Hemorrhoids are a chronic disease in which one or more soft venous masses form as a result of varicose veins at the base of the anorectum and the anal mucosa. First, the etiology of hemorrhoids on the etiology of two main doctrines. The first is the varicose vein theory, that hemorrhoids is the lower rectum under the mucous membrane and the skin of the anal canal under the venous plexus stasis, dilatation and flexion of the formation of the vein mass. However, the current widely accepted theory is Thomson’s theory of anal cushion displacement, that hemorrhoids were originally the normal anatomical structure of the anal canal area, i.e., vascular cushion, which is a band of annular spongy tissue at the dentate line and 37,5px above it. Only when the anal cushion tissue is abnormal and combined with symptoms, it can be called hemorrhoids, only need to be treated, the purpose of treatment is to relieve symptoms, rather than eliminating hemorrhoids. There are many triggering factors for hemorrhoids, among which constipation, long-term alcohol consumption, eating a lot of stimulating food and sedentary are the main triggers. Second, classification hemorrhoids according to the occurrence of different parts of the internal hemorrhoids, external hemorrhoids, mixed hemorrhoids. In the anal canal skin and rectal mucosa of the connection of a jagged visible line called the anal canal dentate line. Above the dentate line for internal hemorrhoids, is the anal cushion of the support structure, venous plexus and arteriovenous anastomotic branch pathological changes or displacement, covered rectal mucosa, due to the internal sphincter contraction, anal cushion to Y-shaped groove is divided into the left, right anterior, right posterior side of the three, so internal hemorrhoids are common in the left side, the right anterior and right posterior side; in the dentate line below the external hemorrhoids, is covered by the mucous membrane of the anal canal, can be divided into the connective tissue external hemorrhoids, varicose external hemorrhoids, thrombosed external hemorrhoids; and both external hemorrhoids, varicose external hemorrhoids and thrombosed external hemorrhoids. The thrombosed external hemorrhoids; both internal hemorrhoids and external hemorrhoids for the mixed hemorrhoids, is the internal hemorrhoids through the venous plexus and the corresponding external hemorrhoids fusion, that is, the upper and lower venous plexus anastomosis, mixed hemorrhoids prolapse out of the anus, when the plum blossom, known as ring hemorrhoids, if the sphincter embedded, the formation of incarcerated hemorrhoids. Third, the clinical manifestations 1, the main manifestation of blood in the stool, the nature of the blood in the stool can be painless, intermittent, fresh blood after stool, blood dripping or blood on the toilet paper, constipation, drinking or eating irritating food aggravated. 2.Simple internal hemorrhoid painless only swelling feeling, can bleed, development to prolapse, combined with thrombosis, incarceration, infection only when the pain. 3.Internal hemorrhoids are divided into 4 degrees. (1) Ⅰ degree bleeding during defecation, bleeding can be stopped by itself after defecation, hemorrhoids do not prolapse out of the anus; (2) Ⅱ degree often have blood in the stool; prolapse out of the anus during defecation, and automatically after defecation; (3) Ⅲ degree hemorrhoids need to hand-assisted prolapse return to the Ⅳ degree hemorrhoids in the anus for a long period of time outside the anus, can’t return to the Ⅳ degree hemorrhoids, in which the internal hemorrhoids of the degree of II or above are often formed as a mixture of hemorrhoids, which is the simultaneous existence of the internal hemorrhoids and external hemorrhoids, and may be pain, discomfort, itching, which often due to the hemorrhoid prolapse, itching. Among them, itching is often due to the hemorrhoids prolapse when there is viscous secretion outflow. The last three degrees are mostly mixed hemorrhoids. 4, external hemorrhoids usually no special symptoms, thrombosis and inflammation can be swollen, pain. Fourth, check 1, anal visual diagnosis, except for the I degree of internal hemorrhoids are visible, squatting position can observe the degree of prolapse. 2.Rectal palpation is of little significance to internal hemorrhoids, but it can be used to understand whether there are other lesions in the rectum. 