This morning in the outpatient clinic, received a 72-year-old man with anal incontinence, this old man has no special medical history, he only has a history of two “mixed hemorrhoid” surgery, so consider the old man’s anal incontinence and mixed hemorrhoid surgery; similarly, I recalled that in 2007 in the United States when I was a visiting scholar in Cleveland, and Dr. Wexner together to conduct research on the etiology of anal incontinence patients, found that many people do not have a special history, 80% of the patients had mixed hemorrhoids or anal fissures when they were young. Similarly, I recalled that when I was a visiting scholar in Cleveland, USA in 2007, when I conducted a study on the etiology of anal incontinence with Dr. Wexner, I found that many people did not have any special medical history, and 80% of the patients had a surgical history of mixed hemorrhoids or anal fissure when they were young, so Dr. Wexner said that even minor anal surgery like mixed hemorrhoids and fissure could lead to anal incontinence. In our clinical work, mixed hemorrhoids is a very common disease, in our country there is an ancient “ten men nine hemorrhoids” saying that mixed hemorrhoids patients are very common, and in the usual clinical, the patient for mixed hemorrhoid surgery is also very casual, in the clinic there are often patients who say, “to cut off the hemorrhoids! “Many people do not have very serious symptoms of bleeding and prolapse, in fact, there is no need for surgical treatment; there are also some patients in the outpatient clinic, asked hemorrhoid surgery can not “cure”, in fact, there is no “cure” for hemorrhoids. Surgery, hemorrhoid treatment is aimed at relieving the patient’s symptoms, rather than eliminating the hemorrhoids themselves. In order to understand this issue, it is necessary to figure out what the nature of hemorrhoids is? How are what kind of hemorrhoids graded? What are the treatments for hemorrhoids? 1, what is the nature of hemorrhoids? Hemorrhoids is the lower end of the rectum pathologically hypertrophied anal cushion downward or dilated venous mass, manifested as hemispherical bulge, prolapse. Hemorrhoid pathogenesis has anal cushion downward shift doctrine and varicose vein doctrine, the former that hemorrhoids for the lower end of the anal canal of the human body’s normal tissues, and the anal sensory and fine control of stools, equivalent to the faucet interface liner, there is a role in preventing leakage of liquid leakage, when due to a variety of reasons lead to hemorrhoidal tissue hyperplasia, hypertrophy, or dislocation, resulting in anal cushion pathology, called hemorrhoidal disease; varicose vein doctrine that the human body under the rectal venous plexus and hemorrhoidal veins The theory of varicose veins that the human body subrectal venous plexus and hemorrhoidal venous plexus between the existence of traffic branches, these traffic branches in normal circumstances did not expand, when due to forceful defecation, abdominal pressure, sedentary and other circumstances under the anal canal mucosa subrectal venous plexus and hemorrhoidal venous plexus between the traffic branches of the expansion of the expansion of the hypertrophic, the formation of the varicose mass, known as hemorrhoids; in general, regardless of whether it is the pathology of the anal cushion or the varicose veins, hemorrhoids itself is the human body to play a normal role in the physiology of the tissues occurring in some Pathological changes caused by the body’s normal play a physiological role in the organization of some pathological changes, in this sense too much excision of the nucleus may lead to a decline in bowel control function; modern point of view that external hemorrhoids for the perianal dermatophyte and proliferative tissues, generally symptomatic, only in which thrombosis, inflammation may appear pain, edema symptoms; mixed hemorrhoids refers to both internal hemorrhoids, and external hemorrhoids, is one of the most common state in the clinic. Regardless of which doctrine, the essence of hemorrhoids is hemorrhoids for the body’s normal tissues and structures, these normal tissues have undergone pathological changes, bleeding, prolapse and other symptoms, called hemorrhoidal disease. Usually internal hemorrhoids show symptoms of bleeding, prolapse; external hemorrhoids show symptoms of perianal skin, hyperplasia, if the external hemorrhoids thrombus, edema called thrombosed external hemorrhoids or inflammatory external hemorrhoids. Hemorrhoid