Hemorrhoids (commonly known as “hemorrhoids”) are a common disease located in the anal area and can develop at any age. As the saying goes, “Hemorrhoids don’t occur at an advanced age”. So the severity of hemorrhoids is not directly proportional to age, but the incidence gradually increases with age. In our country, hemorrhoids are the most common anorectal disease, and there are “nine hemorrhoids in ten men” and “ten hemorrhoids in ten women”. The actual fact is that you can find a number of types of hemorrhoids. 1, according to the site where the hemorrhoids occur, hemorrhoids are divided into internal hemorrhoids, external hemorrhoids, mixed hemorrhoids. The actual hemorrhoids are divided into internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids according to the site of occurrence. There is a jagged visible line at the connection between the skin of the anal canal and the rectal mucosa called the anal canal dentate line. The soft venous mass formed by the enlarged and varicose plexus under the mucous membrane at the end of the rectum is called internal hemorrhoid, which occurs above the dentate line. The external hemorrhoid is formed by the enlarged varicose plexus of the external hemorrhoid, the rupture of the external hemorrhoid vein, and the fibrous hyperplasia caused by repeated inflammation, which occurs below the dentate line. If the varicose veins of internal and external hemorrhoids are communicating and anastomosing with each other so that the internal and external hemorrhoid parts form a whole, it is a mixed hemorrhoid. In addition, when the external hemorrhoids are connected into a week or at least three hemorrhoid bodies are fused, the external hemorrhoids are plum-shaped, called ring-shaped hemorrhoids. 2, internal hemorrhoids are divided into four degrees: Stage I: bleeding with blood or dripping or jet bleeding during the stool, no internal hemorrhoids prolapse, bleeding can stop on its own after the stool. Stage II: Blood, dripping or spraying bleeding at stool, with internal hemorrhoids prolapsing, can be returned after stool. Stage III: Blood or dripping blood in the stool with prolapsed internal hemorrhoid, or prolapsed internal hemorrhoid when standing for a long time, coughing or exerting weight, which must be returned by hand. Stage IV: Internal hemorrhoids can not be returned, accompanied by anal relaxation and varicose veins type external hemorrhoids, if not sent back in time, easy to form a ton. 3, external hemorrhoids are divided into four types: Inflammatory external hemorrhoids: anal edge skin breakage or infection. The local redness, oozing or broken, pain is obvious. Thrombosed external hemorrhoids: subcutaneous greenish-purple lump at the anal verge, local skin edema, the lump is still soft at the beginning, pain is intense, gradually hardening, movable, clearly demarcated, painful to touch. Middle-aged men are the majority. Varicose external hemorrhoids: soft bruise-purple masses bulge under the skin of the anal verge during defecation or after prolonged squatting, which can be accompanied by a feeling of swelling and can disappear after pressure. Connective tissue external hemorrhoids: superfluous skin flap at the edge of the anus, gradually increasing in size, soft texture, generally no pain, no bleeding, only feel a sense of foreign body in the anus, occasionally swollen with infection to feel pain, swelling disappears after the superfluous skin still exists. The clinical manifestations of hemorrhoids 1, internal hemorrhoids mainly manifest as blood in the stool, the nature of blood in the stool can be painless, intermittent, fresh blood after the stool, blood dripping during the stool or blood on the hand paper, constipation, drinking alcohol or eating irritating food aggravated. 2.Simple internal hemorrhoids are painless only the feeling of swelling, can bleed, develop to prolapse, combined with thrombosis, impaction, infection only when the pain appears. 3.External hemorrhoids usually have no special symptoms, but they can be swollen and painful when thrombosis and inflammation occur. What are the predisposing factors for hemorrhoids? There are many predisposing factors for hemorrhoids, among which constipation, long-term alcohol consumption, eating a lot of irritating food and being sedentary are the main triggers. In addition genetic factors are also an important reason. This is one reason why many children also suffer from hemorrhoids, and some young people have serious hemorrhoids. Fourth, do I need surgery for hemorrhoids? A lot of friends say that hemorrhoids are not serious and that they will pass if they endure. This means that your hemorrhoids are not serious. If hemorrhoids manifest as repeated anal pain, frequent blood in the stool, and anal prolapses that affect bowel movements, you need to actively treat them. Because serious hemorrhoids may also be life-threatening. 