Basic Overview Hemorrhoids are soft venous masses formed by the dilation and flexion of the venous plexus under the mucous membrane at the end of the rectum and the skin of the anal canal. They are most commonly seen in people who stand a lot and those who are sedentary. Hemorrhoids, including internal, external, and mixed hemorrhoids, are a chronic condition in which one or more soft venous masses form as a result of varicose veins at the base of the anorectum and the mucous membrane of the anus. Usually, when straining continuously during defecation, the pressure in the veins here is repeatedly raised and the veins become enlarged. Women are prone to hemorrhoids because of their unique physiological characteristics, as well as the fact that during pregnancy, hemorrhoids often occur due to the compression of the pelvic veins, which hinders blood circulation. The reason for the high incidence of hemorrhoids in women Why is this? Because of their physiological structure, women have more chances of having their pelvic organs compressed and their blood flow obstructed, which causes congestion and stasis of blood in the pelvic organs and affects the blood circulation in the anus, resulting in compression of the rectum, obstructing the passage of feces and poor defecation, which eventually triggers hemorrhoids. In addition, women have two special periods, menstruation and pregnancy, during which the burden on the anus is often increased, so some women often have difficulty defecating and prolonged intervals during menstruation or pregnancy, defecating only once every 2-3 days. What is more serious is that during the second trimester of pregnancy, the fetus enlarges and presses on the rectum, and in addition to the difficulty in defecating, the venous blood return to the rectum and anus becomes impaired, which not only makes it easy to develop hemorrhoids, but also further aggravates the existing hemorrhoids. The puerperium period after pregnancy is also a high incidence of hemorrhoids. The data on the treatment of anorectal diseases shows that the incidence of hemorrhoids after childbirth is very high. After delivery, the abdominal cavity is empty and the urge to defecate tends to become sluggish, which, combined with the relaxation of the abdominal wall and reduced activity, increases the symptoms of weakness and difficulty in defecation, often for several days without defecation. If the stool stays in the intestine for too long, it will be highly rigid and damage the anorectum during strong defecation, causing hemorrhoids. In addition to pregnancy and childbirth, menopause is also a high incidence of hemorrhoids in women. During menopause, the muscles of the entire body become flaccid and weak, and the tissues related to anal function, such as the sphincter, anal levator, and puborectal muscles, also become weak, and anal function decreases. At the same time, women often experience endocrine and neurological dysfunction during menopause, making them irritable and feeling like they can’t finish their bowel movements, resulting in frequent trips to the toilet, which can also be a trigger for hemorrhoids. The dangers of female hemorrhoids Anemia: Iron deficiency anemia due to blood loss from hemorrhoids, early female friends often feel a lack of vitality and easy fatigue. When the anemia is heavier or progresses faster, there will be pallor, tiredness, loss of appetite, palpitations, rapid heart rate and shortness of breath and swelling after physical activity. Skin disorders: Constipation is a beauty killer for women, and hemorrhoids can aggravate constipation, which can lead to acne, acne, hyperpigmentation and other skin disorders due to the inability to excrete toxins from the body in a timely manner, and can lead to anemia and malnutrition over time. Obesity: Patients with hemorrhoids often have a tingling sensation because of swollen blood vessels in the anal tissues, inconvenience of movement, plus most women nowadays are often sedentary, blood circulation is blocked, metabolism slows down, in addition, three unbalanced meals, unhealthy diet, not only led to hemorrhoids, obesity also came. Gynecological inflammation: Some young women, because hemorrhoids can cause perianal abscesses, the infection of the perianal area which in turn affects the vaginal opening, causing other gynecological inflammatory infections, making the beautiful life greatly reduced. Rectal cancer: Because of the similarity between the sites of hemorrhoids and rectal cancer, more than 90% of rectal cancer cases are misdiagnosed as hemorrhoids in the initial stage. It is clinically proven that 1% to 3% of patients who come to the hospital for hemorrhoids are eventually diagnosed with rectal cancer. Affecting the health of pregnant women and fetuses: Pregnant women are a high-risk group for hemorrhoids, with