Management of Hemorrhoids
Publication Date: January 31, 2024
Last Updated: February 16, 2024
Recommendations
EVALUATION OF HEMORRHOIDS
A disease-specific history and physical examination should be performed, emphasizing degree and duration of symptoms and risk factors. (1C)
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EVALUATION OF RECTAL BLEEDING
Complete endoscopic evaluation of the colon is indicated in select patients with symptomatic hemorrhoids and rectal bleeding. (1B)
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MEDICAL TREATMENT OF HEMORRHOIDS
Dietary modification consisting of adequate fluid and fiber intake and counseling regarding defecation habits typically form the primary first-line therapy for patients with symptomatic hemorrhoid disease. (1B)
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Medical therapy for hemorrhoids represents a heterogeneous group of treatment options that can be offered with expectations of minimal harm and a decent potential for relief. (2B)
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OFFICE TREATMENT
Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation (IRC). Hemorrhoid banding is typically the most effective option. (1A)
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THROMBOSED EXTERNAL HEMORRHOIDS
Select patients with thrombosed external hemorrhoids may benefit from early surgical excision. (2C)
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SURGICAL HEMORRHOIDECTOMY
Hemorrhoidectomy should typically be offered to patients whose symptoms result from external hemorrhoids or combined internal and external hemorrhoids with prolapse (grades III–IV). (1A)
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Patients undergoing surgical hemorrhoidectomy should use a multimodality pain regimen to reduce narcotic usage and promote a faster recovery. (1B)
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Title
Management of Hemorrhoids
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
January 31, 2024
Last Updated Month/Year
February 19, 2024
External Publication Status
Published
Country of Publication
US
Target Patient Population
Patients with hemorrhoids
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient
Intended Users
Medical assistant, nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D006484 - Hemorrhoids, D061865 - Hemorrhoidectomy
Keywords
hemorrhoid, internal and external hemorrhoids, hemorrhoidopexy
Source Citation
Hawkins AT, Davis BR, Bhama AR, Fang SH, Dawes AJ, Feingold DL, Lightner AL, Paquette IM; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2024 Jan 31. doi: 10.1097/DCR.0000000000003276. Epub ahead of print. PMID: 38294832.
Methodology
Number of Source Documents
64
Literature Search Start Date
April 1, 1996
Literature Search End Date
April 1, 2017