheets or hemorrhoid guidance. We found no study of skin care during prep.

  • A barrier layer. A New Zealand screening program leaflet says to apply Vaseline before starting prep and after each bowel motion. Memorial Sloan Kettering names petroleum jelly or A&D ointment after every bowel movement. UChicago Medicine lists petroleum jelly or diaper cream. FDA rules list petrolatum as an anorectal protectant.
  • Soft wipes. Stanford Health Care suggests baby wipes free of alcohol and fragrance. UChicago suggests soft toilet paper or unscented wipes.
  • Gentle cleaning. The FDA labeling rule for anorectal products says to clean with mild soap and warm water or a cleansing pad. It then says to dry by patting or blotting, which is a good model for each trip.
  • Warm water. The NIDDK says a warm sitz bath several times a day can relieve hemorrhoid pain. That advice is not specific to prep. Prep can also cause dizziness and fainting, per the New Zealand leaflet, so have someone nearby.
  • Less sitting. The NIDDK advises against long periods on the toilet. Get up between bowel movements if you can stay close to the bathroom.
  • Witch hazel pads. FDA rules list witch hazel as an anorectal astringent at 10 to 50 percent. The Arizona practice names Tucks pads as one option.

If irritation gets bad, UChicago suggests short breaks between prep doses. Keep any break inside the timing on your sheet.

Which products should you check with your unit first?

Sources are thinner here, and they do not all agree. Your unit's sheet comes first.

  • Suppositories. The Arizona practice tells prep patients not to use them. It allows a prescribed hemorrhoid cream. We found no national guideline on this, so ask.
  • Anything with alcohol. The same sheet says to avoid products containing alcohol, and Stanford's wipe advice matches it.
  • Medicated creams. The Arizona sheet lists hydrocortisone creams as an option. An American Family Physician summary of hemorrhoid guidance from the American Society of Colon and Rectal Surgeons warns that prolonged use of anesthetic, steroid, or antiseptic products can cause allergic reactions and sensitization.
  • Pain relievers. The NIDDK lists ibuprofen, naproxen, and aspirin for hemorrhoid pain. Memorial Sloan Kettering lists those same drugs as blood thinners to review with your care team before a colonoscopy. See our guide to medications to stop before a colonoscopy.
  • Fiber. Fiber is standard hemorrhoid care, but Memorial Sloan Kettering stops fiber supplements 3 days before. Follow your sheet, then ask when to restart.

Keep any external product outside the body. The FDA rule warns against pushing external-use products into the rectum with fingers or an applicator.

We looked for a warning about oily or colored products on the anal skin before a scope, and did not find one in the sources we read. Memorial Sloan Kettering's day-of rule on lotions and creams covers the chest and arms. We also found no source that says when to put on the last layer of ointment, so ask your unit.

What does a timed prep checklist look like?

This checklist combines the sources above. It assumes a split-dose prep and a morning procedure. Your sheet's times and rules replace ours.

  1. 3 days before: Buy petroleum jelly or diaper ointment, plus alcohol-free, fragrance-free wipes. Start any low-fiber diet and stop fiber supplements if your sheet says so.
  2. 2 to 3 days before: Call the unit. Ask about your hemorrhoid cream, suppositories, and pain relievers.
  3. Day before, on waking: Follow your diet rules. The task force limits diet changes to this day, though some sheets start sooner.
  4. Before the first dose: Apply your barrier layer. Set wipes and ointment within reach.
  5. About 1 hour after the first dose: Expect bowel movements to start, per Stanford. They may continue for 1 to 4 hours after you finish the dose.
  6. After each bowel movement: Clean gently, pat dry, and reapply. Do not stay on the toilet between trips.
  7. Evening, once things slow down: Take a warm sitz bath if you feel steady and someone is home.
  8. 4 to 6 hours before the procedure: Start the second dose. The task force says to finish at least 2 hours before the start time.
  9. When your sheet says to stop fluids: Stop. Stanford and Memorial Sloan Kettering both use 4 hours, though one counts from the appointment and the other from arrival.
  10. After the last bowel movement: Clean and pat dry.
  11. At check-in: Tell the nurse you have hemorrhoids. List every product you used and when.
  12. After you get home: Keep up gentle cleaning while you are sore. Memorial Sloan Kettering says bowel habits can stay irregular for up to a week.

If worry about the prep is costing you sleep, anxiety.md has plain guidance on handling nerves.

Which symptoms mean you should call the endoscopy unit?

Do not assume blood comes from your hemorrhoids. The NIDDK notes that rectal bleeding can also come from Crohn's disease, ulcerative colitis, or colorectal cancer.

During prep, call for these:

  • Rectal bleeding or severe belly pain. The Suprep medication guide says to tell your provider right away. It links these symptoms to bowel ulcers and ischemic colitis. It does not exempt small amounts of blood, and the FDA anorectal rule says to consult a doctor promptly for bleeding.
  • Severe anal pain with bleeding. The NIDDK says to seek care right away, especially with belly pain, diarrhea, or fever. Prep causes diarrhea, so judge by the pain and bleeding.
  • You cannot finish the prep. UChicago Medicine says to call your doctor. Do not quit in silence because of soreness.

After the colonoscopy, Memorial Sloan Kettering lists heavy rectal bleeding, bleeding between bowel movements, bleeding that lasts more than 24 hours, and a fever of 101 °F or higher. Very bad belly pain or bloating, weakness, faintness, and nausea are also on its list. Our guide to pain and bloating after a colonoscopy covers what is usual.

See a provider if hemorrhoid symptoms last longer than a week, as MedlinePlus advises. The FDA rule uses the same 7-day limit for anorectal products.

The bottom line

Coat the skin early, clean gently, and reapply after every bowel movement. Get answers on suppositories, creams, and pain relievers a few days ahead. Treat rectal bleeding during prep as a reason to call, not as a hemorrhoid you can ignore. Your unit's written sheet overrides anything here.

Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Follow your endoscopy unit's prep instructions, and call them with any concerns about bleeding, pain, or medicines.