the incidence of hemorrhoids as high as 76%, and hemorrhoids often bleed repeatedly, leading to symptoms such as anemia over time, which not only affects the health of pregnant women themselves, but also affects the normal development of the fetus, causing developmental delays, low weight, and even premature birth or death. Clear your hemorrhoids early and have a beautiful and healthy life! Depression: Hemorrhoids grow in the intimate parts of a person, many female hemorrhoid patients are ashamed to let the doctor see the affected area and delay the disease, the longer the disease becomes more serious, the condition of the worry is hoarded in the depths of the heart, into a secret that can not be said, it is easy to cause a burden on the heart. Long-term heart disorder will lead to some other problems, such as avoiding some group activities like swimming, group travel, etc. In fact, in the process of lifting fatigue and releasing stress in a group activity is the best way to adjust, in the process of communication and play will express some feelings, the brain nerves will be easy to lift the sense of fatigue and thus get relaxed, but the lack of communication in life, the human brain The possibility of depression will increase as the brain is not relaxed for a long time and lacks a sense of pleasure. Will treating hemorrhoids during pregnancy affect the fetus? Many women have hemorrhoids that appear when they are pregnant. This is because the pressure in the abdominal cavity increases as the fetus grows after pregnancy. In late pregnancy the expanding uterus compresses the blood vessels in the abdominal cavity, affecting venous reflux and causing varicose veins in the hemorrhoidal plexus, which, combined with hormonal influences, can produce hemorrhoids or aggravate existing hemorrhoids. This is the same reasoning behind the swelling of the legs during pregnancy. In addition, pregnant women are less active, gastrointestinal peristalsis is slow, stool stays in the intestinal cavity for a long time, the water in the stool is excessively absorbed, causing the stool to be dry, and the dry, hard stool can rub the mucous membrane of the hemorrhoid when defecating, and even make the original hemorrhoid nucleus come out, causing impaction and necrosis, and aggravating the symptoms. There has been a debate on whether to use surgical or conservative treatment for hemorrhoid surgery for pregnant women or women in labor. Surgery can be painful, stressful and diet-controlling, and can also interfere with breast milk production. The use of post-surgical antibiotics can also have an effect on the fetus or newborn. The period of lb3 months of pregnancy is a time when miscarriage is likely to occur. Pregnant women with pre-existing hemorrhoids should avoid all conservative or surgical methods that cause irritation to the uterus at this time. 7-9 months of late pregnancy with hemorrhoids are also generally not treated surgically. Only during the 4th-6th months of pregnancy, in patients with severe hemorrhoid symptoms that produce anemia, prolapse and pain, treatment with sclerosing injections, rubber band ligation or surgical excision can be considered. However, this should be done under the joint supervision of the surgeon and obstetrician. Pregnant women with hemorrhoids should exercise properly and eat more fruits, vegetables, honey and other foods to encourage gastrointestinal motility to keep the bowels open and prevent constipation. Apply warm water sitz bath after defecation to promote blood circulation around the anus. If you have constipation, you can take laxative drugs such as laxative tablets. If there is blood in the stool, take Anluo blood, vitamin K, vitamin C, etc. In case of swelling and pain, use Chinese herbal medicine to wash and sit in the bath, and apply topical hemorrhoid cream. The actual hemorrhoid is a lot more than just a little bit of a pile. Cure time: short time, usually 8 to 10 days. Complications: more bleeding, greater patient pain, recurrence rate: higher, up to about 20%. 2.Oral herbal medicine：Introduction：The use of internal herbal medicine to benefit the qi and fix the bleeding, astringent to stop the bleeding, reduce the nucleus of hemorrhoids, reduce the prolapse, reduce or eliminate the symptoms. Applicable people: Any patient. 