Clin Gastroenterol Hepatol
Hemorrhoids guidance shifts focus to fiber, toilet habits over quick fixes
Clinical Takeaway: Start with fiber supplementation and toileting behavior changes (avoid straining, limit time on toilet) for most patients; use topical therapies only short term, and escalate to office procedures like banding if symptoms persist.
A new American Gastroenterological Association (AGA) Clinical Practice Update emphasizes a back-to-basics approach to hemorrhoid care, placing diet and behavior at the center of treatment and questioning the routine use of common over-the-counter remedies.
The expert review stresses that conservative management should be first line for most patients. Increasing dietary fiber intake and reducing time and straining during defecation are identified as the most effective initial interventions for symptom relief.
Diagnosis should not be assumed: clinicians are advised to confirm hemorrhoids with a focused history and physical exam—often including anoscopy—and to evaluate rectal bleeding carefully to exclude more serious pathology.
Drug therapy plays a secondary, symptom-driven role. Topical agents (including corticosteroids, anesthetics, and vasoactive products) may provide short-term relief, but evidence supporting their efficacy is limited. Importantly, topical corticosteroids should be used cautiously and generally for no more than 1 to 2 weeks due to risks such as skin thinning and irritation.
The guideline also highlights that widely used measures such as sitz baths and OTC products are not strongly supported by high-quality data, signaling a shift away from reflexive prescribing toward more evidence-based use.
For patients with persistent or more severe disease, escalation to office-based procedures—particularly rubber band ligation—is recommended before considering surgery. Surgical approaches are reserved for refractory or advanced cases.
Special populations, including pregnant patients, are generally managed conservatively with diet and symptom control. Patient education is emphasized throughout, including counseling on proper bowel habits and when to seek care.
As one author noted, “Hemorrhoid disease is easily and safely managed by the gastroenterologist in the office setting,” reflecting the growing role of non-surgical, stepwise care.
Source: Qureshi W, et al. (2026, April 29). Clin Gastroenterol Hepatol. AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review