Long-term Use of Hemorrhoid Cream: Risks and Alternatives for Relief

Using hemorrhoid ointment for an extended period can cause discomfort in the anal area?

Hello, doctor.
I previously had an anal fissure, and the hospital prescribed a medication called "Hiyu Zhi" ointment, which I applied for about a week, and the fissure healed without pain.
However, whenever I stop using the ointment, I experience significant discomfort around the anus, which feels like a burning sensation, and it becomes very sensitive and uncomfortable when touched.
It resembles the feeling after having multiple bowel movements, but it is different from the tearing pain associated with the fissure.
As soon as I apply the ointment, that discomfort disappears, and I can have normal bowel movements again.
I have been using the anal ointment continuously for nearly 10 years and am afraid to stop because I worry that stopping will lead to significant discomfort during bowel movements.
I would like to ask the doctor: 1.
Is there a possibility that using this ointment for such a long time could lead to rectal cancer or anal cancer? 2.
What methods can I use to avoid relying on hemorrhoid ointment and still have normal bowel movements? Thank you.

Chenchen, 20~29 year old female. Ask Date: 2024/07/03

Dr. Ke Fangxu reply Surgery

1.
You might be overthinking; the probability of developing anal cancer at this age is extremely low, and anal cancer is a rare type of cancer.

2.
The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding.
The pain often lasts for several days, sometimes even more than a week.
The common causes are usually constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
However, to completely resolve the issue, it is essential to start by improving bowel habits.

Reply Date: 2024/07/03

More Info

Long-term use of hemorrhoid creams, such as the one you mentioned (likely containing hydrocortisone or similar ingredients), can indeed provide temporary relief from discomfort associated with conditions like anal fissures or hemorrhoids. However, using these creams continuously for an extended period, such as nearly ten years, raises several concerns that warrant careful consideration.

Risks of Long-term Use
1. Skin Thinning and Atrophy: One of the primary risks associated with prolonged use of topical corticosteroids is skin thinning (atrophy). This can lead to increased sensitivity, bruising, and a higher risk of skin infections. The delicate skin around the anal area is particularly susceptible to these effects.

2. Tachyphylaxis: Over time, your body may become accustomed to the medication, leading to reduced effectiveness. This phenomenon, known as tachyphylaxis, means that you might find yourself needing to use more of the cream or applying it more frequently to achieve the same relief.

3. Potential for Systemic Absorption: Although the risk is lower with topical applications compared to oral medications, prolonged use of strong topical steroids can lead to systemic absorption, particularly if applied over large areas or under occlusion. This can potentially affect adrenal function and lead to other systemic side effects.

4. Increased Risk of Infections: Long-term use of corticosteroids can suppress local immune responses, increasing the risk of bacterial, viral, or fungal infections in the area.

5. Cancer Risk: While there is no direct evidence linking the long-term use of hemorrhoid creams to rectal or anal cancer, chronic irritation and inflammation in the anal area can potentially lead to changes in the tissue that might increase cancer risk. However, this is more commonly associated with untreated conditions rather than the use of topical treatments.

Alternatives and Management Strategies
1. Dietary Changes: One of the most effective ways to manage bowel health and reduce the need for topical treatments is through dietary modifications. Increasing fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

2. Stool Softeners and Laxatives: If dietary changes alone are insufficient, consider using over-the-counter stool softeners or mild laxatives. These can help ease bowel movements without the need for topical medications.

3. Warm Sitz Baths: Regular sitz baths can provide relief from discomfort and promote healing of anal fissures. Soaking in warm water for 10-15 minutes several times a day can help soothe the area.

4. Topical Alternatives: If you find that you need to continue using a topical treatment, discuss with your healthcare provider about switching to a less potent formulation or using non-steroidal options, such as creams containing witch hazel or aloe vera, which can provide soothing effects without the risks associated with long-term steroid use.

5. Behavioral Modifications: Establishing a regular bowel routine can help. Try to go to the bathroom at the same times each day, and avoid straining. Responding promptly to the urge to have a bowel movement can also help prevent issues.

6. Consultation with a Specialist: Given your long-term use of the cream and ongoing discomfort, it would be beneficial to consult a gastroenterologist or a colorectal surgeon. They can provide a thorough evaluation and suggest a tailored management plan that addresses the underlying issues without relying solely on topical medications.

Conclusion
While hemorrhoid creams can provide significant relief, their long-term use should be approached with caution due to potential side effects. By exploring alternative management strategies and making lifestyle changes, you may find ways to reduce your reliance on these creams and improve your overall bowel health. Always consult with a healthcare professional before making any changes to your treatment regimen.

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