Safety of Anusol (Hydrocortisone) Cream During Pregnancy
Anusol cream containing hydrocortisone is safe to use during pregnancy, especially in the second and third trimesters, for the treatment of hemorrhoids.
Evidence for Safety
- Topical hydrocortisone preparations are considered safe during pregnancy, particularly after the first trimester 1.
- A prospective study of 204 pregnant women exposed to hydrocortisone foam (Proctofoam-HC) for hemorrhoids in the third trimester showed no adverse events compared to placebo, with no negative effects on birth weight, gestational age, rates of prematurity, or pre/postnatal complications 1.
- Topical corticosteroids, when used as directed, have minimal systemic absorption and are generally considered safe for use during pregnancy 2.
Timing Considerations
- While generally safe throughout pregnancy, topical corticosteroids should be used with particular caution during the first trimester 3.
- Second and third trimester use has more supporting safety data and is considered lower risk 1.
Recommendations for Use
- Use the lowest effective dose for the shortest duration needed to control symptoms 3.
- Apply only to the affected area as directed to minimize absorption 2.
- Avoid prolonged continuous use without medical supervision 3.
Alternative Treatments for Hemorrhoids in Pregnancy
- Increasing dietary fiber intake (approximately 30g/day) can help prevent constipation and reduce hemorrhoid symptoms 3.
- Adequate fluid intake, particularly water, helps soften stools and ease bowel movements 3.
- Bulk-forming agents such as psyllium husk are safe in pregnancy due to lack of systemic absorption 3.
- Mechanical treatments such as specialized toilet seat devices may provide symptomatic relief without medication 4.
General Precautions
- All medication use during pregnancy should be discussed with healthcare providers 5.
- The benefits of treating symptomatic hemorrhoids should be weighed against any potential risks 5.
- For severe or persistent symptoms, consult with an obstetrician before continuing treatment 3.
FDA Pregnancy Categories
- While the FDA pregnancy category system has been revised, hydrocortisone was previously classified as Category C, indicating that animal studies have shown adverse effects but human studies are inadequate or lacking 3.
- Despite this classification, clinical experience and observational studies support the safety of topical hydrocortisone in pregnancy, especially for short-term use 1.
Hemorrhoids are common during pregnancy, affecting approximately 80% of pregnant women, particularly in the third trimester 3. When symptoms are bothersome, topical treatments like Anusol cream can provide significant relief with minimal risk to the developing fetus.