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Topical Rectal Corticosteroid Pregnancy: Use with caution — some systemic absorption; use only if benefit clearly outweighs risk. Rectal mesalazine preferred in pregnancy for distal UC.

Hydrocortisone Acetate Rectal Foam / Enema

Brand names: Colifoam (foam), Hydrocortisone Enema

Adult dose

Dose: Colifoam rectal foam: 1 application (125mg hydrocortisone acetate) once or twice daily for 2–3 weeks; then 1 application on alternate days for 2–3 weeks. Hydrocortisone enema: 100mg in 100–200mL water per rectum once or twice daily.
Route: Rectal (foam applicator or enema)
Frequency: Once or twice daily initially; alternate days (maintenance)
Max: 125mg per application (foam); 200mg/day (enema)
For distal ulcerative colitis, proctitis, and proctosigmoiditis. Topical rectal application reduces systemic steroid exposure vs oral prednisolone. Colifoam preferred over enema for proctitis limited to rectum (retained more easily). Some systemic absorption occurs — consider for patients unable to tolerate systemic steroids.

Paediatric dose

Route: Rectal
Frequency: Once or twice daily
Max: Seek specialist opinion
Seek specialist paediatric gastroenterology opinion for rectal corticosteroid use in children. BNF for Children provides limited guidance — use under specialist supervision only.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution — some systemic absorption occurs; monitor for steroid side effects in severe hepatic impairment.

Clinical pearls

  • Rectal foam vs enema: foam (Colifoam) is retained better than liquid enema — preferred for isolated proctitis. Enema reaches higher up to sigmoid colon — preferred for proctosigmoiditis.
  • BSG guidelines: topical rectal corticosteroids (or rectal mesalazine) are first-line for distal UC/proctitis. Combined oral + rectal therapy is superior to either alone.
  • Systemic absorption: approximately 50% of hydrocortisone from rectal foam is absorbed systemically — not truly 'topical-only'. Prolonged use can cause HPA axis suppression.
  • Positioning: lie on left side after foam application for 15–30 minutes to allow retention and distribution up to sigmoid.

Contraindications

  • Intestinal obstruction
  • Bowel perforation or peritonitis
  • Severe local infection (without antibiotic cover)
  • Recent bowel anastomosis

Side effects

  • Local irritation (burning, itching — usually mild)
  • Adrenal suppression (with prolonged use — systemic absorption occurs)
  • Increased infection susceptibility (local)
  • Cushingoid features (rare — with prolonged high-frequency use)

Interactions

  • Other corticosteroids: additive adrenal suppression with systemic steroids
  • NSAIDs: additive GI risk (minimal with rectal route but consider if also taking oral NSAIDs)

Monitoring

  • Symptom response (rectal bleeding, stool frequency)
  • Signs of systemic steroid effects (prolonged use)
  • Blood glucose in diabetics

Reference: BNFc; BNF 90; BSG Ulcerative Colitis Guidelines 2019; SPC Colifoam. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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