I. What are hemorrhoids? Hemorrhoids are the most common anorectal disease. According to a survey in 1997, the incidence of hemorrhoids is as high as 87.5%, close to the “nine out of ten hemorrhoids” that is circulating in our folklore, and the incidence of women is also slightly higher than that of men. There are two theories about the formation of hemorrhoids. One theory is that hemorrhoids are formed by pathological tortuosity, dilatation and stasis of the venous plexus under the mucous membrane at the end of the rectum or under the skin of the anal canal. The other theory is that there is a special structure formed by blood vessels, smooth muscle, elastic tissue and connective tissue under the mucosa at the end of the rectum, called the “anal cushion”, whose function is to assist in the tight closure of the anus, just like the role of the rubber washer of a faucet; when the anal cushion becomes relaxed, hypertrophied and shifts downward, it is complicated by the stasis and expansion of the venous plexus, thus forming hemorrhoids. thus forming hemorrhoids. These two theories are interrelated and complement each other. In addition to the above pathogenesis, many other factors have been found to contribute to the development of hemorrhoids, such as chronic alcohol consumption, large amounts of irritating food, perianal infection and perivenous inflammation due to inattention to anal hygiene, chronic constipation or diarrhea, prolonged sedentary or standing, lack of exercise, atrophy of perianal tissue due to malnutrition, and other factors that contribute to chronic long-term increase in abdominal pressure (such as pregnancy, ascites, chronic cough, poor urination), etc. This shows that hemorrhoids are complex and closely related to daily diet and living. Hemorrhoids are the preserve of humans. This is because only humans are advanced vertebrates that walk upright. As a result of the earth’s vertical downward gravitational force on the human rectum and anal tissue vessels, coupled with the fatigue, disease, diet and many other factors that constantly arise in the human workforce, the reflux resistance of the anal veins increases, the elasticity of the vessels decreases, the veins clump together, sagging, and the pelvic floor muscle tone relaxes, and so on, over time hemorrhoids occur. Second, what are the symptoms of hemorrhoids? Hemorrhoids are divided into internal, external and mixed hemorrhoids, with the dentate line (a normal structure within the anus) as the boundary. Internal hemorrhoids occur above the dentate line, external hemorrhoids occur below the dentate line, and mixed hemorrhoids have hemorrhoid masses above and below the dentate line (i.e. both internal and external hemorrhoids exist at the same time). The symptoms vary from one hemorrhoid to another. The main symptoms of internal hemorrhoids are anal bleeding during stool and prolapse of the hemorrhoid mass from the anus, which is usually painless, but can be accompanied by pain when complicated by thrombosis, infection or impaction. Internal hemorrhoids are classified into four degrees according to the severity of symptoms. Bleeding during stool, prolapsed hemorrhoids are so severe that they cannot be retracted even when pushed by hand, often accompanied by pain The main symptoms of external hemorrhoids are anal discomfort, dampness, itching, and perianal skin tags, and when thrombosis or inflammation occurs, there can be severe pain. External hemorrhoids can be classified as general external hemorrhoids or connective tissue external hemorrhoids (i.e. dermatomes), inflammatory external hemorrhoids, and thrombotic external hemorrhoids. Mixed hemorrhoids have both internal and external hemorrhoids, and it is actually a consequence of the gradual aggravation of internal hemorrhoids, which mostly form mixed hemorrhoids when they develop to degree II or III or higher. When the mixed hemorrhoids gradually worsen and prolapse outside the anus in a ring shape, they are called circumferential hemorrhoids. If the ring-shaped hemorrhoid is embedded by the spastic anal sphincter to the point of stasis, edema or even necrosis, it is called an embedded hemorrhoid or strangulated hemorrhoid. What are the dangers of hemorrhoids? The main symptoms of hemorrhoids are “blood in the stool” and “prolapsed hemorrhoids”. Repeated bleeding during stool can cause the body to lose a lot of iron, causing iron deficiency anemia. Iron is an important element that is indispensable for the composition of red blood cells. Under normal circumstances the absorption and excretion of iron is balanced and the loss of iron is very small. Normal adult men do not lose more than 2 mg of iron per day, while patients with blood in stool