3, anoscopy can be directly visualized to understand the rectum, anal canal situation. Differential diagnosis 1, rectal cancer, the main symptom is change of bowel habit, may have rectal irritation symptoms, palpation and cauliflower pattern swelling, colonoscopy and biopsy pathology can be characterized. Rectal polyps are common in children, mostly low polyps with tips, which are round, solid and with good mobility. 3.Rectal prolapse The mucosa is ring-shaped, the surface is smooth, and the sphincter is loose. Six, treatment 1, non-surgical treatment Asymptomatic hemorrhoids do not need treatment; symptomatic hemorrhoids do not need radical treatment; to non-surgical treatment. (1) general treatment. Apply to the vast majority of hemorrhoids, including thrombosed and embedded hemorrhoids in the early stage. Pay attention to diet, avoid alcohol and spicy stimulating food, increase fibrous food, more intake of fruits and vegetables, drink more water, change the bad defecation habits, keep the stool smooth, take laxative if necessary, wash the anus after stool. For prolapsed hemorrhoids, pay attention to the hand gently back to the hemorrhoidal block, to stop re-projecting. Avoid sitting and standing for a long time, carry out appropriate exercise, and take a sitz bath with warm water (containing potassium permanganate) before going to bed. (2) Local medication. It has been widely used, and the drugs include suppositories, creams and lotions, most of which contain traditional Chinese medicine ingredients. (3) Oral medication. Generally the drugs used to treat varicose veins are used. (4) Injection therapy. It is more effective for Ⅰ, Ⅱ degree hemorrhagic internal hemorrhoids; sclerosing agent is injected around the venous plexus of submucosal layer to cause inflammatory reaction and fibrosis, so as to press and close the varicose veins; the treatment can be repeated after 1 month to avoid necrosis caused by injecting sclerosing agent into the mucosal layer. (5) Physiotherapy. Laser therapy, cryotherapy, direct current therapy and copper ion electrochemistry, microwave thermocoagulation therapy, infrared coagulation therapy, less frequently used. (6) Coil ligation. Sleeve the root of hemorrhoids, block its blood supply in order to make hemorrhoids fall off and necrosis; applicable to II, III degree internal hemorrhoids, for the huge internal hemorrhoids and fibrosis internal hemorrhoids are more suitable. 2, surgical treatment (1) surgical indications. Conservative treatment is ineffective, hemorrhoid prolapse is serious, larger fibrosis internal hemorrhoids, injection and other poor treatment, combined with anal fissure, anal fistula, etc.; (2) surgical principle. Through surgery to make the prolapsed anal cushion reset, as far as possible to retain the structure of the anal cushion, so that after the operation as little as possible to affect the ability of fine bowel control; (3) preoperative preparation. When there are ulcers and infections on the surface of internal hemorrhoids, laxative and warm water sitz baths are used first for conservative treatment, and then surgery is performed after the ulcers have healed; bowel preparation is done. (4) Surgical methods ① thrombosed external hemorrhoidal stripping surgery For thrombosed external hemorrhoids after conservative treatment of pain does not relieve or the lump does not shrink. ② Traditional hemorrhoidectomy, i.e., external stripping and internal ligation. ③ Hemorrhoidal circumcision (Whitehead’s operation) Textbook classic operation, easy to lead to anal stenosis, the current clinical application is rare. ④ PPH surgery anastomotic hemorrhoidal rectal mucosal ring cutting and stapling. It was created by Dr. Longo of Italy and started to be promoted in 1998, which is mainly applied to prolapsed III-IV degree mixed hemorrhoids, circumferential hemorrhoids, and part of II degree internal hemorrhoids that bleed severely.The mechanism of PPH treatment of prolapsed hemorrhoids: circumferential excision of 2-3 cm of mucosal and submucosal tissues from the lower end of the rectum, restoring the normal anatomical structure, i.e., the anal cushion is returned to its position; the excision of submucosal tissues blocks the blood supply of the hemorrhoidal arteries to the hemorrhoidal area, making the postoperative blood supply to the hemorrhoidal region more efficient. Compared with traditional hemorrhoidectomy, PPH surgery has shorter operation time, less postoperative pain, faster recovery and fewer complications, but the price of the instruments is more expensive. (5) Postoperative treatment Observe whether there is any complication, pay attention to diet and keep bowel movement smooth.