Hemorrhoids are common and frequent diseases, and there are many treatment methods, each with its own indications and contraindications, and more serious complications and sequelae can occur if they are not treated properly. The treatment of hemorrhoids should be based on the patient’s specific condition, the different types of hemorrhoids and symptoms, combined with the doctor’s clinical experience and medical conditions, etc., choose the appropriate, reasonable non-surgical or surgical treatment methods. It should be especially noted that according to the pathogenesis of hemorrhoids, the modern view of hemorrhoid treatment is: ① asymptomatic hemorrhoids do not require treatment, all treatment is aimed at eliminating, reducing and relieving symptoms as the standard of treatment effect, more meaningful than changing the size of the hemorrhoid body and eradicating the hemorrhoid tissue itself, to maximize the preservation of the anal cushion, through the fibrosis of the tissue around the hemorrhoid, in order to achieve the purpose of fixing the anal cushion in the rectal muscle wall, and To prevent symptoms; ② Strictly grasp the indications for surgery, first give conservative treatment, when conservative treatment fails or II, III, IV degree (stage) internal hemorrhoids are no longer reversible, the choice of surgical excision is necessary; at the same time, when the patient has symptoms that affect daily life and conservative treatment is ineffective, surgical treatment is also required. First of all, we should emphasize and advocate the conservative treatment of hemorrhoids, i.e. non-surgical treatment. This includes medication, physical therapy, diet therapy, functional exercise and other non-invasive therapies. On the one hand, because most hemorrhoids can be relieved or cured by non-surgical treatment; on the other hand, it is difficult to withstand repeated traumatic treatment at the important and delicate outlet of the human body. 1.General treatment Soften the stool and keep the bowel movement smooth to reduce the damage effect of dry stool and forceful defecation on the anal cushion. Adjust dietary habits, ensure sufficient daily water intake, increase the intake of sufficient dietary fiber, and apply laxative drugs as appropriate. Diet and life conditioning, avoid drinking alcohol and eating spicy and stimulating food. Establish good bowel habits, defecate regularly, do not sit or squat for a long time when defecating, and avoid excessive straining and prolonged defecation. Local care. Take a sitz bath after defecation or before going to bed, and gently reset the hemorrhoid after it is dislodged; take frequent sitz baths, keep the perineum clean and dry, etc. Insist on doing anal lifting exercises. Repeated anal lifting will help to exercise the muscular connection of the anal cushion and promote the reset of the anal cushion; repeated anal lifting is also conducive to improving the blood circulation in the anal area, promoting the repair of the anal cushion tissue structure and reducing the complications of anal diseases. 2.Medication Medication is an important method of hemorrhoid treatment, and patients with Ⅰ and Ⅱ degree (stage) internal hemorrhoids should prefer medication. There are many drugs for hemorrhoids at home and abroad, divided into external suppositories and creams as well as emulsions and oral medications. Commonly used drugs include venous enhancers, microcirculatory regulating drugs, anti-inflammatory and anal anal cushion mucosal repair and protection agents, as well as the application of Chinese medicine dialectical treatment. Venous enhancers, microcirculatory regulating drugs, anal cushion mucous membrane repair and protection agents and Chinese medicine can reduce the symptoms of internal hemorrhoids in the acute stage; anti-inflammatory analgesics can effectively relieve the pain caused by internal or thrombosed external hemorrhoids. 