Many people know they have hemorrhoids, but what are they? It is not clear to say. All you know is that there is bleeding in the stool, a little sticking to the paper, a lot like a fountain, or an extra piece of flesh at the anal opening all the time, or something falls out of the anus when you have a bowel movement and has to be pushed back in. People have known about hemorrhoids for more than 4,000 years, and there are numerous doctrines about them. Hemorrhoids are also called piles or hemorrhoids, and hemorrhoids means protruding, and any soft swelling that protrudes from inside or outside the anus is called a hemorrhoid. There is a rich plexus of veins in the lower rectum or anal canal that becomes hemorrhoids if they become dilated or varicose in one or several places. It is just one of the anal diseases. The junction of the anal canal and rectum is an annular structure called the dentate line. Hemorrhoids that occur above the dentate line are called internal hemorrhoids, which are covered with rectal mucosa and bleed easily. Hemorrhoids that occur below the dentate line are called external hemorrhoids. They are covered with the mucous membrane of the anal canal and bleed less often. The hemorrhoids formed by the venous plexus above and below the dentate line are called mixed hemorrhoids. The bleeding is mainly in the early stages of mixed hemorrhoids, but in the later stages, due to local fibrosis, the bleeding will be reduced, but in severe cases, it will lead to embedded mixed hemorrhoids, which will cause severe swelling and pain and produce a lot of mucus, and the patient is often in pain. It is usually believed that the formation of hemorrhoids mainly has the following factors: Evolutionary factors: four-legged reptiles do not have hemorrhoids, the reason may be that the four-legged animals torso forward, the relative position of the anorectum higher, conducive to rectal blood reflux. And people keep walking upright, the human upright so that the anal position is relatively low, due to the role of gravity around the anus blood vessels undergo greater tension; life and diet factors: sedentary, weather changes and over-eating spicy food, irregular life, old age and physical weakness can lead to poor blood flow around the anus, blood circulation stasis; there are also genetic factors, as well as childbirth and other causes of increased abdominal pressure, dysentery, enteritis The damage to the rectal mucosa and submucosal muscle layer caused by genetic factors, increased abdominal pressure due to childbirth, dysentery, enteritis, parasites, anal skin diseases, anal abscesses, etc., causes the blood vessels and other tissues to become brittle and congested. Various factors lead to stagnation of anorectal blood flow in the veins, which eventually contributes to the formation of hemorrhoids. Pathological observations of hemorrhoids reveal not only a large number of highly tortuous and dilated veins in the hemorrhoidal tissue, but also edema in the interstitial tissue of the hemorrhoid with inflammatory cell infiltration and thrombus formation in some of the vessels. Therefore, the pathological changes of hemorrhoids are essentially the same as those caused by varicose veins in other parts of the body, except that the vascular masses or lumps that appear in the anorectum are called hemorrhoids. The clinical classification of hemorrhoids is generally divided into internal, external and mixed hemorrhoids according to the location of the hemorrhoids. They are divided by the dentate line (the dentate line is an interlocking, jagged line where the rectal mucosa and anal skin meet). Internal hemorrhoids occur on the dentate line and are covered with mucous membrane, which cannot be seen normally, and may or may not prolapse out of the anus during stool. External hemorrhoids are formed by the external venous plexus, under the dentate line, covered with skin, which can be seen and cannot be sent back to the anus, and they do not bleed often. Mixed hemorrhoids refer to the varicose veins of internal and external hemorrhoids in the same position, which communicate and anastomose with each other, so that the internal and external hemorrhoid parts form a whole. They occur at the 3, 7, and 11 o’clock of the truncated position, with the 11 o’clock being the most common. They have both internal and external hemorrhoids. Patients with mixed hemorrhoids show a full 360-degree distribution of external hemorrhoids at the anal verge or/and a complete down-turning of the anal canal with a relative down-turning of the dentate line or/and a circular swelling or prolapse of the hemorrhoids during stool, called circumferential mixed hemorrhoids. In brief, the classification of hemorrhoids: internal hemorrhoids are enlarged varicose and congested intra-hemorrhoidal plexus under the mucous membrane at the end of the rectum, along with visible loosening and fracture of the fixed supporting structures around them; external hemorrhoids are vascular external hemorrhoids, i.e., dilated perianal subcutaneous vascular