Corticosteroid (Rectal)

Rectal corticosteroids are generally used to treat patients suffering from colitis. They may also be used for conditions such as hemorrhoids and inflammatory conditions of the rectum that are brought about by radiation therapy.

Overview

Rectal corticosteroids are usually used as part of a holistic therapy in the treatment of patients who are suffering from colitis. This form of medication is also often used to provide relief from disorders such as hemorrhoids and inflammatory conditions of the rectum that are brought about by radiation therapy.

This form of medication may only be obtained from a medical professional on prescription.

Your dose of rectal corticosteroids may be given to you in one or more of the following forms:

  • suppository
  • solution
  • kit
  • cream
  • enema
  • foam

In the US, rectal corticosteroids are sold under a number of brand names, including the following:

  • Uceris
  • Rectasol-Hc
  • Rectacort-HC
  • Proctozone-HC
  • Proctosol-HC
  • Proctosert HC
  • Procto-Kit 25
  • Procto-Kit 1
  • Proctocort
  • Hemril-HC Uniserts
  • Hemril-30
  • GRx HiCort 25
  • Encort
  • Cortifoam
  • Colocort
  • Anuzone-HC
  • Anusol-HC
  • Anusol HC
  • Anu-Med HC
  • Anucort-HC

In Canada, rectal corticosteroids are known by the following brand names:

  • Cortiment-10
  • Cortiment-40
  • Rectocort

Conditions Treated

  • colitis
  • hemorrhoids
  • rectal inflammation

Type of medicine

  • anti-inflammatory
  • suppository
  • solution
  • kit
  • cream
  • enema
  • foam

Side Effects

In addition to the benefits they provide to patients, rectal corticosteroids can cause side effects that may prove troublesome. You probably will not experience all the effects mentioned in this section of the guide. However, if you do notice a few of them, it is a good idea to mention them to your doctor, as you may need further medical treatment.

  • straining while passing stool
  • stabbing pains
  • rectal bleeding
  • pins and needles
  • painful, or itchy blisters with pus being present in the hair follicles
  • mood swings
  • infection
  • fever
  • feeling of burning, itching, dryness, or pain not present prior to treatment
  • diarrhea
  • depression
  • chills
  • changes in personality
  • burning and itching sensation of the skin
  • a false sense of well-being

If you have been using rectal corticosteroids for a long period of time, you may find that some effects occur that will not need further medical treatment. These effects often sort themselves out, once your body becomes acclimatized to the drug. However, if the effects are very persistent and do not go away, have a chat with your GP. They may be able to offer advice on how you can manage the more troublesome effects so that they do not interfere too much with your daily life.

  • unusual weight gain
  • thinning hair on scalp
  • thin, fragile skin
  • sensation of spinning
  • passing of gas (with budesonide only)
  • lightened skin color
  • increased sweating
  • increase in appetite
  • dry, scaly skin
  • dizziness

This list of effects is not necessarily all-inclusive, and you may notice different effects that are not noted here. If you do experience any other unusual effects, have a chat with a trained healthcare professional.

Dosage

While you are receiving treatment with rectal corticosteroids, you must visit your doctor for regular progress assessments. These visits are important as they enable your treating physician to check on your progress, ask you about any side effects that you may have noticed since beginning your treatment, and adjust your dose of medicine if necessary.

Before you begin using your prescription of rectal corticosteroids, be sure to read the patient information leaflet that is supplied with the drug.

The enema form of this drug will usually be administered to you by a nurse or other medical professional in a clinic or hospital setting.

Using rectal corticosteroid foam:

You will be given a special applicator for use with this form of rectal corticosteroids. Use the applicator only; do not push any part of the aerosol can containing the drug into your rectum.

Using rectal corticosteroid suppositories:

  • You may find that the suppository is too soft in texture for easy insertion. In this case, just put the suppository in the fridge for half an hour or so, or run it under cold water, before you take it out of the wrapper.
  • To use the suppository, remove the wrapping. Dampen the suppository by using cold water. Position yourself on your side and use one full finger to gently but firmly, push the suppository up inside the rectum.

