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Sunday, July 27, 2025

Hydrocortisone for piles and itchy bottom


Hydrocortisone for piles (hemorrhoids) and itchy bottom (pruritus ani) is a well-established topical treatment option used to reduce inflammation, swelling, redness, and itching in the anal region. It belongs to the class of mild corticosteroids and is commonly formulated in ointments, creams, suppositories, and rectal foams tailored for anorectal use. Hydrocortisone does not cure the underlying cause of hemorrhoids or anal irritation but effectively alleviates the local inflammatory symptoms associated with these conditions.

Pharmacological Classification

  • Drug class: Mild topical corticosteroid

  • ATC Code: C05AA01 (hydrocortisone for hemorrhoidal disease)

  • Available formulations:

    • Hydrocortisone 0.5%–1% cream or ointment (topical perianal use)

    • Hydrocortisone acetate 25–100 mg suppositories (rectal insertion)

    • Hydrocortisone foam (for internal hemorrhoids or proctitis)

Mechanism of Action

Hydrocortisone exerts anti-inflammatory, anti-pruritic, and vasoconstrictive effects when applied to the perianal region or inserted rectally. Its action includes:

  • Inhibition of inflammatory mediators such as prostaglandins and leukotrienes

  • Suppression of local immune responses (T-cell and cytokine activity)

  • Reduction of capillary permeability, leading to less swelling and redness

  • Decreased sensation of itching by dampening histamine-mediated and cytokine-driven signaling

These actions relieve pain, discomfort, and irritation in both external and internal hemorrhoids, and in non-specific pruritus ani.

Indications

Primary Indications

  • Hemorrhoids (piles) – internal and external

  • Pruritus ani – chronic or acute anal itching

  • Proctitis (inflammation of rectal mucosa)

  • Anal eczema or dermatitis

  • Perianal inflammatory conditions, including post-hemorrhoidectomy irritation

Secondary Indications (off-label or combination products)

  • Postoperative inflammation following anal surgery

  • Symptomatic relief in fissures (only with physician approval)

  • Infective proctitis (used with antimicrobials)

Dosage and Administration

Topical Hydrocortisone Cream/Ointment (0.5–1%)

  • Apply a thin layer to the external anal area 2–3 times daily, after cleaning the area

  • Limit duration to 7 days without medical supervision

  • Wash hands before and after application

  • Best applied after bowel movement and gentle cleaning with warm water

  • May be used with or without a plastic applicator for internal delivery (depending on formulation)

Hydrocortisone Rectal Suppositories (25–100 mg)

  • Insert 1 suppository once or twice daily

  • Used for internal hemorrhoids or inflammation higher in the anal canal

  • Duration: usually 5–7 days, up to 2 weeks under medical supervision

Hydrocortisone Rectal Foam (e.g., 10% hydrocortisone acetate)

  • Shake well before use

  • Administer into the rectum using applicator provided

  • Dose: 1 application once or twice daily

  • Foam is particularly effective for proctitis or inflammation of the lower rectum

Contraindications

  • Untreated bacterial, fungal, or viral infections in the perianal region

  • Anal tuberculosis

  • Hypersensitivity to hydrocortisone or formulation ingredients

  • Use in children under 12 years without medical advice

  • Ulcerated or broken skin without diagnosis

  • Presence of anal abscess or fistulae (requires surgical or antimicrobial intervention)

Precautions

  • Short-term use only – risk of skin atrophy and local irritation with prolonged use

  • Do not occlude the area (e.g., tight clothing or occlusive dressings) unless advised

  • Avoid using hydrocortisone concurrently with other topical steroids in the same area

  • Wash area gently with water (avoid soaps or alcohol-based wipes) before application

  • Monitor for infection – hydrocortisone can suppress local immune response

  • Avoid rectal use in cases of suspected rectal bleeding or severe pain unless prescribed

  • Do not use during diarrhea, acute fissures, or perianal abscess unless instructed

Adverse Effects

Local Side Effects

  • Burning, stinging, or irritation after application

  • Skin thinning (atrophy) with prolonged use

  • Stretch marks or discoloration (especially in sensitive skin)

  • Perianal contact dermatitis (rare)

  • Exacerbation of fungal or bacterial infections if misused

  • Local hypopigmentation

Systemic (rare with topical use)

  • HPA axis suppression, especially in long-term high-potency use or occlusion

  • Cushingoid features in sensitive individuals

  • Growth retardation in children with inappropriate prolonged use

  • Hyperglycemia or mood changes (extremely rare and typically with stronger corticosteroids)

Drug Interactions

  • Minimal systemic absorption at low doses – interactions are rare

  • Do not combine with other topical corticosteroids in the same area

  • Avoid use with strong skin sensitizers (e.g., benzocaine, soaps, astringents) that may worsen irritation

  • Avoid concurrent antifungals or antibacterials unless included in a combined formulation (e.g., hydrocortisone + clotrimazole)

Use in Special Populations

Pregnancy

  • Topical hydrocortisone 1% is considered safe for short-term use

  • Avoid frequent or prolonged application on large areas

Breastfeeding

  • Safe when not applied near the nipple area

  • Avoid application to skin that the infant may come into contact with

Children

  • Avoid use in children under 12 years unless supervised

  • High risk of skin thinning, percutaneous absorption, and adrenal suppression

Elderly

  • Skin may be thinner – use with caution

  • Monitor for skin fragility and delayed wound healing

Comparison with Other Treatments for Hemorrhoids

  • Hydrocortisone vs Lidocaine-containing creams:

    • Hydrocortisone targets inflammation

    • Lidocaine provides pain relief but no anti-inflammatory effect

  • Hydrocortisone alone vs Combination products:

    • Some brands include hydrocortisone + zinc oxide or local anesthetic (e.g., cinchocaine)

    • Combination products may offer broader symptom relief (e.g., Anusol HC®)

  • Suppositories more effective for internal hemorrhoids

  • Creams and ointments are more suitable for external hemorrhoids and itchy skin

Patient Counseling

  • Explain that the medication is intended for external anal use unless labeled as suppository or foam

  • Recommend good anal hygiene: warm water cleansing, pat dry gently

  • Avoid scratching, perfumed soaps, and tight undergarments

  • Do not exceed 7 days of use without medical reassessment

  • Inform patients to seek medical attention if bleeding, pain, or symptoms persist or worsen

Brand Names and Products

  • Anusol HC® – hydrocortisone + zinc oxide (cream/suppository)

  • Proctosedyl® – hydrocortisone + cinchocaine

  • Scheriproct® – hydrocortisone + local anesthetic (cinchocaine)

  • Xyloproct® – hydrocortisone + lidocaine

  • Generic Hydrocortisone 1% cream/ointment – OTC for mild symptoms

  • Colifoam® – rectal hydrocortisone foam (Rx) for internal inflammation

  • Anovate®, Procto-Glyvenol® – regional brands with corticosteroids ± anesthetics

Storage

  • Store creams and ointments at 15–25°C (room temperature)

  • Keep away from children

  • Do not share medications due to hygiene risk

  • Use within expiry date and discard contaminated applicators




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