lose more than 3-4 mg of iron if the daily blood loss exceeds 6-8 ml. The total amount of iron in a normal human male is 50 mg/kg body weight, and in a female it is about 35 mg/kg body weight. If you have blood in your stool for a long time, you will lose a lot of iron, making the total amount of iron in your body lower than normal, which will cause iron deficiency anemia. Another major symptom of hemorrhoids is the prolapse of the hemorrhoidal mass. As the anal cushion relaxes, breaks and prolapses, it eventually leads to the prolapse of the hemorrhoid mass. The hemorrhoid block that comes out of the anus is further held by the sphincter muscle, resulting in obstructed venous return, while arterial blood is still being input to make the hemorrhoid nucleus bigger and bigger; until finally the arterial blood vessels are pressed shut and a thrombus is formed, resulting in a hard, painful hemorrhoid nucleus that is difficult to send back into the anus, which is called an “embedded hemorrhoid”. If the hemorrhoid is embedded for a long time, the following complications can occur. (1) Necrosis: The nucleus of the hemorrhoid is embedded outside the anus, and due to a series of pathological changes, the local metabolites accumulate, further aggravating the local edema of the anus and aggravating the nucleus of the hemorrhoid, which is a vicious circle. Therefore, if the internal hemorrhoid is embedded for a long time, necrosis will eventually occur. At first, the necrosis is confined to the mucosal part of the hemorrhoid nucleus, but if the impaction continues, the necrosis will expand to the deeper part, which may eventually lead to serious infection. There have been reports from abroad where the thrombus in the hemorrhoid nucleus spread upward and the necrotic area extended to the rectal wall, resulting in severe sepsis in the pelvis. This is a rare condition, but it must be taken seriously by clinicians. (2) Infection: After the hemorrhoid nucleus is embedded, it is often combined with different degrees of infection, and the patient may experience symptoms such as urgency and anal swelling; at the beginning, the infection is mostly confined to the anal area, and if it is reluctantly reset, the infection may spread and cause submucosal or deeper infection, or even perianal or sciatic rectal fossa abscess; if the dislodged bacterial embolus travels up the vein, coupled with improper use of antibiotics or no antibacterial drugs If the dislodged bacterial embolus travels up the vein, coupled with improper use of antibiotics or failure to use any antibacterial drugs, it may form portal vein bacteremia or even sepsis, or liver abscess. There have been foreign reports of fatal portal vein sepsis caused by embedded hemorrhoids. Why do you have hemorrhoids? Most doctors at home and abroad believe that hemorrhoids occur mainly for the following reasons: 1. Anatomical reasons: when a person is standing or sitting, the anorectum is located in the lower part, and due to gravity and the compression of the organs, the venous upward reflux is impaired. Rectal vein and its branches lack of venous valves, blood is not easy to reflux, easy to stasis. Its vascular arrangement is special and crosses the muscular layer at different heights, which is easily compressed by the fecal mass and affects the blood return. The vein also passes through the loose tissue of submucosa, and the lack of scaffolding around it is easily expanded and flexed. 2, genetic relationship: the vein wall is congenitally weak, tension is reduced, can not tolerate the intravascular pressure, and therefore gradually dilate; or pelvic floor muscles are congenitally lax, the support of the rectum and anal canal is weakened. 3.Occupational relationship: long standing or sitting, long-term weight-bearing distance travel, affecting venous reflux, so that the pelvic blood flow is slow and intra-abdominal organ congestion, causing excessive filling of hemorrhoidal veins, the tension of the venous wall decreases, and vascular stasis dilates. Or because of insufficient exercise, diet is too fine (lack of coarse food), intestinal peristalsis reduced, feces downward slow; or habitual constipation, fecal mass compression and stimulation of veins, so that local congestion and blood return obstruction, causing hemorrhoid veins within the pressure rise, the vein wall resistance is reduced. 4, local stimulation and diet: constipation, diarrhea, excessive drinking, often eat spicy food, etc., can stimulate the anus and rectum, so that the hemorrhoid venous plexus congestion, affect the venous blood return, resulting in a decrease in the resistance of the venous wall. 5, the anal vein pressure increase: liver stiffness, portal vein pressure increase, cardiac insufficiency, etc., can make the anal vein congestion, pressure increase, affect the rectal venous blood return. 