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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Recommendation Grading

Overview

Title

Management of Hemorrhoids

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

January 31, 2024

Last Updated Month/Year

October 1, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Patients with hemorrhoids

Inclusion Criteria

Male, Female, 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

Treatment, Management, Prevention

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.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
64
Literature Search Start Date
April 1, 1996
Literature Search End Date
April 1, 2017