(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy) Abstract: Hemorrhoids are a common and frequent disease with an increasing incidence with age, and are classified as internal, external and mixed hemorrhoids. If the hemorrhoid is internal and only occasionally has blood in the stool and prolapse, it can be relieved by simply paying attention to diet, keeping bowel movements open, and applying hemorrhoid creams or suppositories appropriately, whereas the patient in the case, who had failed conservative treatment, had severe bleeding, prolapsed significantly, and was accompanied by hemorrhagic anemia, had timely surgery and anti-inflammatory treatment before her symptoms were eliminated, and the treatment was effective. Basic Information】Female, 55 years old 【Disease Type】Hemorrhagic internal hemorrhoid, internal hemorrhoid stage III, hemorrhagic anemia 【Visiting Hospital】Hegang City People’s Hospital 【Visiting Time】April 20, 2021 【Treatment Plan】Surgical treatment (minimally invasive-PPH non-circular hemorrhoid mucosal resection) + anti-inflammatory medication (cefixime tablets) 【Treatment Period】Hospitalization for 7 days, outpatient follow-up after 6 months 【Treatment Result】Anal appearance The patient was 55 years old and came to the outpatient clinic with intermittent fresh blood in the stool for more than 10 years, which had been aggravated for 2 months. At that time, the patient walked into the clinic with the help of her family members, and at first glance, we saw that the patient was pale and walking weakly. After inquiring about her condition, we learned that the patient had repeatedly had blood in her stool for nearly 10 years, but she did not go to the hospital because she was shy and treated herself with hemorrhoid suppositories. I used hemorrhoid cream, hemorrhoid suppositories and Yunnan Baiyao orally to stop the bleeding, but the results were not good. At that time, the patient underwent a specialist anal examination and found that the anal verge was flat, the internal hemorrhoid nucleus was prolapsing from the anus in a circular shape when the patient did defecation, the internal hemorrhoid nucleus was congested and swollen, some of the internal hemorrhoid mucous membrane surface was eroded and oozing blood, and no swelling was palpable at the end of the anal canal rectum. Outpatient emergency blood test showed erythrocytes of 2.38×10^12/L and hemoglobin of 45g/L suggesting severe anemia. The patient was then informed that he was initially considered to have hemorrhagic internal hemorrhoids, internal hemorrhoids stage III, and hemorrhagic anemia, which required inpatient examination and treatment. The patient agreed, and then went through the hospitalization procedure. After the patient was admitted to the hospital, he was given a blood transfusion to correct the anemia in consideration of his anemic condition. After the transfusion of 8U of red blood cells, the patient’s face was flushed, his speech was strong, and his anemia was corrected. At this time, we communicated with the patient that there were more diseases causing blood in the stool and that the patient was an elderly woman, so we could not rule out intestinal pathology and should perform colonoscopy, which the patient approved. Immediately after taking oral laxatives to cleanse the intestines, colonoscopy was performed and no abnormalities were seen, ruling out intestinal diseases. The patient was informed that the anemia was caused by bleeding internal hemorrhoids, which had progressed to stage III and could not be cured without surgery. At this point, the patient also wanted surgical treatment but was afraid of postoperative pain. It was then explained to the patient that he could choose minimally invasive-PPH non-circumferential hemorrhoid mucosal resection, which means that he could avoid the disadvantages of postoperative pain and long healing time of traditional surgery, as well as avoiding the narrowing of the anal canal caused by circumferential resection of hemorrhoid mucosa or the painful discomfort of anal drop caused by excessive postoperative anastomotic staples. The patient agreed to choose minimally invasive surgery. In view of the fact that the patient had no medical disease and the anemia had been corrected to tolerate the surgery, the patient was then given surgical treatment under combined rigid-lumbar anesthesia, and the surgical procedure went smoothly, and the patient was given oral anti-inflammatory drug cefixime tablets for 3 days after surgery. The patient was diagnosed with hemorrhagic internal hemorrhoids combined with hemorrhagic anemia, and after hospitalization, the anemia status was corrected after blood transfusion treatment, and the discomfort caused by anemia was also significantly relieved. The patient’s symptoms of blood in the stool and hemorrhoid prolapse were effectively controlled through minimally invasive surgery, and the patient responded painlessly after the operation. 6 months later, the patient’s outpatient follow-up indicated that the stool was normal, the internal hemorrhoid did not recur, and no complications such as anal drop discomfort occurred, so the treatment effect was obvious. We are glad that the patient’s condition was effectively controlled and he was successfully discharged from the hospital, but we still need to pay attention to the following points: 1. Patients should pay attention to a light diet after surgery and avoid spicy and stimulating food to avoid recurrence of hemorrhoids; 2. The patient should take anti-inflammatory drugs as prescribed by the doctor to avoid wound infection and other adverse reactions; 4. V. Personal insight The patient in this case had a history of internal hemorrhoids for many years and had repeated symptoms of fresh blood in the stool, and delayed treatment due to shame of the affected area and embarrassment, so that hemorrhagic internal hemorrhoids combined with hemorrhagic anemia appeared at this visit, increasing the patient’s treatment burden and risk. So after the appearance of internal hemorrhoids, you should actively seek medical examination to clarify the severity of the disease and treat it correctly under the guidance of a doctor to prevent delaying the condition. Usually, after active and correct treatment, the condition can be effectively improved, but you need to review it on time, pay attention to daily observation for recurrence symptoms, and also usually pay attention to change bad habits, such as sedentary, squatting and standing, and avoid eating spicy and irritating food to avoid the reoccurrence of internal hemorrhoids.