6, increased intra-abdominal pressure: intra-abdominal tumors, uterine tumors, ovarian tumors, prostate hypertrophy, pregnancy (pregnancy), eating too much, squatting too long, etc., can make the intra-abdominal pressure increase, impede the venous blood return to the rectal and anal parts. 7.Anal infection: acute and chronic infection (inflammation) of the hemorrhoid plexus, the elastic tissue of the vein wall gradually fibrosis and weakness, lack of resistance, resulting in venous stasis expansion; if coupled with the joint action of other causes, will eventually make the varicose veins more and more heavy, generating hemorrhoid mass. V. Why do hemorrhoids recur after some people have been cured? The hemorrhoid is a disease that grows at the lower end of the rectum and anus, the occurrence and development of which has a lot to do with people’s habits, work and study environment, walking and straining, diet and sleep. It is impossible for a person not to produce a single vein stasis and varicose in the anus during his life, unless the excrement does not pass through the lower rectum and anus. Therefore, it can be said that everyone will have a mild or severe anal disease. The so-called absence of hemorrhoids is nothing more than the absence of symptoms. From this point of view, the aim of any treatment is only to alleviate or make symptoms disappear, to reduce local histopathological changes and restore them to their original state as far as possible, but it is not yet possible to make the lower end of the anorectum and its venous plexus cease to undergo pathological changes such as bruising, dilatation and prolapse. Therefore, there is still a possibility of recurrence after hemorrhoids have been cured. The key to preventing recurrence is to actively cooperate with your doctor after healing, change your bad habits, and remove the above-mentioned factors that may cause hemorrhoids to occur. VI. How are hemorrhoids treated? There are many treatments for hemorrhoids, and there are a variety of advertisements, propaganda and hemorrhoid clinics that can be found everywhere, making it difficult to distinguish between right and wrong. In particular, some people in our society often administer unnecessary or incorrect treatments to patients for profit, resulting in not only a waste of money, but also often causing unnecessary harm to patients, some even causing serious complications. The actual fact is that you will be able to get a lot more than just a few of the most popular and popular items. So, what is the most reliable way to treat hemorrhoids? The regular treatment methods for hemorrhoids include medication (oral or topical), injection therapy, rubber banding therapy and surgery, each with its own advantages and disadvantages. In addition, there are cryotherapy, infrared irradiation therapy, microwave therapy, radiofrequency therapy, etc., which are now less commonly used due to inaccurate efficacy or more complications. The above therapies must be selected by experienced specialists according to the specific situation. However, there are two main and most effective treatments that are currently recognized: one is collar ligation therapy, and the other is hemorrhoid block surgery therapy. Among them, collar ligation is the preferred treatment for hemorrhoids in developed countries such as Europe, the United States and Japan. Seven, what is collar ligation therapy? Collar ligation is the application of appropriate instruments to ligate a certain amount of mucosa and submucosal tissue above the hemorrhoid mass at an appropriate location 1.5 to 3 cm above the dentate line; or directly at the base of the hemorrhoid mass. Since the ligature site is located 1.5 cm above the dentate line, there is no nociceptive innervation in this area, and therefore no pain after the procedure (a few patients only have a mild sensation of swelling or urgency). Moreover, the ligation lifts the anal cushion and blocks the backflow of the hemorrhoidal vein at the same time, thus eliminating the two major factors in the development of hemorrhoids – the downward shift of the anal cushion and venous stasis – and the effect is quite definite. Many clinical studies in Europe and the United States have shown that of all the therapies other than hemorrhoidectomy, collar ligation has the best efficacy. In what cases is surgical treatment used? Generally speaking, all stages of hemorrhoids (including mild, moderate and severe hemorrhoids) can be cured or relieved by collar ligation therapy and external or internal medications, and surgical removal is rarely required. Especially