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MICHAEL J. ARNOLD, MD, MHPE, AND DAVID SMITH, MD

Am Fam Physician. 2025;112(6):694-695

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.
• Patients with hemorrhoids should be evaluated for constipation because addressing the constipation can substantially reduce symptoms.
• Increased fluid and fiber intake is recommended to reduce symptoms by more than 50%.
• Topical hemorrhoid treatments containing hydrocortisone, phenylephrine, or pramoxine, or flavonoid-containing oral supplements can reduce pain and pruritus.
• Office-based procedures such as rubber band ligation, injection sclerotherapy, and infrared coagulation are preferred over surgery due to similar benefits with fewer complications.
From the AFP Editors

Hemorrhoids are perianal vascular structures defined as external or internal by their relationship to the dentate line, although they often coexist and communicate with each other. Symptoms due to hemorrhoids are common in the industrialized world, although other sources of perianal symptoms can be misinterpreted as hemorrhoidal. The American Society of Colon and Rectal Surgeons (ASCRS) has published guidelines on the diagnosis and management of hemorrhoids.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, MHPE, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

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