From the Guidelines
Hydrocortisone suppositories do not have sufficient evidence to support their use in treating internal hemorrhoids. According to the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1, over-the-counter topical agents and suppositories, including corticosteroid creams, lack data supporting their use in reducing hemorrhoidal swelling, bleeding, or protrusion.
Key Points to Consider
- The use of psyllium has been shown to reduce hemorrhoidal bleeding and painful defecation in one double-blind, placebo-controlled trial 1.
- Topical analgesics may bring symptomatic relief of local pain and itching, but their effectiveness in treating internal hemorrhoids is not well-established 1.
- Corticosteroid creams may ameliorate local perianal inflammation, but long-term use of high-potency corticosteroid creams is deleterious and should be avoided 1.
- The most effective treatment for internal hemorrhoids involves adding dietary fiber and avoiding straining at stool, as recommended by the american gastroenterological association technical review 1.
Recommendations for Treatment
- Increase fiber intake to reduce hemorrhoidal bleeding and painful defecation.
- Avoid straining during bowel movements to prevent exacerbating hemorrhoidal symptoms.
- Consider using topical analgesics for symptomatic relief of local pain and itching, but be aware that their effectiveness is not well-established.
- Consult a healthcare provider if symptoms persist or worsen, as alternative treatment options may be necessary.
From the Research
Hydrocortisone Suppositories for Internal Hemorrhoids
- Hydrocortisone suppositories are used to treat internal hemorrhoids, delivering hydrocortisone directly to the site of inflammation to alleviate symptoms 2.
- A study compared the efficacy and safety of recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids, finding that hydrocortisone suppositories had a lower response rate compared to recombinant streptokinase 3.
- Another study investigated the potential of rectal suppositories containing a combined extract of Cissus quadrangularis Linn. and Acmella paniculata compared to a commercialized rectal suppository containing hydrocortisone and cinchocaine, finding that both treatments had comparable effects on bleeding, prolapse size, and anal pain 4.
Efficacy of Hydrocortisone Suppositories
- The study comparing recombinant streptokinase to hydrocortisone suppositories found that the 5th-day complete response rate was 27.1% for hydrocortisone acetate suppositories, which was significantly lower than the response rates for recombinant streptokinase 3.
- The study investigating the combined extract of Cissus quadrangularis Linn. and Acmella paniculata found that the effects of this treatment on bleeding, prolapse size, and anal pain were comparable to the commercialized rectal suppository containing hydrocortisone and cinchocaine 4.
Safety of Hydrocortisone Suppositories
- The study comparing recombinant streptokinase to hydrocortisone suppositories found that there were no adverse events attributable to the hydrocortisone acetate suppositories, but the patients in the hydrocortisone acetate group experienced a higher incidence of adverse events, including anal pain and bleeding, in another study 4, 3.