for bleeding hemorrhoids and locally prolapsed hemorrhoids, lancing therapy is the most effective and can have an immediate effect. For a few severe hemorrhoids, such as some grade IV circumferential hemorrhoids, thrombosed external hemorrhoids, inflammatory external hemorrhoids, and embedded and strangulated hemorrhoids, surgical treatment may be required. But in any case, if the problem can be solved with a rubber band ligature or other treatment, try not to opt for surgery (both traditional surgery and suprahemorrhoidal mucosal circumcision) unless forced to do so. This is because there are many hidden neuroreceptors and chemoreceptors in the human rectum and anus, all of which have their own unique functions, and once they are removed, they may bring about some adverse effects, especially when surgical complications occur. This is also the reason why collar ligation therapy is preferred when treating hemorrhoids in Europe and America. Nine, how should hemorrhoid patients cooperate with treatment? What should I pay attention to in terms of diet and living? Although hemorrhoids are not a major disease, they often make people restless and can bring about some unexpected and serious consequences if not handled properly. Therefore, in addition to believing in science and regular treatment, the patient himself must actively cooperate with the doctor and carry out some necessary auxiliary treatment in order to achieve the most desirable results. First, an inappropriate diet often leads to flare-ups or aggravation of hemorrhoids, so care must be taken in the diet. It is important to avoid irritating foods (such as spicy foods), drink less alcohol (especially strong alcohol), drink more water, and eat more foods that are high in fiber (such as vegetables and fruits). Secondly, constipation is an important cause of hemorrhoids and attacks, so it is important to develop good bowel patterns and habits and pay attention to keeping your stools open. If your stool is too dry, you must eat more foods with high fiber, drink more water, exercise properly, and also drink honey water often, or eat some bananas every day, all of which help soften the stool. However, if this does not solve the problem, you must take some stool softening drugs or laxatives orally under the guidance of a doctor, but do not overdose and cause diarrhea, because diarrhea can also aggravate hemorrhoids. Of course, some constipation is pathological (such as rectal prolapse, colonic redundancy, etc.), we must ask the doctor to carefully diagnose, clarify the causes, targeted treatment. Thirdly, proper basin sitting with warm water and anal stretching exercises are effective aids to hemorrhoid treatment. The so-called basin sitting is to use boiled warm water (as hot as possible, but not too hot) in the basin, add the appropriate liquid, and then sit in it with the anus exposed for 10 to 15 minutes, 2 to 3 times a day. The warm solution helps to improve local blood circulation and promote the decreasing of inflammatory edema. The so-called anal stretching and contraction exercise is to use the muscles around the anus and perineum to consciously contract, relax, contract and relax …… This is good for improving the blood return to the anorectum and reducing blood stasis. The above two aids can be used in combination, such as sitting in the basin while doing anal stretching and contraction exercises. You can also do anal stretching exercises alone in sitting or standing still. Fourth, pay attention to the hygiene of the anus and perineum, bathe regularly, avoid unclean sex (especially anal sex, etc.), strengthen physical exercise, avoid sitting or standing for a long time, and locally apply some effective anal suppositories, etc., all of which help the treatment and recovery of hemorrhoids. Ten, hemorrhoids patients 7 taboos Avoid drinking alcohol: drinking alcohol can make hemorrhoid veins congested, dilated, hemorrhoid nucleus swollen. The actual fact is that you will not be able to get a good deal on your own. The actual fact is that you will not be able to get a good deal on your own. The actual fact is that you will not be able to get a good deal on your own. The actual fact is that you will not be able to get a good deal on your own. Avoid holding stool: stool in the intestinal tract for a long time, water is too much absorbed will be dry and hard, causing the patient defecation difficulties, increased abdominal pressure, hemorrhoid fissure bleeding. The hemorrhoid patient should not be embarrassed to seek medical attention because of the special location, or think it is a minor problem and do not pay attention to it, resulting in a serious condition to bring difficulty to cure as soon as possible.