What is Hydrocortisone?
Hydrocortisone is a corticosteroid medication that mimics the effects of cortisol, a hormone naturally produced by the adrenal glands [1.5.4]. It is used to treat a wide variety of conditions due to its potent anti-inflammatory and immunosuppressive properties [1.5.4]. Medical professionals prescribe hydrocortisone for allergic reactions, skin conditions like eczema, autoimmune diseases such as lupus, and to replace cortisol in people with adrenal insufficiency (a condition where the body doesn't produce enough steroids) [1.5.2, 1.6.5]. It is available in many forms, including oral tablets, topical creams, injections, and enemas [1.5.1, 1.6.3, 1.4.7]. While highly effective, hydrocortisone and other corticosteroids come with a significant list of potential side effects, especially with long-term or high-dose use [1.5.5].
The Link Between Hydrocortisone and Gastrointestinal Issues
Corticosteroids are well-known for their potential to cause gastrointestinal (GI) problems [1.2.1, 1.4.2]. The most commonly discussed GI side effects include stomach pain, gastritis (stomach lining inflammation), peptic ulcers, and an increased risk of GI bleeding [1.2.4, 1.4.1]. These effects can occur because steroids may irritate the stomach lining and potentially impair tissue repair, which can delay the healing of ulcers [1.4.4, 1.4.5]. The risk of these complications increases significantly when corticosteroids are taken concurrently with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin [1.4.2].
While issues like ulcers and bleeding are more severe, more common symptoms include stomach upset, nausea, bloating, and increased appetite [1.2.5]. About 10% of patients may experience stomach pain when starting corticosteroid treatment [1.4.3]. For this reason, doctors often recommend taking oral hydrocortisone with food to help reduce stomach irritation [1.2.5].
So, Does Hydrocortisone Cause Diarrhea Specifically?
Yes, diarrhea is a listed potential side effect of oral hydrocortisone [1.5.1, 1.3.2]. It is often included in the list of side effects for which you should contact your doctor if they become severe [1.5.2]. However, it is generally considered a less common side effect compared to others like weight gain, mood changes, and increased appetite [1.2.1].
Interestingly, severe diarrhea while taking hydrocortisone is a cause for significant concern, particularly for patients with adrenal insufficiency. Persistent vomiting or diarrhea can prevent the body from absorbing the oral medication, leading to a sharp drop in steroid levels and potentially triggering a life-threatening adrenal crisis [1.3.5, 1.3.7]. An adrenal crisis can involve symptoms like severe dizziness, weakness, confusion, and abdominal pain [1.3.6]. Therefore, any instance of severe or persistent diarrhea while on hydrocortisone requires immediate medical attention [1.3.7].
Systemic side effects from topical hydrocortisone (creams) are rare unless a very potent steroid is used over a large area of skin or for a prolonged period, allowing it to be absorbed into the bloodstream [1.6.2, 1.6.3]. In such cases of significant systemic absorption, GI issues could theoretically occur [1.6.4].
Comparison of Common Corticosteroid GI Side Effects
Hydrocortisone and prednisone are two commonly prescribed corticosteroids. While they share a similar side effect profile, their potency and specifics can differ.
| Feature | Hydrocortisone | Prednisone |
|---|---|---|
| Primary Use | Replacement therapy (adrenal insufficiency), anti-inflammatory for various conditions [1.5.4, 1.4.7] | Potent anti-inflammatory for a wide range of diseases (e.g., asthma, arthritis) [1.4.5] |
| Common GI Effects | Stomach pain, cramps, nausea, increased appetite [1.2.2, 1.2.5] | Upset stomach, nausea, vomiting, stomachache, increased appetite [1.8.2, 1.3.4] |
| Risk of Ulcers | Increases risk, especially with NSAIDs [1.2.4, 1.4.1] | Increases risk, especially with NSAIDs [1.4.5, 1.8.4] |
| Diarrhea | Listed as a known side effect, though incidence is not specified [1.5.1, 1.3.2] | Listed as a possible GI symptom [1.8.1, 1.4.6] |
| Management | Take with food to minimize irritation [1.2.5]. | Take with food; doctor may prescribe stomach-protecting medication [1.4.1]. |
How to Manage Side Effects and When to See a Doctor
Managing the side effects of hydrocortisone involves close communication with your healthcare provider. Here are some key strategies:
- Take with Food: Always take oral hydrocortisone with food or milk to help protect your stomach lining from irritation [1.7.2, 1.7.5].
- Stay Hydrated: If you experience diarrhea, it's crucial to drink plenty of fluids like water to avoid dehydration [1.7.2]. Signs of dehydration include peeing less than usual or dark, strong-smelling urine [1.7.2].
- Avoid NSAIDs: Do not take NSAIDs like ibuprofen or aspirin with hydrocortisone unless specifically approved by your doctor, as this combination significantly raises the risk of stomach bleeding [1.4.1].
- Dietary Adjustments: Your doctor might recommend a diet low in sodium and rich in potassium and calcium, as steroids can affect electrolyte balance and bone density [1.5.3, 1.7.6].
- Do Not Stop Suddenly: Never stop taking hydrocortisone abruptly. Doing so can cause withdrawal symptoms or an adrenal crisis [1.5.2]. Your doctor will provide a schedule to taper the dose gradually [1.5.2].
You should contact your doctor immediately if you experience severe or persistent diarrhea, severe abdominal pain, vomiting, black or tarry stools, or signs of an adrenal crisis (extreme fatigue, dizziness, weakness) [1.5.6, 1.3.7].
Authoritative Link: Learn more about Hydrocortisone Side Effects from the NHS
Conclusion
So, does hydrocortisone cause diarrhea? Yes, it is a possible side effect of oral hydrocortisone, although other GI issues like stomach pain, irritation, and increased appetite are more commonly reported [1.5.1, 1.7.2]. While often mild, diarrhea can be a sign of a more serious problem, especially for individuals relying on hydrocortisone for hormone replacement. Due to the risk of dehydration and malabsorption, any severe or lasting episode of diarrhea should be discussed with a healthcare provider immediately. Proper management, such as taking the medication with food and avoiding NSAIDs, can help mitigate many of the gastrointestinal risks associated with hydrocortisone therapy.
