Hydrocortisone rectal (Anucort-HC, Cortifoam, others): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD

What Is Rectal Hydrocortisone?

Hydrocortisone is a corticosteroidbasically a “calm down” signal for irritated tissue. When used rectally, it’s designed to reduce
inflammation, swelling, itching, and discomfort in or around the anus and rectum. Depending on the product, it can work mostly locally (right where you apply it),
but some absorption into the bloodstream can still happenespecially with certain forms.

Rectal hydrocortisone shows up in several forms:

• Suppositories (commonly 25 mg; e.g., Anucort-HC and similar products)
• Foam (e.g., Cortifoam, often used for ulcerative proctitis when enemas can’t be retained)
• Creams/ointments (some prescription, some over-the-counter formulations for external symptoms)
• Enemas (for certain ulcerative colitis patternsoften used nightly in treatment phases)

Common Uses: What Doctors Prescribe It For

Rectal hydrocortisone is used for inflammatory and itchy conditions in the anorectal area. The “why” matters, because dosing and product choice can differ based on
what you’re treating.

1) Hemorrhoids and anal itching

If hemorrhoids are inflamed, tender, or itchy, a rectal hydrocortisone cream or suppository may help reduce swelling and irritation. For hemorrhoids, many people
use a cream externally and reserve suppositories for deeper internal discomfortdepending on clinician advice.

2) Ulcerative proctitis (inflammation in the distal rectum)

In ulcerative proctitis, inflammation is concentrated near the rectum. Rectal steroids can be used as adjunctive therapymeaning they’re often paired with
other medications in an overall plan. Foam products can be especially useful for people who can’t retain steroid enemas.

3) Distal ulcerative colitis patterns

Rectal formulations can be targeted options for disease limited to the rectum and nearby sections. Enema formulations can treat farther up the colon than suppositories
and many foams, but comfort and retention can be the deciding factor for real humans with real schedules.

How It Works (Without the Pharmacology Lecture)

Inflammation is your body’s version of a smoke alarm. Helpful when there’s a fire, annoying when someone burned toast and now the whole house is screaming.
Hydrocortisone reduces inflammatory signaling so tissue can calm down: less swelling, less itching, less “why does sitting feel like a hobby I can’t afford?”

That said, steroids can also dampen immune responses. That’s part of why they workand part of why warnings exist.

“Pictures”: What These Products Typically Look Like (Identification Guide)

Medication appearance varies by manufacturer and strength, so treat this as a general “spot the category” guidenot a forensic ID system. When in doubt, match
the name, strength, and NDC/label info on the box, and ask your pharmacist.

Practical tip: suppositories and creams can stain fabrics. If your medicine has ever “ghosted” a pair of underwear, you’re not aloneplan accordingly.

Dosing Overview (Typical RangesAlways Follow Your Prescription)

Dosing depends on the condition, the formulation, and how you respond. Clinicians often aim for the lowest effective dose for the shortest
time that gets symptoms under control.

Hydrocortisone suppositories (commonly 25 mg)

• Typical regimen: 1 suppository twice daily (morning and night) for about 2 weeks for nonspecific proctitis.
• More severe cases: may be increased (for example, 1 suppository three times daily or 2 suppositories twice daily) per clinician direction.
• Duration: some cases may require several weeks; your prescriber should guide how long you continue.

Cortifoam (hydrocortisone acetate rectal foam)

• Typical regimen: 1 applicatorful once or twice daily for 2–3 weeks, then every other day afterward if needed (based on response).
• Expected response: improvement is often noticed within about 5–7 days, but evaluation shouldn’t rely on symptoms alone in ulcerative proctitis.

Hydrocortisone rectal cream (often for hemorrhoids)

• Adults and children 12+ (common labeling): up to 3–4 times daily for hemorrhoid symptoms.
• OTC caution: if using without a prescription and you’re not improving within about a week, stop and contact a clinician.

Hydrocortisone enema (for ulcerative colitis patterns)

• Typical regimen: often nightly for a few weeks; some regimens require longer treatment courses depending on response and clinician guidance.

