Inexpensive Prescription Topical Corticosteroid for Hemorrhoids
Prescribe hydrocortisone 1% cream or ointment applied to the perianal area up to 4 times daily for a maximum of 7 days. 1, 2
Why Hydrocortisone 1% Is the Optimal Choice
Hydrocortisone 1% is the least expensive prescription-strength topical corticosteroid that effectively reduces local perianal inflammation in adults with external or mixed hemorrhoids. 3
The 7-day maximum duration is mandatory to prevent perianal and anal mucosal thinning, which increases injury risk and can worsen symptoms long-term. 1, 2, 4
Hydrocortisone 1% has been safely used in pregnancy (third trimester) with no adverse events compared to placebo in a prospective study of 204 patients, making it appropriate for most adult populations. 2
Critical Application Instructions
Apply only to external perianal skin and the anal verge—never insert deeply into the rectum, as the medication is designed for external inflammation. 1, 2
Stop after 7 days even if symptoms persist; if relief is inadequate, switch to alternative therapies rather than continuing corticosteroids. 1, 2, 4
Combine with mandatory dietary measures: 25–30 g fiber daily (5–6 teaspoons psyllium husk mixed with 600 mL water) and adequate hydration to soften stool and reduce straining. 1, 2
When Hydrocortisone Alone Is Insufficient
For thrombosed external hemorrhoids presenting within 72 hours, topical 0.3% nifedipine combined with 1.5% lidocaine ointment (applied every 12 hours for 2 weeks) achieves a 92% resolution rate compared to only 45.8% with lidocaine alone—far superior to hydrocortisone for this specific presentation. 2, 4
If pain is the dominant symptom, add lidocaine 2% ointment or gel for immediate symptomatic relief of local pain and itching, which can be applied concurrently with hydrocortisone within the 7-day window. 2, 4
For persistent bleeding or prolapse after 1–2 weeks of conservative therapy, refer for office-based procedures (rubber band ligation for grade I–III internal hemorrhoids has 70–89% success rates) rather than prolonging topical therapy. 2
Common Pitfalls to Avoid
Never use high-potency corticosteroids (e.g., clobetasol, betamethasone) for hemorrhoids—they cause rapid mucosal atrophy and are potentially harmful with long-term use. 2
Do not prescribe hydrocortisone suppositories as first-line therapy—they lack strong evidence for reducing hemorrhoidal swelling, bleeding, or protrusion, and clinical data supporting their long-term efficacy are limited. 2
Never attribute anemia or positive fecal occult blood to hemorrhoids without colonoscopy—hemorrhoids alone rarely cause anemia (0.5 cases per 100,000 population), and proximal colonic pathology (inflammatory bowel disease, colorectal cancer) must be excluded. 1, 2
Alternative Low-Cost Prescription Options
Lidocaine 2% ointment or gel provides rapid symptomatic relief (onset within 10 minutes, lasting 10–12 hours) and is safe for repeated anorectal administration with minimal systemic absorption. 4, 5
Tribenoside 5% + lidocaine 2% rectal cream (if available and affordable in your region) offers comprehensive efficacy on all hemorrhoidal symptoms with fast onset and has been formally evaluated in well-conducted studies, including postpartum women. 5