Painful hemorrhoids are generally caused by two conditions, the first of which is external hemorrhoids. External hemorrhoids are more painful when there is a thrombus in the blood vessels in the nucleus or when there is a local infection with edema. If the pain is caused by a thrombus, surgical treatment is usually recommended, either thrombectomy or thrombosed external hemorrhoidectomy. If the pain is caused by local infection with edema, conservative treatment can be performed by using a 1:5000 potassium permanganate solution in a sitz bath for anti-inflammatory purposes and topical application of Ma Yinglong hemorrhoid cream. The second situation is when the internal hemorrhoids prolapse out of the anus with edema, which can also lead to more serious pain, most of these hemorrhoids are stage three or four hemorrhoids, usually conservative treatment first, after the hemorrhoid nucleus edema subsided, then surgery.