If you have diabetes, high blood pressure, a history of infections, or you’re pregnant or breastfeeding, dosing decisions and monitoring may be more cautious.

How to Use It Correctly (So the Medicine Goes Where the Problem Is)

Suppository: quick, tidy, and surprisingly common

1. Wash your hands. Remove the wrapper/strip carefully.
2. Try to use it after a bowel movement (so the medicine can stay put longer).
3. Insert gently, pointed end first. If it’s softening, handle minimallyit melts at body temperature.
4. Stay lying on your side for a few minutes so it doesn’t immediately attempt a dramatic escape.

Foam: the “hold it upright” product (seriouslyupright)

1. Shake the canister (many products recommend about 5–10 seconds).
2. Keep the canister upright and fill the applicator to the indicated line (foam expandspatience helps).
3. Insert only the applicator tip and gently depress the plunger.
4. Remove the applicator, clean it as directed, and wash your hands.

Safety note: never insert the canister into the anus. The applicator exists for a reason.

Enema: effective reach, requires a calm moment

1. Empty your bowels if you can.
2. Lie on your left side with the right knee bent (a common position recommended on patient instructions).
3. Insert the tip gently and administer slowly.
4. Remain on your side for at least 30 minutes; many regimens aim to retain it overnight.

Cream: read the labelsome are external only

Many hydrocortisone “rectal creams” are intended for the skin around the anus and should not be pushed inside unless the product specifically provides an internal-use
applicator and directions. If your label says “external use,” believe it.

Side Effects: What’s Common vs. What’s Concerning

Most people notice either relief or mild local irritation. But because corticosteroids can be absorbedespecially with prolonged useserious effects are possible,
even if they’re uncommon.

Common (usually local) side effects

• Burning, itching, or irritation at the application site
• Dryness or skin changes around the rectum
• Rectal discomfort after use
• Minor leakage (especially with enemas or foam)

Call a clinician promptly if you notice

• Severe rectal pain, significant burning, or bleeding
• Fever or signs of infection
• New or worsening irritation that doesn’t settle
• Severe headache, vision changes, or eye pain

Possible systemic steroid effects (more likely with higher doses/longer use)

• Blood sugar increases (important if you have diabetes)
• Fluid retention, blood pressure increases, electrolyte changes
• Mood changes or sleep disturbance
• Suppression of the body’s stress-hormone system (HPA axis) after longer use

The key idea: rectal doesn’t automatically mean “zero systemic effects.” It usually means “more targeted,” not “magically consequence-free.”

Interactions: What to Mention Before You Start

Interactions are more commonly discussed with oral steroids, but rectal hydrocortisone can still matterespecially if you’re using it frequently, for weeks,
or alongside other steroid medications.

Examples of interaction categories clinicians often watch

• Blood thinners (like warfarin): steroids can alter response; monitoring may be needed.
• Diabetes medications: steroids can raise blood sugar; dose adjustments may be required.
• NSAIDs/aspirin: combined use can increase GI side-effect risk in some contexts.
• Potassium-depleting drugs (certain diuretics, amphotericin B): electrolyte issues can worsen.
• Antifungals and antibiotics: some drugs can increase steroid effects by reducing clearance.
• Vaccines: steroid therapy can reduce immune response; live vaccines may be avoided at immunosuppressive doses.

Bring a complete med list to your clinician or pharmacistincluding OTC products, supplements, and any other steroids (inhalers, creams, pills, injections).

Warnings & Precautions (The Stuff People SkipBut Shouldn’t)

Do not use if you have certain rectal/intestinal complications

Intrarectal steroids may be avoided in situations such as obstruction, abscess, perforation, peritonitis, fresh intestinal surgical connections, extensive fistulas,
or significant sinus tractsbecause the risk profile changes dramatically.

Infections: steroids can mask symptoms

Corticosteroids can make infections harder to spot early and harder to contain. Tell your clinician if you have an active infection, unexplained fever,
persistent diarrhea, or a history of recurrent infections.

Do not stop suddenly after prolonged use without guidance

Longer or higher-dose steroid use can suppress your body’s own cortisol production. If your clinician wants you off after a longer course, they may recommend a taper
or a step-down schedule.

