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Overview: Rectal hydrocortisone is used to treat inflammatory conditions in or near the anal and rectal areas, such as ulcerative proctitis, ulcerative colitis, inflamed hemorrhoids, and cryptitis. Rectal hydrocortisone works by reducing inflammation and shrinking enlarged blood vessels. The most common side effects are reactions where the product is applied, including burning, itching, irritation, dryness, inflamed hair follicles, and lightening of skin. The most serious side effects of rectal hydrocortisone include reduced adrenal gland function and increased risk of infections.

Uses

What is rectal hydrocortisone used for?

Rectal hydrocortisone is commonly used to treat the following inflammatory conditions in or near the anal and rectal areas.

  • Ulcerative proctitis, which is inflammation of the anus and the lining of the rectum
  • Ulcerative colitis, which is an inflammatory bowel disease that causes irritation, inflammation, and ulcers in your large intestine 
  • Inflamed hemorrhoids
  • Cryptitis, which is inflammation of certain parts of the intestines known as crypts

Rectal hydrocortisone may also be used for other conditions as determined by your healthcare provider.

Note: The Food and Drug Administration (FDA) has not found some forms of this medicine to be safe and effective, and the labels for these products are not approved by the FDA. Learn more about unapproved drugs here.

How does rectal hydrocortisone work (mechanism of action)?

Hydrocortisone belongs to a group of medicines called corticosteroids. It works by reducing inflammation and itching. It also constricts (narrows) enlarged blood vessels in inflamed areas.

How is rectal hydrocortisone supplied (dosage forms)?

Brands and other names

  • Anucort-HC
  • Anusol-HC
  • Colocort
  • Cortenema
  • Cortifoam
  • Hemmorex-HC

Dosage forms and strengths

  • 10% rectal foam
  • 100 mg/60 mL retention rectal enema
  • 25 mg, 30 mg rectal suppository

See also: Hydrocortisone and Hydrocortisone topical 

How should I store rectal hydrocortisone?

Rectal Foam. Hydrocortisone rectal foam should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). Do not refrigerate. Do not store at temperatures above 120 F (49 C).

Rectal Enema and Suppository. Hydrocortisone rectal suppositories and enema should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Keep the suppositories away from heat. Do not freeze the suppositories.

Side Effects

What are the most common side effects of rectal hydrocortisone?

The most common side effects of rectal hydrocortisone are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Skin reactions where the product is applied, including burning, itching, irritation, dryness, inflamed hair follicles, and lightening of skin (see below)
  • Allergic skin reaction (see below)
  • Infection (see below)

There may be other side effects of rectal hydrocortisone that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of rectal hydrocortisone?

While less common, the most serious side effects of rectal hydrocortisone are described below, along with what to do if they happen.

Severe Allergic Reactions. Rectal hydrocortisone may cause allergic reactions, which can be serious. Stop using rectal hydrocortisone and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Reduced Adrenal Function. Long-term use of rectal hydrocortisone may cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your healthcare provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure

Increased Blood Pressure (Hypertension). Rectal hydrocortisone may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your healthcare provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Infections. Rectal hydrocortisone may increase your risk of infections, including serious infections. Call your healthcare provider right away if you have an infection or any of the following symptoms.

  • Burning or stinging when you pee 
  • Cough or coughing up blood
  • Fever, sweats, chills, or muscle aches
  • Shortness of breath
  • Diarrhea or stomach pain
  • Weight loss

Reactivated Infections. Some types of microbes that cause infections (such as bacteria or viruses) can remain in the body after you recover from that infection. When a microbe stays in the body but does not cause an infection, it is called a “latent” microbe. Rectal hydrocortisone may increase your risk of a latent microbe becoming active again, causing an infection. Before you start treatment with rectal hydrocortisone, tell your healthcare provider if you have ever had tuberculosis (TB) or any other serious infections.

Vision Problems. Rectal hydrocortisone may cause cataracts and glaucoma, which can lead to blindness. Tell your healthcare provider right away if you have any of the following symptoms.

  • Cloudy or foggy vision
  • Nearsightedness
  • Changes in how you see colors
  • Problems with glare (such as traffic lights when driving at night)
  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Weak Bones. Using rectal hydrocortisone for a long time may cause your bones to become weaker, leading to reduced bone density (osteopenia). It may also cause a more serious condition called osteoporosis, which can cause your bones to break (fracture) more easily. This risk may be higher if you have gone through menopause. Tell your healthcare provider if you break a bone, and get a bone mineral density test if one is ordered for you.    

Muscle Problems. Rectal hydrocortisone may cause muscle problems, including muscle pain, weakness, and tenderness called myopathy. Stop using rectal hydrocortisone and get help right away if you have any of the following symptoms of myopathy.

  • Muscle pain, stiffness, or cramps
  • Muscle spasms
  • Low energy levels or feeling easily tired, especially with activity

Mood Changes. Rectal hydrocortisone can cause changes in your mental status, including mood swings, personality changes, and depression. Tell your healthcare provider if you notice any changes in mood, thoughts, or behaviors.

Skin Reactions. Hydrocortisone suppositories can rarely cause skin-related side effects. Tell your healthcare provider if you have any of the following side effects.

