Proctosedyl (Hydrocortisone/Cinchocaine)
Is It Right for You?
A complete guide to Proctosedyl (Hydrocortisone/Cinchocaine) — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Proctosedyl?
Proctosedyl is a combination topical preparation available as an ointment and suppositories, each containing two active ingredients: hydrocortisone 0.5% (a mild topical corticosteroid) and cinchocaine hydrochloride 0.5% (a potent local anaesthetic of the amide class). It is used for the symptomatic relief of pain, itch, discomfort, and inflammation associated with haemorrhoids (piles) and other anorectal conditions.
Hydrocortisone reduces the local inflammatory response and itching associated with haemorrhoidal tissue; cinchocaine provides rapid and effective local anaesthesia to relieve the acute pain that is often the most distressing symptom of haemorrhoids. Together, these components address both the inflammatory and nociceptive components of haemorrhoidal disease simultaneously.
Proctosedyl is a prescription-only medication in the UK due to the presence of cinchocaine — a potent local anaesthetic capable of causing systemic toxicity if absorbed in sufficient quantities — and the corticosteroid component.
What Conditions Is Proctosedyl Used For?
Proctosedyl is indicated for:
relief of pain, itch, burning, and discomfort associated with internal and external haemorrhoids
symptomatic relief of pain and inflammation in acute proctitis where local treatment is appropriate
symptomatic relief (pain relief and reduction of spasm) in anal fissure, as an adjunct to definitive treatment
Proctosedyl is a symptomatic treatment. It does not shrink haemorrhoids, heal anal fissures, or resolve proctitis. Underlying causes — including constipation, dietary fibre deficiency, and increased intraabdominal pressure — must be addressed with dietary modification, adequate hydration, and where appropriate, surgical referral. New rectal bleeding must always be investigated before attributing it solely to haemorrhoids.
How Does Proctosedyl Work?
Proctosedyl's dual mechanism addresses both the pain and inflammatory components of anorectal conditions:
Hydrocortisone is a naturally occurring glucocorticoid. Applied topically to the anorectal mucosa and perianal skin, it binds intracellular glucocorticoid receptors and suppresses the transcription of pro-inflammatory mediators — reducing the vasodilation, oedema, and pruritus that characterise inflamed haemorrhoidal tissue. Hydrocortisone is classified as a mild topical corticosteroid and has a relatively low potency compared to agents such as betamethasone, making it suitable for use on sensitive perianal and mucosal surfaces for short courses.
Cinchocaine hydrochloride is an amide local anaesthetic. It blocks voltage-gated sodium channels in sensory nerve fibres at the application site, preventing the generation and propagation of action potentials and producing reversible local anaesthesia. Its onset of action is rapid, typically within minutes of application, providing effective relief of acute anorectal pain — including pain on defaecation, which is often the most debilitating symptom.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
For the ointment: Apply a small amount externally to the perianal area and, if directed, use the applicator nozzle to apply a small amount internally into the anal canal. Wash hands thoroughly before and after.
For suppositories: Unwrap the suppository and moisten slightly with water. Lie on your side, draw your upper knee towards your chest, and gently insert the suppository into the rectum with a finger. Remain lying down for a few minutes to allow absorption.
Do not use for more than 7 days without clinical review. Prolonged use of even mild topical corticosteroids on perianal and mucosal skin carries a risk of skin atrophy and increased local infection susceptibility.
Do not use if rectal bleeding is unexplained. New rectal bleeding must be clinically assessed before symptomatic treatment is used.
Avoid contact with eyes. Cinchocaine can cause irritation if it contacts the ocular surface.
Side Effects of Proctosedyl
Most side effects are mild and resolve on their own. Serious side effects are rare but require immediate medical attention.
- Local burning, stinging, or mild irritation on application --- usually transient and settles within minutes
- Skin sensitivity at the application site
- Systemic cinchocaine toxicity --- rare at recommended doses but possible with excessive or prolonged use, or if large amounts are absorbed through inflamed or fissured mucosa; presents as tinnitus, dizziness, perioral tingling, metallic taste, confusion, arrhythmias, or seizures; seek immediate emergency care
- Hypersensitivity reactions --- contact allergy to cinchocaine or hydrocortisone; worsening rash, urticaria, or angioedema
- Local skin atrophy and perianal thinning --- with prolonged use of hydrocortisone on perianal skin
- Increased susceptibility to local infections --- prolonged corticosteroid use may mask or worsen local bacterial, fungal, or viral infections at the application site
- HPA axis suppression --- unlikely at recommended doses but possible with excessive or widespread topical corticosteroid use
Cinchocaine is a potent amide local anaesthetic. While systemic toxicity is uncommon at prescribed doses, excessive application, prolonged use, or absorption through inflamed mucosa can produce serious central nervous system and cardiac toxicity. Always use the minimum effective amount for the shortest possible duration.
Drug Interactions
Proctosedyl may interact with other medications, including systemic corticosteroids and antiarrhythmic drugs. Always inform your clinician about all medications you are taking.
additive corticosteroid load with extensive or prolonged topical hydrocortisone use; risk of HPA axis suppression is amplified in patients already on systemic steroids.
theoretical additive effect of cinchocaine with sodium channel-blocking antiarrhythmics (e.g., lidocaine, mexiletine) at supratherapeutic topical doses; not clinically significant at recommended doses.
no significant interactions with standard anorectal preparations when used as directed.
Important Warnings
Rectal bleeding must never be assumed to be haemorrhoidal without clinical assessment, particularly in patients over 45 years or those with a change in bowel habit. Colorectal cancer, inflammatory bowel disease, and other serious conditions can present with rectal bleeding. A clinician must assess new rectal bleeding before prescribing symptomatic treatment.
Proctosedyl is intended for short-term symptomatic use only. Treatment courses should not exceed 7 days without clinical review. Prolonged use increases the risk of perianal skin atrophy, local infection, and sensitisation.
Proctosedyl is not recommended for use in children. Seek specific paediatric clinical advice.
Use during pregnancy and breastfeeding should only be undertaken if the clinical benefit clearly outweighs potential risks. Seek clinician guidance before use.
Speak to a Clinician About Treatment
Getting advice no longer means sitting in a waiting room. Through The GP Service, you can consult with a licensed clinician in minutes — from home, on your lunch break, or wherever works for you. If treatment is clinically appropriate, your clinician can issue a prescription during the consultation. A consultation does not guarantee a prescription.
The treatment you need, when you need it.
Proctosedyl FAQs
Cinchocaine acts rapidly, typically providing local anaesthetic relief within a few minutes of application. This makes Proctosedyl particularly useful for pain on defaecation. The anti-inflammatory effect of hydrocortisone develops over the first few days of regular use.
External haemorrhoids and perianal symptoms are generally better treated with the ointment applied to the perianal area. Internal haemorrhoids may benefit from suppositories or from the ointment applied internally via the applicator. Your clinician will advise based on the location and nature of your symptoms.
No. Proctosedyl is intended for short-term symptomatic use only (up to 7 days per course). Frequent recurrence of haemorrhoidal symptoms indicates the need to address underlying causes — principally constipation and dietary fibre intake — and may warrant specialist surgical referral for definitive treatment options such as banding or haemorrhoidectomy.