You must follow your prescribed dose of rectal corticosteroids, without exceeding the amount you have been told to take. The drug is absorbed into the body through the wall of the rectum. If you use too much, you run the risk of suffering side effects or overdosing.

The dose of rectal corticosteroids that are prescribed for different patients will vary. Always use the drug as you have been directed to by your medical professional or follow the guidelines on the product label. The information contained in this guide is only intended to reflect the average usually prescribed. Your dose may be different. If so, do not alter it unless your GP advises you to.

Your dose will depend on the preparation's strength. Other factors, including the reason you have been given the medication will influence the length of your course of treatment, the amount of times you use the drug daily, and the time you are advised to leave between doses.

Patients using betamethasone enema for ulcerative colitis:

Adults: Use the medicine as directed, nightly for two to five weeks, at a rate of one unit (5 mg).

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using budesonde enema for ulcerative colitis:

Adults: Use the medicine as directed, nightly for four to eight weeks, at a rate of one unit (2 mg).

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using hydrocortisone enema for ulcerative colitis:

Adults: Use the medicine as directed, nightly for two to three weeks, at a rate of one unit (100 mg), until your medical professional tells you to discontinue treatment.

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using hydrocortisone acetate foam for ulcerative colitis:

Adults: Initially, use one applicator as directed, once or twice daily for two to three weeks. The dose may be reduced to one applicator on alternate days.

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using hydrocortisone suppository for ulcerative colitis:

Adults: Take 25 mg to 30 mg twice daily, morning and evening for a fortnight. More severe cases may require 25 mg to 30 mg thrice daily. Alternatively, take 50 mg or 60 mg twice daily.

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using hydrocortisone suppository for rectal inflammation caused by radiation treatment:

Adults: Take 25 mg to 30 mg twice daily, morning and evening for a six to eight weeks.

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using hydrocortisone suppository for general rectal issues:

Adults: Take 20 mg to 30 mg daily, for three days only. Alternatively, take 40 mg or 80 mg daily or as required.

Children: The use and dose of this drug must be calculated by a medical professional.

Patients using tixocortol enema for ulcerative colitis:

Adults: Take one unit (250 mg) in the evening for 21 days consecutively.

Children: The use and dose of this drug must be calculated by a medical professional.

If you forget to use your scheduled dose of this medication, you should try to administer it straight away if practical. Do not take two doses at once. Omit the skipped dose and revert to your usual dosage schedule.

Interactions

Although there are no drugs that are listed as causing an interaction when used together with rectal corticosteroids, you should mention to your doctor any forms of prescription and non-prescription medicines that you regularly use. This should include herbal remedies and vitamin supplements.

Some medications should not be taken at the same time as eating some types of foods, drinking alcohol, or using tobacco, as this could cause an interaction. Have a chat with your doctor about this if you habitually use tobacco, drink alcohol, or have a preference for certain food groups.

Warnings

Be sure to tell your doctor if you are allergic to any forms of foodstuffs, or to the dyes and preservatives that are sometimes contained in foods. You should also tell your medical professional if you are allergic to steroids, any other prescription medication, or over-the-counter drugs.

Teenagers and children who are undergoing treatment rectal corticosteroids should have regular check-ups with a doctor. These drugs are readily absorbed into the body through the rectal wall and can cause growth retardation in some cases, especially if used over a long period of time or in large amounts. Although this is a very rare side effect, before you begin using this medication in children, you should discuss the potential consequences of doing so with the child's GP.

Betamethasone can affect the quality and quantity of sperm produced by men.

Some forms of corticosteroids are though to pass through the placenta, potentially endangering the fetus and causing birth defects in babies that do go full-term. You should not use this medication if you are expecting a baby or if you are planning on becoming pregnant while you are taking this drug. You should consider using condoms for contraception during the course of your treatment with this drug or if you are pregnant.

Although it is not known whether or not corticosteroids that are administered rectally can pass into breast milk. However, there is evidence to suggest that injection and oral corticosteroids do pass into breast milk where they could potentially affect nursing infants. If you are breastfeeding, you may be advised to stop doing so until your course of treatment with rectal corticosteroids has finished. If you do decide to carry on feeding your infant in this way, be alert for any side effects that may affect it and consult your doctor or midwife if you have any concerns.