flare-ups are often associated with constipation, sedentary lifestyle, eating spicy and stimulating foods, pregnancy or old age. 2.How are hemorrhoids graded? Domestic will be based on hemorrhoid bleeding, prolapse and other symptoms will be divided into four degrees of hemorrhoids, one degree refers to defecation with blood, dripping blood or jet bleeding, bleeding can stop by itself after defecation, no anal swelling out; second degree refers to blood in the stool, defecation, there is a swelling outside the anus, after the stool can be self-contained; third degree refers to the defecation or long standing, coughing, exertion, loaded with the anal swelling out of the anus, need to use the hand to return to the fourth degree refers to the occasional blood, the anal swelling out of the anus Can not be returned, strangulation, incarceration, severe pain. Generally speaking, one degree of hemorrhoids only conservative treatment can be used, two degrees of hemorrhoids using conservative treatment after the lack of effect so that you can use injection therapy, ligation therapy or surgical treatment, three and four degrees of hemorrhoids are generally used in surgical treatment, conservative treatment is often unable to alleviate its symptoms, especially to alleviate the symptoms of prolapse. 3, what are the treatments for hemorrhoids (1) general treatment Adjust the dietary structure, more dietary fiber and crude fiber food, develop good defecation habits, at the same time, warm water bath, appropriate exercise, do not sit for a long time, keep the anus part of the clean, promote the local blood circulation, to improve the symptoms of the early stage of hemorrhoids and prevention of hemorrhoids, is very necessary. (2) Conservative treatment Oral medications commonly used by hemorrhoid patients are venous tensors such as Mai Zhi Ling, Ablation Stop, Diosmin Ai, etc., which have the effect of hemostasis and decongestion to alleviate the patient’s symptoms such as bleeding and edema; in addition, Chinese medicine can be given orally according to Chinese medicine diagnosis. Sitz bath is very important in the treatment of hemorrhoids. Potassium permanganate was commonly used in sitz bath in the past, but due to the fact that it is not easy for patients to grasp the concentration, and the concentration is too high to lead to skin burns, it is seldom used nowadays; commonly used decoctions of some traditional Chinese medicines or important medicines in sitz bath, which can achieve a better effect. Rectal use of suppositories and creams in the treatment of hemorrhoids is also very important, its role has anti-inflammatory, astringent effect, commonly used taining suppositories, Jiuhua hemorrhoidal suppositories, Ma Yinglong hemorrhoidal suppositories and so on. Conservative treatment, these methods are often used in conjunction with each other to play a therapeutic effect. (3) Surgical treatment When conservative treatment is ineffective, surgical treatment is considered, and hemorrhoid surgical treatment is currently available. The most basic hemorrhoid surgery for external stripping and internal ligation (foreign countries become M-M surgery), the operation has been used for nearly a hundred years of history, the effect is the most certain, and the long-term effect is the best; but external stripping and internal ligation postoperative pain is more serious, especially the first time defecation patients with severe pain, and prone to oedema, bleeding, and other symptoms, so some patients are reluctant to accept; but in recent years, with the improvement of the surgical techniques, the rational use of some of the stopgap measures, and the use of the surgery, the patients are more likely to suffer from the pain. However, in recent years, with the improvement of surgical skills and the reasonable use of pain medication, the pain of external peeling and internal ligation surgery has not been so obvious, and most of the patients’ postoperative pain is mild to moderate, with the use of some local pain medication or oral medication. In foreign countries, rubber band ligation and hemorrhoidal artery ligation as the first line of treatment, the main reason is that these techniques do not need special anesthesia or only use local anesthesia can be completed, is a kind of “clinic” can complete the operation, so in the clinic is widely used. The basic principle of rubber ring ligation is to use a rubber ring ligated on the hemorrhoidal nucleus or hemorrhoidal nucleus mucosa, so that the hemorrhoidal nucleus