From the Guidelines
Hydrocortisone suppositories are not the preferred treatment for hemorrhoids or proctitis, as mesalamine suppositories are more effective for inducing remission in patients with mild-moderate ulcerative proctitis. According to the AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis 1, mesalamine suppositories are recommended for patients with mild-moderate ulcerative proctitis who opt for rectal therapy. The guidelines suggest that rectal corticosteroid therapy, such as hydrocortisone suppositories, may be considered for patients who are refractory to or intolerant of mesalamine suppositories, but the evidence for this is low quality.
The use of hydrocortisone suppositories for hemorrhoids is not supported by strong evidence, and the American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids 1 notes that data supporting the use of topical agents and suppositories, including hydrocortisone, are lacking.
Key points to consider when using hydrocortisone suppositories include:
- They should not be used for longer than recommended without medical supervision, as prolonged use can lead to thinning of rectal tissue or systemic absorption.
- If symptoms persist beyond a week or worsen, medical attention should be sought as this may indicate a more serious condition requiring different treatment.
- Mesalamine suppositories are the preferred treatment for mild-moderate ulcerative proctitis, and hydrocortisone suppositories should only be considered for patients who are refractory to or intolerant of mesalamine suppositories.
From the Research
Hydrocortisone Suppositories for Hemorrhoids
- Hydrocortisone suppositories have been used to treat internal and external hemorrhoids, as well as anal fissures, with a uniquely designed suppository called the Rectal Rocket delivering lidocaine and hydrocortisone directly to the site of inflammation 2.
- A study comparing rectal suppositories containing combined extract of Cissus quadrangularis Linn. and Acmella paniculata with commercialized rectal suppository containing hydrocortisone and cinchocaine found that both treatments had comparable effects on bleeding, prolapse size, and anal pain in patients with hemorrhoids 3.
- Another study found that recombinant streptokinase suppositories were more effective than hydrocortisone acetate-based suppositories in treating acute hemorrhoidal disease, with a higher complete response rate and faster time to response 4.
Hydrocortisone Suppositories for Proctitis
- A study comparing mesalazine suppositories with hydrocortisone foam in the treatment of acute proctitis found that mesalazine suppositories were more effective in reducing rectal blood loss and mucus, and had a greater decrease in endoscopy score 5.
- Another study found that budesonide enema was as effective as hydrocortisone foam enema in treating active haemorrhagic proctitis, but without the potential for side-effects associated with suppression of plasma cortisol 6.