Hemorrhoids are masses of the anal cushion on either side of the dentate line that can produce bleeding, embolism, and prolapse. Internal, external, and mixed hemorrhoids occur in adults and have a high incidence. Etiology Thomso [ppt] hemorrhoid n states that hemorrhoids are formed by the subluxation of the anal cushion. The anal cushion is a spongy erectile tissue within the submucosa of the anal canal, containing small arteries and veins, which short-circuit the traffic and have smooth muscle and connective [ppt] hemorrhoid tissue, with the muscle fibers and connective tissue keeping the cushion fixed to the muscular wall of the anal canal. As a result of local tissue degeneration, increased abdominal pressure, etc., the anal cushion hypertrophy downward displacement to form hemorrhoids. Hemorrhoids are pathologic hypertrophy of the anal cushion. The cause of varicose veins: ①Anatomical factors: the portal venous system and its branches of rectal veins do not have venous valves, blood [ppt] hemorrhoidal fluid is easy to stagnate; rectal submucosal tissue is lax. ②Habitual constipation: forceful defecation increases the pressure within the venous plexus, destroying smooth muscle fibers and elastic connective tissue, causing varicose veins. ③Increased intra-abdominal pressure: such as pregnancy, pelvic tumor, prostate hypertrophy urinary difficulties, etc., so that venous reflux is blocked. Hemorrhoids are soft venous masses formed by stasis, flexion, and dilation of the venous plexus near the dentate line. Classification and disease [ppt] Hemorrhoid theory Internal hemorrhoid (Internal Hemorrhoid) is the result of pathological changes or displacement of the anal cushion; commonly found on the left, right anterior, and right posterior three (the location of the anal cushion); truncated at 3, 7, and 11 points. External hemorrhoid (External hemorrhoid) is a mass of varicose veins of the inferior rectal plexus, located below the dentate line and covered by the skin of the anal canal, often protruding from the anal orifice or outside the anus due to intravenous thrombosis. Mixed Hemorrhoids (M[ppt] Hemorrhoidsixed Hemorrhoid) are formed by the anastomosis of the upper and lower rectal plexus, affecting each other and fusing the hemorrhoids with each other; they are located above and below the dentate line, and the surface is covered by both the rectal mucosa and the skin of the anal canal. The internal hemorrhoids are divided into four degrees: ① Ⅰ degree: [ppt] hemorrhoids with blood in the stool, hemorrhoids do not prolapse out of the anus, only anoscopy can be seen; ② Ⅱ degree: hemorrhoids prolapse out of the anus during the stool, and return on their own after the stool; ③ Ⅲ degree: hemorrhoids prolapse out of the anus during the stool, can not return on their own and need to be held back by hand; ④ Ⅳ degree: can not return to the anus or return to the anus and then prolapse. The internal hemorrhoids have often become mixed hemorrhoids to the third degree, and they are constantly aggravated, ringing out of the anus called “ring hemorrhoids”. Sometimes the hemorrhoids are embedded by the spastic sphincter, resulting in stasis of blood and edema, dark purple or even necrosis, called embedded hemorrhoids or strangulated hemorrhoids. Thrombosed external hemorrhoids: Mostly due to forceful defecation, the veins at the edge of the anus rupture and blood seeps into the subcutaneous tissue, becoming a hematoma and coagulating into a painful mass. The hemorrhoid examination reveals a prominent dark purple long garden-shaped mass at the anal verge, with edematous surface skin, hard texture, obvious pressure pain, and inactivity. The actual hemorrhoid is a very good and also a great deal more than just a few of the most important and also the best. The local area is not easy to keep clean, prone to inflammation. Clinical manifestations Bleeding at stool : It is a common symptom of internal hemorrhoids, manifested as painless intermittent blood after stool; the amount of bleeding is usually not much, sometimes more, in the form of jets, which can cause severe anemia over time. Prolapsed hemorrhoids: Internal hemorrhoids of degree II and III can be prolapsed outside the anus, and the hemorrhoids must be pushed back into the anus by hand from self-return, otherwise they are easily embedded and necrotic. Clinical manifestations Pain: Simple internal hemorrhoids are painless. When the internal hemorrhoid mucous membrane erosion, edema, secondary infection can have pain, such as the occurrence of embedded strangulation, necrosis infection, can have severe pain . Thrombosed external hemorrhoids have pain as the main manifestation. [ppt] Hemorrhoids Itching : Due to the prolapse of hemorrhoids, stimulation of rectal mucosal secretions increase, sphincter relaxation, secretion outflow, making the perianal skin itchy and uncomfortable, and even skin eczema occurs. Diagnosis and differential diagnosis According to the typical symptoms of hemorrhoids, rectal finger examination and anoscopy, it is generally not difficult to diagnose, but should be differentiated from the following diseases. Rectal polyps: Mostly seen in children, painless blood in the stool is a common symptom, low tipped polyps can be prolapsed [ppt] outside the hemorrhoid anus, confused with hemorrhoid prolapse, finger examination can be found masses, most have a tip. Rectal cancer: not difficult to identify, need to carefully do