plexus manifesting as raised soft masses; mixed hemorrhoids are internal hemorrhoids fused with external hemorrhoids in the corresponding area. Clinically, internal hemorrhoids are generally divided into four stages according to the severity of hemorrhoid development. Stage I internal hemorrhoids: blood in the stool, bright red, the amount of blood can be more or less, less if there is only blood on the stool paper, more if there is dripping or spraying bleeding, bleeding can stop on its own after the stool without the nucleus of the hemorrhoid prolapsing. The pathological manifestations are varicose veins in the hemorrhoids, which increase, expand and thicken, and protrude under the rectal mucosa, soft and red in color, with capillary masses of varicose veins and connective tissue inside. Stage II internal hemorrhoids: This stage is still visible with blood in the stool, dripping blood or jet bleeding, but bleeding is relatively less than stage I internal hemorrhoids. The nucleus of the hemorrhoid is separated from the muscle layer and moves downward because it is often pushed by feces during defecation. The nucleus of the hemorrhoid comes out of the anus during defecation and can be naturally returned to the anus after defecation because of the contraction of the sphincter muscle. If there is infection, there is pain in the anus and a feeling of urgency. The pathological manifestations are enlarged varicose veins, thickened mucosa, and purple-red color. Stage III internal hemorrhoids: The symptoms can be seen as blood in the stool, dripping blood, this stage of internal hemorrhoids is mainly characterized by prolapse, after prolapse can not return on its own, must be returned by hand or after rest to return to the anus. The hemorrhoid nucleus can be prolapsed out of the anus when exerting force, coughing, walking, squatting, or bearing weight, and it bleeds little and is easily inflamed and painful. The pathological manifestations are: connective tissue hyperplasia, hardening and thickening of the mucosa, and red-purple color. Stage IV internal hemorrhoids: If the internal hemorrhoid prolapses for a long time and cannot be returned in time, it can lead to obstruction of blood flow, poor reflux, painful swelling of the hemorrhoid nucleus, and inability to be returned. The symptoms can be seen in the prolapsed hemorrhoid nucleus, with strangulation, embedded gu, pain. The pathological manifestations are varicose veins within the hemorrhoid, dilatation and thickening, massive thrombosis, and ulceration of the surface of the hemorrhoid. According to the histopathological characteristics, external hemorrhoids are divided into four categories: connective tissue external hemorrhoids, thrombotic external hemorrhoids, varicose veins external hemorrhoids, and inflammatory external hemorrhoids. Connective tissue external hemorrhoids are soft elevated tissues below the dentate line, covered with skin on the surface, without pain or redness, formed by the enlargement of the skin folds and proliferation of connective tissues at the edge of the anus, mostly seen after inflammatory external hemorrhoids, or due to hard stool causing anal injury, infection, edema after the inflammation dissipates, the folds cannot recover and so on repeatedly, or due to increased anal secretion, etc. This type of hemorrhoid is characterized by the usual absence of any symptoms, only after defecation is not easy to wipe, so that the anal canal has a sense of dampness, itching and other irritation. Varicose external hemorrhoids are characterized by an elevated anal edge into an oval or long shape, soft to the touch, painless, and a dark purple lump visible at the anal edge when straining to defecate, and the size of the lump can be reduced after defecation or rest. Thrombosed external hemorrhoids are characterized by sudden red and swollen masses below the dentate line. Pain is obvious and hard nodules can be palpated under the skin. Most of them are caused by strenuous activities such as straining to defecate, dry stool, coughing, etc., which rupture the veins at the anal margin, and blood extravasates into the connective tissue and becomes a hematoma, forming a small raised hematoma with sudden onset, severe pain, swelling and discomfort, and a hard and slippery stasis mass may be palpated under the skin at the anal margin, which may be one or several. If the hemorrhoid is not infected, it may heal spontaneously within 4 to 5 weeks; if it is infected, it may form a perianal abscess. Inflammatory external hemorrhoids are red and swollen masses that occur below the dentate line and have an acute onset, with edematous flushed skin and significant pressure pain. It is due to inflammatory edema, pain, swelling, redness and heat in the anal folds. Most of them develop due to damaged anal friction and infection with bacteria. With hemorrhoids, the discomfort comes and goes. It is best to go to your doctor and have an anal finger exam or observe with anoscope to make a clear diagnosis and then be aware of your hemorrhoid treatment.