3.External medication: Introduction: One is to use Chinese herbal medicines that clear heat and detoxify the body, fix and release the bowel and astringent, decoction for external washing, such as bitter ginseng soup. It can be used for various patients. The second is the use of skin easily absorbed Chinese herbal medicine or Chinese and Western medicine combination, made into ointment, medicine cloth, paste in the umbilicus or sacral tail of the long strong point for treatment. Drugs: Ma Yinglong musk hemorrhoid cream, anal tide paste, hemorrhoid suppository. Applicable symptoms: Internal hemorrhoids with mild condition and occasional pain and bleeding symptoms. Effectiveness: Suppositories can usually be kept for 12 hours. Disadvantages: The course of treatment is long and painful, while the concentration of the drug is more difficult to grasp, often wetting and rotting the hemorrhoids along with the surrounding skin. Note: Do not eat spicy food for 3 months during the medication period. You can take appropriate drinks to relieve fire, such as chrysanthemum with wolfberries, or drink some herbal tea. The above treatment is generally suitable for mild cases, such as first and second stage patients. The purpose is to reduce the symptoms of hemorrhoids, for patients with mild disease, and pay attention to life diet avoidance, or can play a radical role. However, for heavy people, the effect will be slow, and it is difficult to eliminate the lesion, not complete. Long-term medication is costly and has side effects on the body, so physicians will recommend surgery. Second, surgical treatment Patients may hear surgery, may smell surgery, this is just no specific understanding of surgery, produce a mysterious color and fear. As long as you understand the surgery, you are actually not afraid at all. Besides, the whole surgery is anesthesia and there is no pain. Then we’ll unveil the surgery. Surgical treatment, removal of hemorrhoids nucleus, is still the most commonly used treatment method, characterized by improvements in surgical methods, less pain during and after surgery, fast healing of the wound, and positive efficacy, but requires high surgical conditions, is currently the most reliable method of treating hemorrhoids. Whether it is traditional hemorrhoid surgery or modern high-tech surgery, it can be summarized into the following categories: 1. Ligature Excision Surgery: Introduction: It is to remove the external part of the mixed hemorrhoid, but not to stitch the wound and let it heal naturally open. The internal part of the hemorrhoid on the tooth line is ligated with thread at the base and falls off naturally for about a week. There are also internal hemorrhoids that are partially removed and then sutured, called excisional suturing. Disadvantages: It may block the blood circulation in the anus, which may cause bruising and edema, pain, and difficulty in defecation. 2.Circular excision surgery: Introduction: It is to fix the ring-shaped mixed hemorrhoids with wooden pegs or circumferential cutters, and then remove the hemorrhoids and part of the rectal mucosa in a circular fashion for a week on the tooth line, and suture the upper and lower edges of the skin and mucosa while cutting, so that the wounded surface is circumferential after the excision is completed. The effect: It can make the hemorrhoid atrophy, K and make the prolapse situation improve together, more radical effect, only slight pain after the operation, can be in the shortest time caries porcelain Tou Tou 3, external peeling internal ligation excision surgery: Introduction: It is the most classic surgical method, because convenient and easy to use, more widely used. Make a prismatic or fan-shaped incision to the external hemorrhoid along the lateral distal end of the external hemorrhoid, fully peel off the external hemorrhoid to the tooth line, destroy the capillary mass of the hemorrhoid, ligate the peeled external hemorrhoid at the tooth line, and ligate the internal hemorrhoid at the same point at the same time, remove the excess tissue and keep the stump of the ligation so that the tissue can fall off naturally. Applicable symptoms: All stages of hemorrhoids. Disadvantages: bleeding and pain are more obvious. 4, ultra-low temperature, ultra-high temperature surgery: Introduction: liquid nitrogen freezing, laser, microwave, electronic (including low frequency, radio frequency, capacitive field, ion penetration and electric oscillation) and other treatment instruments, the principle of treatment is the use of ultra-low temperature or ultra-high temperature to produce cold or thermal effects, oscillation ion penetration biophysical effect, electric field capacitive effect, etc., so as to make the focal tissue protein coagulation, vascular embolism closure, electrocautery Electrocoagulation hemostasis, cutting, tissue degeneration, necrosis off or sclerosis atrophy and other therapeutic purposes, still belong to sclerosis and withered hemorrhoid therapy type repeated reproduction, with the traditional surgical treatment results are similar. After healing: the trauma delayed healing, but there is the possibility of secondary bleeding, and long pain, slow wound healing, hemorrhoid mass remaining more, high recurrence rate, there are certain limitations. 