aseptic detachment and necrosis, to achieve immediate haemostasis, dealing with pathological anal cushion; hemorrhoidal arterial ligation refers to ultrasound Doppler-guided ligation of the hemorrhoidal tissue supplying blood vessels, to achieve immediate haemostasis, hemorrhoidal nucleus atrophy, and to achieve the purpose of treating hemorrhoids. At home, because the health insurance payment method is different from foreign countries, these treatments often need to be hospitalized in order to do, and the long-term efficacy of this procedure is also poor. In the last decade, the biggest progress in hemorrhoid treatment is hemorrhoidal mucosal loop excision (PPH surgery), the basic principle of this surgery is to excise the hemorrhoidal nucleus on the 4cm mucous membrane, the downward displacement of the anal cushion uplift, back to its original position, so as to achieve the purpose of the treatment of hemorrhoids. the main purpose of the PPH surgery is to solve the hemorrhoids external stripping and internal ligation of the postoperative pain problem, and therefore imported into the country by the widely sought after, but Some complications after PPH surgery such as persistent anal pain, urgency to defecate, bleeding and other complications have been reported more, especially reported some serious surgical complications such as pelvic abscess, rectovaginal fistula, etc., so that the use of this technology must be very careful; long-term follow-up studies have proved that the recurrence rate of PPH surgery is significantly higher than that of the external stripping and internal ligation surgery, and the cost is also higher. Therefore, PPH surgery must be used only in particularly suitable patients. Recently developed selective hemorrhoidal mucosal resection surgery (TST), which improves some of the shortcomings of PPH surgery to remove too much, significantly reducing surgical complications, postoperative pain and other symptoms of the patient is also relatively light, in the domestic use of more widely. Correct understanding of hemorrhoids “minimally invasive treatment” in our clinic, often encountered some patients ask you can do minimally invasive treatment of hemorrhoids, for us to engage in anorectal surgery for more than 20 years of doctors tend to be very confused, don’t know the concept of minimally invasive treatment of hemorrhoids for what! On the contrary, when we open some network search engine, hemorrhoid minimally invasive treatment of publicity all over the world, in fact, the so-called minimally invasive treatment of hemorrhoids to the current treatment of hemorrhoids, such as some of the methods such as PPH surgery, TST surgery, ligation surgery, hemorrhoidal artery ligation surgery, and even some of the previous use of laser surgery, etc. After a package, there is a little over-promotion of the suspicion; in particular, in the The concept of “minimally invasive treatment” covers up some of the risks that hemorrhoid treatment may face, making the patient regret after surgery, surgical treatment is a “double-edged sword”, any one of the surgical methods, there may be its insufficient side, therefore “The right attitude is to choose the lesser of two evils. Minimally invasive surgery without risk does not exist. The actual hemorrhoids surgery is actually a very good way to get rid of the hemorrhoids and also the hemorrhoids will not be able to be eliminated completely, therefore if you don’t take care of the hemorrhoids after the hemorrhoids surgery and also make lifestyle changes, there is still the possibility of a recurrence. Hemorrhoid surgery need to pay attention to the following issues: (1) avoid drinking alcohol: drinking alcohol can make the hemorrhoidal veins congestion, expansion, hemorrhoidal nuclei swelling; (2) avoid spicy: hemorrhoidal patients, if addicted to eating irritating spicy food, such as chili, garlic, ginger, etc., can contribute to the hemorrhoidal congestion, which exacerbates the pain; (3) avoid sedentary: sitting for a long time without exercise, it will make the waist, the buttocks of the blood circulation is impeded, and aggravate hemorrhoids condition; (4) avoid holding back: fecal matter is the most important thing to do is to avoid the use of the hemorrhoids, so that they are not in a state of shock. (4) avoid holding stool: feces in the intestinal tract for a long time, water is too much absorption will be dry and hard, resulting in patients with defecation difficulties, increased abdominal pressure, hemorrhoidal fissure bleeding.