  • Inflamed hair follicles or skin swelling or burning
  • Bumps or blisters on the skin that may look like acne
  • Rash around your mouth
  • Lightening of skin color
  • Skin infections at the site of application
  • Skin thinning
  • Skin itching, dryness, cracking, or scaly skin
  • Stretch marks
  • Heat rash or sweat rash caused by blocked sweat glands

Warnings & Precautions

Who should not use rectal hydrocortisone?

Allergies to Ingredients. People who are allergic to any of the following should not use rectal hydrocortisone.

  • Hydrocortisone
  • Anucort-HC
  • Anusol-HC
  • Cortenema
  • Cortifoam
  • Hemmorex-HC
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific rectal hydrocortisone products they stock.

Whole-Body Fungal Infections. People who have fungal infections in their body should not use hydrocortisone enema.

Recent Ileocolostomy. People who have recently had an ileocolostomy (a surgical procedure that connects two parts of the intestine) should not use hydrocortisone enema.

Certain Rectal Conditions. Hydrocortisone rectal foam should not be used if you have any of the following conditions near the rectal area.

  • Blocked intestine
  • Pus-filled infection (abscess)
  • Holes in the intestine
  • Infection in the lining of your belly area (peritonitis)
  • Recent intestine surgery connecting two parts of the intestine (anastomosis)
  • Abnormal openings (fistulas or sinus tracts)

What should I know about rectal hydrocortisone before using it?

Do not use rectal hydrocortisone unless it has been prescribed to you by a healthcare provider. Use it as prescribed.

Do not share rectal hydrocortisone with other people, even if they have the same condition as you. It may harm them.

Keep rectal hydrocortisone out of the reach of children.

There are several forms of rectal hydrocortisone available and they may be used to treat different conditions. Ask your healthcare provider if you are not sure how to use the rectal hydrocortisone product you are prescribed. 

If you are prescribed hydrocortisone rectal foam, do not insert any part of the aerosol container directly into the anus. Do not burn or puncture the container.

Hydrocortisone suppositories are designed to melt at body temperature. Avoid handling or holding the suppositories more than necessary.

When using rectal hydrocortisone enema, lie on your left side as you are giving it and for 30 minutes afterwards. Try to retain the enema for at least one hour, or if you can, all night.

If you are using hydrocortisone rectal foam or enema and your symptoms do not get better within two to three weeks, stop using the product and tell your healthcare provider.

Do not stop using rectal hydrocortisone without talking to your healthcare provider. Stopping too quickly after using it at a high dose or for a long time may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms.

  • Fatigue
  • Fever
  • Joint or muscle pain
  • Lightheadedness
  • Loss of appetite
  • Difficulty breathing
  • Vomiting
  • Weight loss
  • Headaches

Avoid exposure to chickenpox or measles while you are using rectal hydrocortisone. If you think you have been exposed to chickenpox or measles, tell your healthcare provider right away.

What should I tell my healthcare provider before using rectal hydrocortisone?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if rectal hydrocortisone is right for you.

In particular, make sure that you discuss any of the following.

Other Medicines and Supplements. Rectal hydrocortisone may interact with other medicines and supplements. Before using rectal hydrocortisone, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Vaccines. Talk with your healthcare provider about any vaccines that you may need. You may not be able to receive certain vaccines right before or while using rectal hydrocortisone. Tell your healthcare provider about any vaccines you have recently received or have scheduled.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Heart disease, such as heart failure or recent heart attack
  • High blood pressure
  • An infection, including serious infections you have had in the past (such as tuberculosis)
  • Kidney problems
  • Stomach or bowel problems, including ulcers
  • Thyroid problems, such as hypothyroidism
  • Liver damage and scarring (cirrhosis)
  • Nerve or muscle problems, such as myasthenia gravis
  • Mental health problems
  • Diabetes

Pregnancy. It is not known if or how rectal hydrocortisone could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. Hydrocortisone passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use rectal hydrocortisone while breastfeeding.

Interactions

Does rectal hydrocortisone interact with foods or drinks?

There are no known interactions between rectal hydrocortisone and foods or drinks.

It is unknown if drinking alcohol will affect rectal hydrocortisone.

Does rectal hydrocortisone interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using rectal hydrocortisone.

  • A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • A cholinesterase inhibitor, such as rivastigmine or donepezil (which is a medicine commonly used for Alzheimer’s disease) or pyridostigmine (which is a medicine commonly used for myasthenia gravis)
  • Warfarin, which is a blood thinner
  • A medicine for diabetes
  • Isoniazid or rifampin (Rifadin), which is a medicine used to treat an infection called tuberculosis
  • Cholestyramine (Prevalite), which is a medicine to lower cholesterol
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Estrogen, which is found in certain birth control pills, patches, creams, rings, or vaginal suppositories 
  • A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
  • Any medicine for seizures, such as carbamazepine or phenytoin
  • Ketoconazole, which is a medicine used for fungal infections
  • Aspirin, which is in many prescription and OTC products, including those for pain, swelling, and fever
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which is in many prescription and OTC products for pain, swelling, and fever
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure

Many other medicines may alter the blood levels of hydrocortisone. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with rectal hydrocortisone. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much rectal hydrocortisone?

If you or someone else has used too much rectal hydrocortisone, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of rectal hydrocortisone?

If you miss your scheduled dose of rectal hydrocortisone, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow the original schedule. Do not use rectal hydrocortisone more often than prescribed.