5.Laser therapy: Introduction: CO2 or YAG laser is used to remove the nucleus of hemorrhoids, which is suitable for all kinds of hemorrhoids. Its characteristic is less bleeding. Applicable symptoms: The scope is small and only applicable to simple external hemorrhoids. The laser machines used: He-Ne, CO2 and YAG lasers Disadvantages: painful 6, PPH surgery Introduction: Of all the surgical methods, PPH surgery is relatively good and is recommended by many doctors. PPH is known as supra-hemorrhoidal mucosal circumferential stapling and is the gold standard in the treatment of hemorrhoids. Surgery: The anus is first dilated during the surgery, and the rectal mucosa is circumferentially sutured in a circle about 4 cm above the dentate line (the junction line between the rectum and the anal canal), then the PPH anastomosis is inserted into the anus, and the prolapsed mucosal band can be removed by striking the anastomosis after ligating the sutures. Since the rectal mucosa above the dentate line is innervated by visceral nerves, the patient has almost no pain after surgery. Effect: PPH surgery not only removes the prolapsed rectal mucosal band, but also blocks the terminal anastomotic branches of the terminal rectal arteries and veins, eliminating the root cause of hemorrhoids and significantly reducing the recurrence rate, which is mainly due to improper diet after surgery. Some patients are unable to remove the complete hemorrhoid nucleus during surgery for physical reasons, and have residual hemorrhoids that may lead to future recurrence. Indications: Prolapsed hemorrhoids, i.e. stage II, III, IV internal hemorrhoids or mixed hemorrhoids with mainly internal hemorrhoids, especially those in a circular circle, are especially suitable for middle-aged and elderly people, white-collar people who focus on efficiency and those who relapse with traditional treatment and those with mild prolapse with internal prolapse of the rectal mucosa. Advantages: no anal pain, less bleeding, significantly shorter surgery time and return to work (generally 3 to 7 days to go to work normally), satisfactory results and few complications; these are unmatched by traditional hemorrhoid surgery. Disadvantages: The hemorrhoid anastomosis is disposable and expensive, and the long-term efficacy of the procedure is yet to be further evaluated. Complications: urinary retention, postoperative bleeding, pain in the anal region, anastomotic stricture, lower abdominal pain, sensory disturbance in the anal region, postoperative hemorrhoid recurrence, rectovaginal fistula, vagal reflex. Cost: The more expensive treatment costs also make it difficult to popularize. The procedure is short, takes only about 30 minutes, has a quick recovery, and has a very low recurrence rate after surgery. It cannot be used with medical insurance. 7.HAL Hemorrhoidal Artery Atresia Introduction: That is, ultrasonic Doppler-guided hemorrhoidal artery ligation (referred to as DG-HAL). U.S. patented hemorrhoidal artery ligation is currently one of the most advanced methods of international surgical treatment of hemorrhoids, using the DG-HAL second-generation ultrasound-guided hemorrhoidal artery electrocoagulation ligation system produced by Mereoer in the United States. The instrument precisely locates the hemorrhoidal artery according to the ultrasound emitted and received by the probe, shows its depth, and performs arterial fractional coagulation at 2-3 CM on the dentate line through the window at the front of the probe to occlude the treatment. Advantages: An organic system that combines high efficiency, simplicity, safety, minimal pain, minimally invasive, and short hospital stay. The system is based on the ultrasound emitted and received by the probe to precisely locate the hemorrhoidal artery, display the depth of the period, and through the window at the front of the probe on the dentate line for arterial ligation treatment, with precise location, rapid ligation, minimally invasive features 8, HCPT ablation Introduction: U.S. HCPT ablation technology is under the high-frequency capacitive field, the tissue charged ions and dipoles in the high-speed oscillation between the two poles to generate heat, when the ions depleted When the electric ions are depleted to the dryness of the interstitial fluid, the instrument automatically stops working and does not produce charring immediately, so it has the characteristics of good controllability, good limitation, good orientation, fast heat production, etc. It has a short treatment time (3~5 seconds for each hemorrhoid nucleus) for various anorectal diseases. It has the advantages of automatic alarm at the end of treatment, no carbonization, no crusting, no odor, good vascular closure, no bleeding, safe and reliable, no infection, no after-effects and complications. It is the cutting-edge technology of anorectal treatment in the world at present. Technical