AGA issues new hemorrhoid guidelines, urges more fiber and less straining

The American Gastroenterological Association said the most effective first step for hemorrhoids is also the least glamorous: eat more dietary fiber and spend less time straining on the toilet. The new clinical practice update, released April 27 from Bethesda, Maryland, said hemorrhoids affect about 50% of people by age 50 and tied prevention to everyday habits that can be changed before symptoms worsen.

AGA’s patient materials describe hemorrhoids as swollen veins around the anus, often triggered by straining to move the bowels or sitting too long on the toilet. Pregnancy, obesity and liver disease can also play a role. That makes the new guidance as much about routine as treatment: the group said shorter bathroom visits and less pushing are the most effective initial measures, while fiber remains the core dietary change.

The update also took aim at the self-treatment habits many people try before seeing a clinician. Sitz baths and over-the-counter topical products may ease symptoms, AGA said, but the evidence supporting them is limited. Topical steroids deserve particular caution, since AGA warned they should not be used for more than two weeks because of the risk of skin thinning and irritation.

Before treatment starts, AGA recommended a physical exam to confirm hemorrhoids, often including anoscopy. That matters because not every case of rectal bleeding or discomfort is hemorrhoids, and the guidance pushes clinicians to verify the diagnosis rather than default to a cream or home remedy.

For persistent or severe cases, AGA said office-based procedures such as banding may be needed, with surgery reserved for more serious disease. Hemorrhoids during pregnancy are usually managed conservatively, with diet changes and symptom relief rather than aggressive intervention.

The hemorrhoid update fits into AGA’s broader effort to rein in constipation, which it said in January affects 8% to 12% of Americans. In that guidance, the association urged a systematic approach to evaluation and treatment before surgery is considered, reinforcing the same message now aimed at hemorrhoids: fix the underlying bowel habits first, then escalate only when needed.