1. About hydrocortisone rectal foam
Hydrocortisone rectal foam is applied directly into the back passage to treat ulcerative colitis and similar diseases of the bowel.
Ulcerative colitis is a long-term illness where patches of inflammation, and sometimes ulcers, grow in the lining of the bowel. The most common symptoms are tummy pain and diarrhoea mixed with blood.
Hydrocortisone rectal foam isn't a cure. It calms down the inflammation in the bowel - and in turn reduces the symptoms.
This medicine is only available on prescription.
Other types of hydrocortisone
There are different types of hydrocortisone, including skin creams, injections and tablets.
2. Key facts
- Hydrocortisone rectal foam is applied directly into the back passage. It's usual to apply it once or twice a day - usually for 2 to 3 weeks.
- The medicine works by calming down inflammation of the bowel to relieve symptoms.
- It's unusual to have any side effects - but some people get redness, burning or itching around the skin where they've used the medicine.
- Hydrocortisone rectal foam can sometimes damp down your general immune system so you're more likely to get infections. Tell your doctor if you come into contact with chickenpox, shingles or measles. If your immune system is damped down, these infections could make you very ill.
- Hydrocortisone rectal foam is also called by the brand name Colifoam.
3. Who can and can't use hydrocortisone rectal foam
Adults and children aged 2 years and older can use hydrocortisone rectal foam. Hydrocortisone rectal foam isn't suitable for some people. Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to hydrocortisone or any other medicine
- have ever had depression or bipolar disorder (manic depression), or if any of your close family has had these illnesses
- have an infection (including eye infections)
- have recently been in contact with someone withchickenpox, shingles or measles (unless you're sure you're immune to these infections)
- have recently had, or are about to have, any vaccinations
- have any other diseases of the bowel or rectum
- are pregnant, trying to get pregnant or you're breastfeeding
Hydrocortisone can make some health problems worse so it's important that your doctor monitors you. Make sure your doctor knows if you have:
- any unhealed wounds
- high blood pressure
- glaucoma (an eye disorder)
- osteoporosis (thinning bones)
If you have diabetes and monitor your own blood sugar, you will need to do this more often. Hydrocortisone rectal foam can affect your blood sugar control.
4. How and when to use it
The medicine comes as a small can of white foam plus a plastic applicator.
Each applicator contains 125mg of hydrocortisone when it's filled with foam.
How much should I use?
The usual dose for both adults and children aged 2 years and older is to use an applicator filled with foam once or twice a day - do this for 2 to 3 weeks.
If you're using the foam twice a day, try to separate the doses by 10 to 12 hours.
If you're using it once a day - or once every other day - try and use it at around the same time of day each time.
Each can contains enough foam for 14 applications. It will last for between 1 and 2 weeks depending on how often you use it.
How to use the foam
- The can of foam comes with an applicator. Read the instructions in the leaflet that comes with them. It explains how to use the foam - with pictures to help you.
- Shake the can well (with the top on) just before you use it.
- Hold the applicator upright. Insert the top of the can of foam into the tip of the applicator.
- Press the top of the can gently so that foam fills about a quarter of the applicator. You only need to press down for a short time to do this.
- Wait a few seconds for the foam to expand and then press the top of the can again.
- Continue to fill the applicator a little at a time until the foam reaches the 'fill' line.
- Stand with one leg raised on a chair - or lie down on your side if you prefer. Gently put the tip of the applicator into your back passage.
- Push the plunger to empty the applicator.
- Take the applicator apart and wash it each time after you've used it.
Will my dose go up or down?
You will only ever be prescribed 1 full applicator of foam to insert at a time. But your doctor might ask you to apply more or less than 1 filled applicator a day depending on how bad your symptoms are.
What if I forget to use it?
If you forget a dose of foam, use it as soon as you remember. If you don't remember until the next dose is due, skip the one you have missed. Never use a double dose of foam to catch up.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take this medicine.
What if I use too much?
Using too much foam by accident is unlikely to harm you. If you're worried, talk to your doctor or pharmacist.
5. Side effects
Most people don't have any side effects when they use hydrocortisone rectal foam for a few weeks or less.
Some people (less than 1 in 100) get redness, burning or itching around their back passage after inserting the foam. This tends to be mild and lasts only a few days. Tell your doctor if the irritation doesn't go away after a few days.
Serious side effects
Hydrocortisone rectal foam is applied directly into the bowel. The aim is for the medicine to get to where it's needed without affecting the rest of your body.
Sometimes, though, hydrocortisone rectal foam gets through the lining of the bowel into the bloodstream. This is more likely to happen if you've been using the foam for a long time.
If hydrocortisone gets into your bloodstream, it travels around your body and there's a very small chance that you may have a serious side effect.