Some other medical conditions or a history of them can affect how rectal and other forms of corticosteroids work. You must have a full and frank discussion of your medical history with your GP before you begin using this medication.

Patients who suffer from acute psychosis may find that condition deteriorates while using rectal corticosteroids.

People who have had chicken pox or measles or who have been recently exposed to sufferers of these conditions should not use rectal corticosteroids, as to do so presents the risk of severe complications in other areas of the body.

Type 2 diabetics should not use rectal corticosteroids, as this can present the risk of losing control over the diabetes through an increase of blood glucose.

Rectal corticosteroids can cause an increase in pressure within the eyeball, potentially leading to glaucoma.

Rectal corticosteroids should be used with extreme caution in patients who have a history of any of the following conditions:

  • swelling of blood vessels
  • overactive thyroid
  • myasthenia gravis
  • kidney disease
  • hypertension (high blood pressure)
  • heart disease

Using rectal corticosteroids in patients who have herpes simplex of the eyes can cause further eye problems to occur.

The use of rectal corticosteroids in people who have a history of any of the conditions listed below can retard healing rates, make existing conditions worse, or trigger new infections:

  • post-surgical ileocolostomy
  • infection
  • tuberculosis

If used in people with liver disease or an underactive thyroid condition, the effect of rectal corticosteroids may be increased, due to the slower rate of removal of the drug from the body

Rectal corticosteroids can cause osteoporosis to worsen, as they can predispose the body to lose calcium.

The use of rectal corticosteroids can mask the symptoms of intestine and stomach problems, including severe ulcerative colitis. This could lead to a patient failing to seek medical treatment when it would in fact be necessary to do so.

Rectal corticosteroids can lead to a build-up of stomach acids, which could exacerbate the symptoms caused by stomach ulcers.

You must not stop using your prescribed dose of rectal corticosteroids without clearing this with your GP first. You will most likely be told to gradually reduce your daily dose of the medication before cutting it out altogether.

If you do not think that your condition is showing any signs of improvement within a maximum of three weeks after you began using rectal corticosteroids, or if you think it is actually getting worse, you must check with your GP.

If you begin to experience any of the following signs around your rectal area, you should talk to your doctor immediately:

  • pain
  • itching
  • burning sensation
  • blistering
  • bleeding from the rectum

You should note that using suppositories may sometimes stain clothing. Ask your doctor or nurse for some disposable underwear to wear while you are using this form of rectal corticosteroids.

If you are due to have any skin tests or any form of surgery, including cosmetic surgery, or dental procedures, or emergency treatment, tell the medical professional in charge that you are using rectal corticosteroids.

While you are using rectal corticosteroids, and for at least two weeks following the conclusion of your course of treatment, do not have any form of immunization, without checking with your doctor first.

Diabetics may be affected by rectal corticosteroids as the drug can alter blood sugar levels. If your usual blood sugar test results change, you should discuss this with your GP.

Storage

Your prescription of rectal corticosteroids should be kept in a closed container and preferably at room or body temperature. Do not place the container where it could be vulnerable to direct sunlight or close to heat sources.

This medication is not suitable for freezing or refrigeration.

Put your supply of rectal corticosteroids somewhere it cannot easily be reached by children and pets.

Be careful not to puncture the foam aerosol canister, even when empty. Do not burn the canister; it might explode.

Any out of date medication or rectal corticosteroids that you are no longer using should not be kept.

Summary

Rectal corticosteroids are usually employed as part of a therapy regimen for the treatment of individuals who are suffering from a number of health conditions, including colitis. Rectal corticosteroids are very effective in providing relief from painful disorders such as hemorrhoids. In patients who are undergoing radiation therapy as part of their treatment for certain types of cancer, rectal corticosteroids can also be helpful to relieve the discomfort of rectal inflammation.

There are a number of medical conditions that could be complicated by the use of rectal corticosteroids. Be sure to discuss your full medical history with your GP before you begin your course of treatment.