Foam canister safety

Foam products are pressurized and often flammable. Keep away from heat and open flames, don’t puncture or burn the canister, and don’t store it in hot environments
(think: a car in summer).

Pregnancy and breastfeeding

Steroids have special risk/benefit considerations in pregnancy and lactation. If you’re pregnant, trying to conceive, or nursing, discuss the safest plan with your clinician.

When to See a Doctor (Instead of Powering Through)

• You have significant rectal bleeding, black/tarry stools, or worsening pain.
• Symptoms don’t improve within the timeframe your prescriber gave you (often about 1–2 weeks for many regimens).
• You develop fever, chills, or feel generally unwell.
• You have ulcerative colitis/proctitis symptoms that escalate quickly (more urgency, dehydration, severe abdominal pain).

Also: if you’re using OTC hydrocortisone for hemorrhoids and it’s not improving within a week, that’s a good moment to get checkedbecause hemorrhoids aren’t the only
cause of rectal symptoms.

Bottom Line

Rectal hydrocortisone can be a practical, targeted tool for hemorrhoid irritation and inflammatory conditions like ulcerative proctitisespecially when the goal is
to calm tissue fast and reduce swelling and itching. Use the right form for the right job, follow dosing directions carefully, and treat warnings like the important
information they arenot optional reading.

If you’re ever unsure whether your product is meant for external-only vs. internal use, or you’re dealing with persistent bleeding or significant pain, your pharmacist
and clinician can clarify quicklyand your future self will thank you.

Real-World Experiences (and Practical Tips People Wish They Heard Earlier)

The official directions are essential, but real life has a way of adding plot twists. Here are common experiences many patients describe when using rectal hydrocortisone
(suppositories, foam, cream, or enemas)plus practical ways to make the process easier and safer. These aren’t personal medical instructions; they’re the kind of
“here’s what it’s like” context that helps you feel less alone and more prepared.

The first few uses can feel awkwardawkward doesn’t mean wrong

A lot of people report that the hardest part isn’t side effectsit’s the learning curve. With suppositories, the most common early issue is timing: if you insert one
right before a bowel movement, it may not stay in place long enough to help. Many people find it smoother to use after a bowel movement and before bed, so gravity and
a horizontal body do some of the work. If a suppository feels like it’s trying to slip out, staying lying down for a few minutes can help it settle.

Foam: the “upright canister” rule is real (and so is the patience)

Foam products can be remarkably effective for distal inflammation, but users often mention two surprises: (1) the foam expands in the applicator, and (2) filling the
applicator is easier if you pause and let it expand rather than pumping like you’re inflating a pool float in a hurry. People also commonly say that a small amount of
leakage can happenespecially early onso a thin liner or older underwear can reduce stress. And yes, keeping the canister upright matters; it’s one of those “annoying
details” that directly affects whether you get medication or mostly air.

Cream: relief is great, but “more” is not automatically “better”

With hemorrhoid symptoms, many people feel relief quickly and assume they should keep applying indefinitely. The more experienced (or more burned, literally) users
learn to respect the timeline: short-term, targeted use is often the goal. If you’re still miserable after several days, it’s worth checking whether something else is
going onlike an anal fissure, infection, inflammatory bowel disease activity, or another cause of rectal bleeding.

Enemas: retention is the real boss battle

People using hydrocortisone enemas for ulcerative colitis often describe the medicine as helpful but the process as… humbling. The most common strategy is building a
routine: same time each night, bathroom first, left-side position, slow administration, then stay put. Many people say it gets easier after a few nights as they learn
the right speed and angle. If you have sharp pain during insertion or significant bleeding afterward, that’s not a “push through it” momentimproper technique can
irritate tissue, and you should contact a clinician.

Emotional reality: it’s okay to laugh about it (quietly)

Rectal symptoms can be isolating and embarrassing, and that stress can make everything feel worse. Many patients say that once they treated it like any other
medicationwash hands, follow steps, move onthe anxiety dropped. If you can’t laugh at the absurdity of reading “do not insert the canister into the anus” on a
Tuesday night, you’re missing one of life’s stranger comedic gifts.