How to Use Anosul (Hydrocortisone) Cream for Hemorrhoids
Apply Anosul cream topically to the affected perianal area 2-4 times daily for a maximum of 7 days only, as prolonged use causes thinning of perianal and anal mucosa with increased risk of tissue injury. 1, 2
FDA-Approved Indications
Anosul is indicated for inflamed hemorrhoids, post-irradiation proctitis, chronic ulcerative colitis (as adjunct), cryptitis, other inflammatory anorectal conditions, and pruritus ani. 3
Application Instructions
For External Hemorrhoids and Perianal Inflammation
- Clean the perianal area gently with warm water and pat dry before application 2
- Apply a thin layer of cream directly to the inflamed external hemorrhoidal tissue and surrounding perianal skin 3
- Use 2-4 times daily, particularly after bowel movements and at bedtime 4
- Gently massage the cream into the affected area 2
For Internal Hemorrhoids
- Use the applicator tip (if provided) to apply cream just inside the anal canal 3
- Insert applicator gently no more than 1-2 cm into the rectum 2
- Apply after each bowel movement and at bedtime 4
Critical Duration Limitation
Never use hydrocortisone cream for more than 7 consecutive days. 1, 2 Prolonged steroid application causes:
- Thinning of perianal and anal mucosa 1, 2
- Increased susceptibility to tissue injury and tears 1
- Potential systemic absorption with adrenocortical suppression 2
What Anosul Does (and Doesn't Do)
Expected Benefits
- Reduces local perianal inflammation and swelling 1, 2
- Provides symptomatic relief of itching and irritation 2, 3
- Ameliorates perianal skin inflammation 2
Limitations
- Does NOT reduce hemorrhoidal swelling, bleeding, or protrusion 2
- Does NOT cure hemorrhoids—only provides temporary symptom relief 5
- Clinical data supporting long-term efficacy are lacking 2
Combination with Other Treatments
First-Line Conservative Measures (Use Simultaneously)
- Increase dietary fiber to 25-30 grams daily 2, 6
- Increase water intake to soften stool 2, 6
- Avoid straining during defecation 2, 6
- Take regular warm sitz baths 2
Superior Alternative for Thrombosed External Hemorrhoids
If you have a thrombosed external hemorrhoid (painful, swollen lump), topical 0.3% nifedipine + 1.5% lidocaine ointment applied every 12 hours for 2 weeks is significantly more effective (92% resolution rate vs. 45.8% with lidocaine alone), with no systemic side effects. 1, 2, 6 This combination works by relaxing internal anal sphincter hypertonicity that contributes to pain. 2
When to Stop and Seek Further Evaluation
Stop using Anosul and consult your physician if:
- Symptoms worsen or fail to improve within 1-2 weeks 2, 7
- Significant bleeding occurs 2
- Severe pain develops 2
- Fever appears (may indicate necrotizing pelvic sepsis, a rare but serious complication) 2
Common Pitfalls to Avoid
- Never attribute rectal bleeding solely to hemorrhoids without proper evaluation—colonoscopy may be needed to rule out other serious conditions like inflammatory bowel disease or cancer 2, 6, 7
- Never use high-potency corticosteroid preparations long-term—this is potentially harmful 2
- Do not assume all anorectal symptoms are from hemorrhoids—anal fissures, abscesses, or fistulas may coexist 2
- Hemorrhoids alone do not cause positive fecal occult blood tests 2
Special Populations
Pregnancy and Postpartum
Hydrocortisone foam can be used safely in the third trimester with no adverse events compared to placebo (prospective study of 204 patients). 2 For postpartum hemorrhoids, hydrocortisone cream is appropriate for short-term use (≤7 days). 2
When Anosul Is Insufficient
If conservative management including Anosul fails after 1-2 weeks, consider:
- Rubber band ligation for persistent grade I-III internal hemorrhoids (70.5-89% success rate) 2
- Surgical excision for thrombosed external hemorrhoids presenting within 72 hours (faster pain relief, lower recurrence) 2
- Hemorrhoidectomy for grade III-IV hemorrhoids, mixed internal/external hemorrhoids, or failure of medical therapy (2-10% recurrence rate) 2