Tell a doctor straight away if you get:
- depressed (including having suicidal thoughts), feeling high, mood swings, feeling anxious, seeing or hearing things that aren't there or having strange or frightening thoughts - these can be signs of mental health problems
- a fever (temperature above 38C), chills, a very sore throat, ear or sinus pain, a cough, pain when you pee, mouth sores or a wound that won't heal - these can be signs of an infection
- sleepy or confused, feeling very thirsty or hungry, peeing more often than usual, flushing, breathing quickly or having breath that smells like fruit - these can be signs of high blood sugar
- weight gain in the upper back or belly, a moon face, a very bad headache and slow wound healing - these can be signs of Cushing's syndrome
- pain or bleeding from the rectum
You should also tell a doctor straight away if you get:
- swelling in your arms or legs
- changes in your eyesight
Children and teenagers
Using hydrocortisone rectal foam for a long time can slow down the normal growth of children and teenagers.
Your child's doctor will watch their growth carefully while they're using hydrocortisone rectal foam. That way their doctor will pick up any slowing of growth and change your child's treatment if necessary.
Talk to your doctor about the risks of your child using hydrocortisone rectal foam if you're worried.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to hydrocortisone rectal foam.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These aren't all the side effects of hydrocortisone rectal foam. For a full list see the leaflet inside your medicine packet.
You can report any suspected side effect to the UK safety scheme.
6. Pregnancy and breastfeeding
Hydrocortisone rectal foam is generally safe to use in pregnancy and while breastfeeding.
However, there's a small chance that the medicine can get into your bloodstream and breastmilk and affect the growth of the baby.
Your doctor will only prescribe hydrocortisone rectal foam for you while you're pregnant or breastfeeding if the benefits of the medicine outweigh the chances of it being harmful.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
7. Cautions with other medicines
Some medicines can increase the effects of hydrocortisone rectal foam. Your doctor may want to check you often if you're taking medicines that don't mix well with hydrocortisone rectal foam.
Tell your doctor or pharmacist before stopping or starting any other medicines and before taking any herbal remedies, vitamins or supplements.
8. Common questions
How does hydrocortisone rectal foam work?
Hydrocortisone rectal foam contains the active ingredient hydrocortisone which is a corticosteroid or 'steroid'.
Hydrocortisone works by damping down immune system overactivity in the lining of the bowel and rectum. This calms inflammation and, in turn, helps to relieve symptoms such as pain and bloody diarrhoea.
When will I feel better?
Your symptoms should improve within a week or 2 of starting treatment with hydrocortisone rectal foam.
How long will I use the foam for?
This varies. If you don't get symptoms very often, you'll probably only need to use hydrocortisone rectal foam for 2 to 3 weeks. If you have frequent bouts of symptoms you might have to use the foam for longer.
Is it safe to use for a long time?
As a general rule, once your symptoms have settled down your doctor will recommend that you stop using this medicine.
Using hydrocortisone rectal foam continuously for a long time can mean some of the medicine gets into your bloodstream. If this happens, there's a very small chance it can cause serious side effects.
Can I drink alcohol with it?
Yes, you can drink alcohol while using hydrocortisone rectal foam.
Are there any foods or drinks I need to avoid?
No, you can eat and drink normally while using hydrocortisone rectal foam.
Why do I need to be careful of infections?
Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. Your doctor may be able to prescribe a medicine to protect you.
Can I have vaccinations?
Before having a vaccination, tell the healthcare professional that you're taking a steroid.
It's possible that if you have a 'live' vaccine while you're using hydrocortisone rectal foam your immune system might not be strong enough to handle it. This could lead to you getting an infection. Live vaccines include:
- shingles vaccine
- BCG (tuberculosis) vaccine
- yellow fever vaccine
- MMR (measles, mumps and rubella) vaccine
- nasal spray flu vaccine
Inactive vaccinations, like the injected flu vaccine, are safe.
If you need to have a live vaccine, check with the nurse or doctor that it's safe for you.
Do I need a blue steroid card?
If you have to use hydrocortisone rectal foam for longer than 3 weeks your pharmacist or doctor will give you a steroid treatment card. Carry this with you all the time.
The card, which is usually blue, is the size of a credit card and fits in your wallet or purse. It tells you how to reduce the risks of steroid-related side effects. It also gives details of your doctor, your dose of hydrocortisone and how long your treatment is expected to last.
If you don't have a blue steroid card, ask your pharmacist or doctor for one.
If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist.
Will it affect my fertility?
Hydrocortisone rectal foam has no effect on the fertility of men or women.
Are there other treatments I could use instead?
A medicine called aminosalicylate is also used to treat ulcerative colitis and other inflammatory disorders of the bowel and rectum.
Aminosalicylate comes as tablets, capsules or rectal foam. It also comes as an enema or suppository (small pellets of medicine that are inserted into the back passage).
Aminosalicylate does not work quite as well as hydrocortisone rectal foam but it has fewer side effects.