Creams/topicals that can help

• Hydrocortisone cream (1%) - reduces local inflammation and itching around the lump.
• Combination hemorrhoid creams with lidocaine (e.g., hydrocortisone + lidocaine) - numbs pain and reduces swelling.
• Heparinoid cream - specifically advised in the medical literature to help clear the clot in a perianal hematoma.
• Witch hazel-based creams/pads - soothing, mildly astringent, good for cleaning and comfort.
• Nitroglycerin or nifedipine ointment - sometimes prescribed to relax the local blood vessels and ease pain in thrombosed hemorrhoids (prescription only).

Alongside the cream

• Warm sitz baths 2-3 times a day (15 minutes, warm water) - this helps more than cream alone.
• Ice/cold compress for the first 24-48 hours to reduce swelling and pain.
• Stool softeners/increase fiber and fluids so you don't strain again - straining is what caused this and will make it worse or recur.
• Oral pain relief (ibuprofen or paracetamol) as needed.
• Avoid sitting for long periods; a donut cushion can help.

When cream is not enough

• If the lump is very painful, hard, and appeared within the last 24-72 hours, a doctor can drain the clot under local anesthetic in a quick office procedure, which gives immediate relief - creams alone won't dissolve a large clot quickly.
• See a doctor if there's heavy bleeding, the lump keeps growing, you develop fever, or pus/foul discharge (could indicate infection or a perianal abscess/pilonidal cyst rather than a simple hematoma, which needs different treatment such as drainage or antibiotics).
• If it's not improving after a week of home care, or this keeps recurring, get it evaluated to confirm it's a hemorrhoid/hematoma and not something else (e.g., pilonidal cyst, skin tag, or anal fissure).