Stop scrolling on the toilet and eat more fibre, new U.S. guidelines on hemorrhoids say

The American Gastroenterological Association (AGA) has put out a new set of guidelines on the treatment and diagnosis of hemorrhoids, urging dietary and lifestyle modifications as the first-line therapies for addressing symptomatic hemorrhoids.These dietary and lifestyle modifications include increasing fibre intake and avoiding straining or “prolonged time on the toilet,” the guidelines say. For treating symptoms, the guidelines say that sitz baths and topical treatments (such as anesthetics, astringents, corticosteroids and vasoactive agents) can be considered, but clinicians should note that there remains limited scientific data to support their effectiveness.When it comes to diagnosing hemorrhoids, the AGA says an anoscopy should be performed “whenever possible, on every new patient with suspected hemorrhoids” prior to treatment. The guidelines add that patients should be carefully examined to avoid confusing hemorrhoids with rectal varices.For hemorrhoids that require an office procedure to treat, the AGA notes that hemorrhoid banding and infrared coagulation are “safe, effective, and easy to perform in the office setting,” adding that they both have similar benefits in the short-term. For patients with significant coagulopathy, infrared coagulation is preferred to banding. For grades 1-3 hemorrhoids, these procedures should be employed before employing surgical hemorrhoidectomy.“As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated,” the guidelines say.For patients with acute thrombosed hemorrhoids, grade 4 internal hemorrhoids, these hemorrhoids are best treated with surgery. Surgical options should also be considered for patients with grade 3 internal hemorrhoids who fail banding procedures.However, for some patient groups, such as those with active Crohn’s disease or ulcerative colitis, the AGA recommends delaying hemorrhoid management until complete remission is achieved. For pregnant patients, treatment should involve fibre, topical ointments and addressing constipation, and banding or infrared coagulation can be considered if the symptoms continue postpartum, or if the patient is planning further pregnancies.

Stop scrolling on the toilet and eat more fibre, new U.S. guidelines on hemorrhoids say

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