rectal finger examination and anoscopy, rectal cancer masses can be found. Diagnosis and differential diagnosis Rectal prolapse: prolapse during defecation, usually the whole rectal wall; mucosa is concentric ring-like folds; sphincter is relaxed. Treatment [ppt] Hemorrhoids Treatment principles: asymptomatic hemorrhoids do not require treatment; symptomatic hemorrhoids focus on alleviating and eliminating symptoms rather than eradicating them; conservative treatment is the mainstay. Thrombosed external hemorrhoids local external anti-inflammatory and pain relief cream or physiotherapy, if the internal hemorrhoid prolapse embedded early, can be promptly pushed back into the anus hemorrhoid mass. Sclerotherapy injection: for Ⅰ Ⅱ degree internal hemorrhoids; inject the drug into the submucosa of the base of the parent hemorrhoid, a sterile inflammatory reaction occurs, reaching small vessel occlusion and fiber proliferation within the hemorrhoid, and hemorrhoid mass atrophy. 【ppt】 Hemorrhoids Commonly used sclerosing agents are 5% sodium cod liver oil acid, compound alum injection, 5% phenol glycerin solution, etc. Treatment Operation method: The patient empties the stool, chest and knee position anal [ppt] hemorrhoid microscopy reveals hemorrhoid block, after sterilization on the tooth line approach tip stab into the submucosa injection, each hemorrhoid block injection 1 ~ 2ml. Treatment Infrared coagulation therapy: Applicable to Ⅰ Ⅱ degree internal hemorrhoids, can make protein coagulation sclerotherapy. Probe focus on the base of the hemorrhoid block [ppt] hemorrhoid anal canal upper mucosa, coagulation for 15 seconds, each hemorrhoid block coagulation 6 small points, there is often a small amount of postoperative bleeding, recurrence rate is high, the need for re-operation more. Surgical treatment [ppt] hemorrhoids Suitable for those with heavy hemorrhoid prolapse or mixed hemorrhoid ring prolapse, surgical treatment is more effective. The most common methods are: Surgery Surgery Surgery Surgical treatment of hemorrhoids has a long history and more procedures, currently more domestic and foreign use is Milligan-Morgan (M-M) surgery (external peeling and internal ligation of hemorrhoids). [ppt] Hemorrhoidectomy for isolated prolapsed hemorrhoids. Hemorrhoidectomy : The anus is dilated under anesthesia to reveal the hemorrhoid mass, the skin and mucosa are cut, the varicose vein mass is peeled out, ligated and removed, the mucosa on the tooth line can be sutured, and the skin incision is left open for drainage. PPH surgery PPH is painless hemorrhoid radical treatment: also known as anastomotic hemorrhoid circumferential hemorrhoidectomy, is based on the anal cushion theory [ppt] hemorrhoids, the use of anastomotic clutch treatment of ring prolapsed hemorrhoids new technology. The procedure involves the circumferential excision of the mucosa and submucosa above the anal cushion, allowing the cushion to move upward. It has been widely carried out at home and abroad. Surgical treatment The anal cushion theory is a new understanding of the nature of hemorrhoids proposed by Thomson in the United States. The theory is that hemorrhoidal tissue is actually normal tissue in the body, and only when it is excessively hypertrophied and displaced does it lead to pathological symptoms and the formation of hemorrhoids. The ppt] hemorrhoid anal cushion is like a “washer in the faucet”, which plays a role in fine control of stool and sensing the nature of rectal contents, once destroyed, there will be varying degrees of air leakage, fecal leakage and other symptoms. The PPH procedure removes the mucosa and submucosa of the hemorrhoid in a circular fashion about 2-3 cm, while instantly completing the anastomosis, while preserving the anal cushion tissue. This blocks the blood flow to the hemorrhoid supply vessels and at the same time moves the anal cushion of the lower [ppt] hemorrhoid up. Because PPH operates in the rectal cavity above the dentate line, it is a painless zone procedure, so the patient feels no pain after the procedure and eliminates the symptoms of hemorrhoids at the same time. Surgical treatment Based on the theory of anal cushion, Johnson & Johnson Medical Devices, in cooperation with Italian scholar Dr. Longo, successfully developed an anastomosis, a surgical instrument specifically for the treatment of II-IV degree internal hemorrhoids, in 1993, which can effectively treat severe prolapsed internal hemorrhoids, intra-rectal mucosal overlap, exit The anastomosis is an effective treatment for severe prolapsed internal hemorrhoids, intra-rectal mucosal stasis, outlet constipation and anterior rectal [ppt] hemorrhoids. The advantages significantly reduce post-operative pain significantly reduce post-operative bleeding significantly shorten hospitalization time [ppt] hemorrhoids significantly accelerate the recovery cycle surgical treatment surgical treatment prevention (a) develop the habit of regular daily bowel movements to prevent constipation and prolonged bowel movements [ppt] hemorrhoids. (B) pay attention to dietary hygiene, eat more vegetables, eat less irritating foods such as chili peppers, and avoid drinking a lot of alcohol. (C) often exercise, adhere to physical activity, long standing and sedentary or old and frail people should adhere to the workplace exercise. (4) Keep the anus clean and treat inflammatory diseases of the anal canal and rectum in a timely manner.