1.Non-surgical treatment Asymptomatic hemorrhoids do not require treatment; hemorrhoids with mild symptoms and infrequent attacks are treated mainly non-surgically. (1) General treatment Applicable to the vast majority of hemorrhoids, including the initial stages of thrombosed and embedded hemorrhoids. Pay attention to diet, avoid alcohol and spicy stimulating foods, increase fibrous foods, consume more fruits and vegetables, drink more water, change bad bowel habits, keep bowel movements smooth, take laxatives if necessary, and wash the anus after stooling. For prolapsed hemorrhoids, pay attention to gently holding the hemorrhoid back with your hand to stop it from prolapsing again. Avoid prolonged sitting and standing, do proper exercises, warm water before bedtime, hot water sitz bath, etc. (2) Local medication has been widely used, and the medication includes suppositories, creams and lotions, most of which contain Chinese herbal ingredients. (3) Oral drug therapy Generally, laxative drugs are used to stop bleeding. (4) Injection therapy The effect is better for Ⅰ and Ⅱ degree bleeding internal hemorrhoids; sclerosing agent is injected around the submucosal venous plexus to cause inflammatory reaction and fibrosis, thus pressing the varicose vein closed to achieve the treatment purpose. (5) Rubber band ligation Ligation of the root of the hemorrhoid, blocking its blood supply in order to make the hemorrhoid fall off and necrosis; applicable to II and III degree internal hemorrhoids, more suitable for huge internal hemorrhoids and fibrosis internal hemorrhoids. (2) Surgical treatment (1) Indications for surgery Conservative treatment is ineffective, serious hemorrhoid prolapse, large fibrotic internal hemorrhoids, poor treatment by injection, combined with anal fissure, anal fistula, etc.; (2) Surgical principles The prolapsed anal cushion is repositioned through surgery to preserve the structure of the anal cushion as much as possible, thus affecting the ability to control the stool as little as possible after surgery; (3) Pre-operative preparation If there is ulcer or infection on the surface of the internal hemorrhoid, conservative treatment of laxative and warm water sitz bath is first. (3) Pre-operative preparation (4) Surgical procedure ① Thrombosed external hemorrhoid debridement For thrombosed external hemorrhoids that do not relieve pain or reduce the size of the mass after conservative treatment. ②Classical hemorrhoidectomy, i.e., external peeling and internal ligation. ③Circumferential hemorrhoidectomy (Whitehead procedure) A textbook classic procedure that is prone to anal stenosis and is rarely used in clinical practice. ④PPH surgery Anastomotic supra-rectal mucosal circumferential stapling of hemorrhoids. It is mainly applied to prolapsed III-IV degree mixed hemorrhoids, circumferential hemorrhoids, and some of the II degree internal hemorrhoids with severe bleeding. mechanism of PPH treatment for prolapsed hemorrhoids: circumferential excision of 2-3 cm of mucosa and submucosal tissue of the lower rectum restores the normal anatomical structure, i.e., anal cushion repositioning; the excision of submucosal tissue blocks the blood supply to the hemorrhoidal area from the supra-hemorrhoidal artery Compared with traditional hemorrhoidectomy, PPH surgery has short operation time, light postoperative pain and fast recovery, but the incidence of postoperative complications varies greatly from surgeon to surgeon, and some serious complications, such as rectal stenosis, can occur, while the price of instruments is more expensive, so you need to strictly grasp the indications for surgery. ⑤ Postoperative treatment Sitting bath and drug change. Observe for any complications, pay attention to diet and keep the bowels open. V. How to prevent hemorrhoids? 1.Physical exercise: proper physical exercise can promote venous reflux and intestinal peristalsis. 2.Prevent constipation: increase fiber foods such as fresh fruits and vegetables; avoid alcohol and spicy foods; drink more water; drink 1 cup of honey water (250ml) on an empty stomach early in the morning for patients without diabetes. 3, to develop good bowel habits; from childhood to develop the habit of regular bowel movements; overcome the bad habit of squatting for a long time to read books, newspapers or smoking (smoking in the toilet can buffer the brain’s defecation reflex easy to cause constipation). 4.Keep the area around the anus clean; clean it regularly, in addition, soak the buttocks in warm water for about 15 minutes every day to help promote blood circulation in the affected area. 5, pay attention to the lower body warmth; 6, avoid sitting for a long time; 7, pay attention to menstruation and maternity health care; (1) due to pregnancy and fetal compression of the pelvic veins, so that venous reflux is blocked, the anorectal part of the blood vessels dilated, can affect intestinal peristalsis to make fecal discharge difficult, prone to constipation and induced hemorrhoids. (2) Luteinizing hormone secretion in women during menstruation inhibits the movement of the anal canal and its sensitivity to stimulation and increases congestion, which can aggravate external hemorrhoids due to the stimulation of menstrual blood and the friction of toilet paper. 8, often do anal lifting exercise; 9, self-massage; 10, timely treatment: prevent small hemorrhoids drag heavy.