principle: It consists of high-frequency capacitive field treatment function, high-frequency electric knife function, high-frequency capacitive field hemostasis function, high-frequency electrocoagulation function, and automatic alarm after the end of treatment. Technical advantages: short time (3-6 seconds for each hemorrhoid nucleus), good controllability, strong local operability, no carbonization, no crusting, good vascular closure, reaching lesion necrosis, drying, and then falling off in the shortest time, and getting satisfactory treatment effect. High precision: digital vision is used to precisely locate the lesion and assist in the smooth operation; faster recovery: the wound recovers quickly after the operation and does not affect the normal function of the anus; less pain: local or complete anesthesia is applied to the lesion during the operation and the patient suffers little pain; low complications: thousands of patients have been successfully restored to health and the probability of complications of the lesion is extremely low through observation and follow-up; minimally invasive and safe: the entire operation is under computerized and precise control. It is minimally invasive, safe and reliable during and after surgery. Applicable diseases: internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fistula, prolapse, perianal eczema, perianal abscess, anal papillary fibroids and other anal intestinal diseases. Three, non-surgical treatment in surgical treatment The above mentioned is surgical treatment in surgical treatment, and now we are going to talk about a non-surgical treatment. For the kind of prolapsed hemorrhoids or hemorrhoids that will prolapse outside the anus but can automatically retract, can be considered with non-surgical treatment. There are usually sclerotherapy injections, rubber band ligation, infrared cautery or cryogenic freezing methods. The following we will list the introduction of 1, drug injection therapy: Introduction: that is, sclerosing atrophy therapy, the sclerosing agent directly injected into the nucleus of the hemorrhoid, can make the nucleus of the hemorrhoid sclerosis atrophy or make the hemorrhoid bolus necrosis off. Drug: Hemorrhoid injection Efficacy: The varicose veins around the hemorrhoid nucleus produce significant edema within 24 hours, with acute and chronic inflammatory cell infiltration and increased fibrous tissue within the submucosa, while the injection site can often be felt as a hard knot because of fibrous tissue degeneration, and can be retained for 2 to 4 months. If the lower part of the hemorrhoid nucleus is injected with drugs, the blood vessels can be blocked, causing thrombosis and shrinking the hemorrhoid nucleus; while the fibrous tissue forms a fibrous membrane that wraps around the hemorrhoid nucleus and protects it from damage. The symptoms of the hemorrhoids are as follows: 1 or 2 internal hemorrhoids, 2, withered hemorrhoid therapy: Introduction: that is, medicine twist therapy, which can make the hemorrhoid tissue abnormal and chemical inflammatory reaction, causing the proliferation of fibrous tissue, to achieve the purpose of treating hemorrhoids. It can also be divided into the withered hemorrhoid scattering therapy and withered hemorrhoid nail therapy. Advantages: During the treatment period, diet is normal, urination and defecation are not restricted, and avoid open surgery, generally do not cause bleeding, low cost, easy to promote, especially suitable for rural applications. The main drugs: arsenic, alum as the main, with vermilion, sulfur, moonstone, frankincense, myrrh, light powder and other complementary preparation into the agent. Applicable symptoms: Second- and third-stage prolapsed internal hemorrhoids in the form of ring-shaped, large internal hemorrhoids. Not suitable for people: first-stage internal and external hemorrhoids, patients with acute perianal infection, eczema, or with diarrhea, abdominal tumor, severe tuberculosis, hypertension, liver disease, kidney disease, blood disease, and pregnant women in the near delivery period, etc. 3.Infrared treatment: Introduction: Infrared radiation or burning of hemorrhoid nuclei is used to shrink the nuclei. Advantages: The incidence of anal edge edema is low, intraoperative bleeding and postoperative secondary hemorrhage are not seen to occur, especially the incidence of intraoperative bleeding is 0. Disadvantages: The shortcoming is the narrow range of indications and easy recurrence. Indication symptoms: It only has a good effect of stopping bleeding and promoting fibrosis of internal hemorrhoids in stage I and II internal hemorrhoids. Cure time: generally 1 to 2 weeks to cure internal hemorrhoids. 