AGA update emphasizes lifestyle changes for effective hemorrhoid management

The American Gastroenterological Association (AGA) has released a new clinical practice update providing expert guidance on the diagnosis and treatment of hemorrhoids, a common condition affecting approximately 50% of people by age 50. 

The update highlights that despite the prevalence of hemorrhoids, effective management often starts with simple, accessible lifestyle changes. 

Key takeaways for patients and providers: 

• Lifestyle changes come first: Increasing dietary fiber and reducing time and straining on the toilet are the most effective initial treatments.

• Common remedies lack strong evidence: Widely used treatments like sitz baths and over-the-counter topical products may provide relief, but data supporting their effectiveness are limited. 

• Use topical steroids cautiously: These products should not be used for more than two weeks due to the risk of skin thinning and irritation. 

• Proper diagnosis matters: A physical exam, often including anoscopy, is recommended to confirm hemorrhoids before starting treatment. 

• When to escalate care: Persistent or severe hemorrhoids may require office-based procedures (such as banding) or surgery. 

• Special populations: Hemorrhoids are common during pregnancy and are typically managed conservatively with diet and symptom relief. 

The update also emphasizes the importance of patient education, including discussing the potential risks of procedures (though rare) and ensuring patients know when to seek urgent care.