4.Cryotherapy：Introduction：That is, the use of freezing machine, liquid nitrogen as a freezing agent, the nucleus of hemorrhoids frozen into a block, so that its necrosis off. The preparation and position is the same as injection therapy, and the freezing probe is directly contacted with the center of the hemorrhoid block through the anoscope for 2 minutes to turn the whole hemorrhoid into a white ice ball, without special treatment after the operation, the hemorrhoid tissue is necrotic in 5-7 days, and the necrotic rot is removed in 10-14 days, while the epithelium grows, leaving a thin white scar locally after healing. Advantages: no anesthesia, easy to operate. Disadvantages: The scope is small, only applicable to the internal hemorrhoid range, and the recurrence rate is high, reaching about 30%. There is mucus flowing out of the anus for a long time after the operation, and the pain is long and the wound is slow to heal. Applicable symptoms: Patients with internal hemorrhoids, hemorrhoids bleeding more than once. Not suitable for people: post-operative recurrence, old and weak or with heart, lung, liver and kidney disease, etc. The first thing you need to do is to get a good idea of what you want to do. Let’s explore together. Pregnant women hemorrhoids treatment Conservative therapy: hemorrhoids during pregnancy due to the treatment needs to consider the impact on the baby, mostly for conservative drug treatment, non-life-threatening cases are generally not surgical treatment. Suitable situation: If the hemorrhoids are serious enough to require immediate treatment, you can start with conservative treatment and wait until the baby is born, when the hemorrhoids may also be reduced, and then you can try the condition again to decide if further treatment is needed. In addition, doctors usually recommend conservative treatment for pregnant women in the early stages of pregnancy because the fetus is not yet stable and because they are worried about medication affecting the fetus, while in the later stages of pregnancy they are worried about triggering preterm labor. The purpose of conservative treatment is to alleviate the severity of hemorrhoids, first of all, you should prevent the occurrence of constipation, such as eating more fruits and vegetables, less stimulating and spicy food, drink more water, and develop good toilet habits; in addition, you can take a warm water sitz bath every day; you should also try to avoid prolonged standing, sitting, and squatting to prevent hemorrhoids from becoming more serious. If the mother-to-be has severe constipation, she can use ointments and stool softeners under the guidance of her doctor to avoid exerting excessive force during toileting and aggravating the situation of hemorrhoid prolapse. The first step in the fight against female hemorrhoids is to keep the area around the anus clean. The female vagina is adjacent to the anus, and the vaginal secretions are more likely to stimulate the anal skin and trigger hemorrhoids. Therefore, you should always keep the area around the anus clean, fumigate it with warm water daily and change your underwear regularly, which can help prevent hemorrhoids. The second trick to resist female hemorrhoids: pay attention to pregnancy health care women after pregnancy can lead to increased abdominal pressure, especially in the second trimester, the inferior vena cava by the growing uterus compression, directly affecting the reflux of hemorrhoidal veins, easy to induce hemorrhoids, this situation is particularly obvious when the fetal position is not correct. Therefore, you should go to the hospital regularly during pregnancy for review. The third trick to resist female hemorrhoids: prevent constipation reasonable deployment of diet, more fruits and vegetables, beans and other foods containing more vitamins and fiber, less chili, mustard, ginger and other spicy stimulating food, both to increase appetite, but also to improve gastrointestinal function, correct constipation. At the same time, it is best to develop the habit of regular defecation every morning and choose the right method to treat constipation, do not take long-term laxatives or long-term enemas. The fourth trick to resist female hemorrhoids: strengthen exercise physical exercise is good for blood circulation, can harmonize the body’s qi and blood, promote gastrointestinal motility, improve pelvic congestion, prevent constipation and prevent hemorrhoids. On the other hand, you can use self-massage to improve local blood circulation in the anus. The fifth trick to resist female hemorrhoids: reduce stress and mood. The actual fact that women are less psychologically capable compared to men, they eat and drink a lot when they are in a bad mood, and their emotions have a more pronounced impact on their physical condition. Therefore, women avoid excessive stress in their lives and keep their moods relaxed, which also plays an important role in preventing hemorrhoids.