3.Sclerotherapy injection Submucosal sclerotherapy is mainly applied to the treatment of Ⅰ and Ⅱ degree (stage) internal hemorrhoids, and also has certain effect on Ⅲ degree (stage) hemorrhoids, and the recent efficacy is remarkable. The principle is to inject a small amount of sclerosing agent into the base of the submucosal hemorrhoid tissue, causing a local sterile inflammatory reaction, causing contraction of the hemorrhoid nucleus, tissue fibrosis, and fixation of the local submigrating anal cushion and mucosa in the muscular layer. Contraindications are any external hemorrhoids and internal hemorrhoids with thrombosis, infection or erosion, and hemorrhoids during pregnancy should not be treated with sclerotherapy injections. Sclerotherapy injections can relieve bleeding hemorrhoids, but are less effective for prolapse. The advantages are that it is cheap, simple, less painful and safe. The disadvantage is that the failure rate is high and many patients need to undergo other treatments. With the development of medical technology, only a few medical institutions now use sclerotherapy. The principle of collar ligation treatment is to insert a collar into the base of the hemorrhoid through a special instrument to block the blood vessels supplying the hemorrhoid tissue, resulting in ulceration, necrosis, and subsequent healing of the wound by itself and fixation of the deep tissue due to fiber healing. It is suitable for internal hemorrhoids of degree I and II (stage) and the internal part of mixed hemorrhoids, and is also effective for degree III (stage) hemorrhoids. The presence of coagulation disorders in patients is a contraindication to collar ligation. The success rate is higher than that of sclerotherapy injection. 5.Infrared coagulation therapy Infrared coagulation therapy is generated by infrared generator, after the photoelectric conductor focus on the hemorrhoid tissue, causing protein denaturation in the hemorrhoid tissue, resulting in a certain depth of local necrosis, ulcer formation, hemorrhoid submucosa fibrosis, hemorrhoid nucleus contraction and fixed on the surface of the muscle. The wavelength, treatment time and depth can be adjusted according to the situation in order to control the scope of tissue destruction. It is commonly used to treat first and second degree (stage) hemorrhoids. It is more effective than sclerotherapy injection for prolapsed hemorrhoids, but less effective for hemorrhoids with more severe prolapse. Because of the high cost of equipment, expensive application is limited. 6, copper ion electrochemical treatment Copper ion electrochemical treatment is through the copper needle left in the nucleus and hemorrhoids on the mucosa and electricity, can cause local sterile inflammation, fibrous tissue formation, promote vascular occlusion, hemorrhoid nucleus atrophy. At the same time, the fibrous tissue formed locally scarifies and subsequently fixes the hemorrhoid in the submucosa. This relieves symptoms such as bleeding and prolapse. It has good effect on internal hemorrhoids of degree I and II (stage) with bleeding as the main symptom, and internal hemorrhoids of degree II and III (stage) with prolapse as the main symptom. However, it is not suitable for IV degree (stage) hemorrhoids. 7.Cryotherapy This method freezes the tissues quickly through the contact between the specially designed freezing probe and the hemorrhoid tissues, and then thaws them quickly afterwards, causing the hemorrhoid tissues to necrosis and fall off. However, it is difficult for doctors to grasp the depth and scope of treatment, and postoperative pain, bleeding, delayed healing, mucosal ulceration, and discharge often occur, and the efficacy is not exact, so it is less used at present. 8, other physical therapy In addition to the above infrared coagulation therapy, copper ion electrochemical therapy and cryotherapy, there are laser therapy, direct current therapy and microwave thermal coagulation therapy. The main indications are Ⅰ, Ⅱ, Ⅲ degree (stage) internal hemorrhoids. The main complications are bleeding, edema, delayed wound healing and infection. Surgical treatment The indications for surgical treatment are internal hemorrhoids that have developed to degree III or IV (stage), or degree II (stage) internal hemorrhoids with severe bleeding; acute embedded hemorrhoids, necrotic hemorrhoids, mixed hemorrhoids and external hemorrhoids with significant symptoms and signs; non-surgical treatment is ineffective and there are no contraindications to surgery. The classic surgical methods are as follows. 1.Circumferential hemorrhoidectomy (Whitehead procedure) Circumferential hemorrhoidectomy for circumferentially prolapsed internal hemorrhoids and circumferential mixed hemorrhoids. The basic point of this operation is to separate the hemorrhoid at 0.3 cm~1.0 cm above the dentate line along the surface of the internal sphincter and remove the mucosa, submucosa and all the hemorrhoid tissue of the lower rectum about 2 cm~3 cm wide in a circular fashion, and suture the rectal mucosa to the skin of the anal canal. This procedure is considered to be a more thorough procedure with a large excision area and is very effective in relieving prolapsed hemorrhoids and bleeding. However, the procedure is long, bleeds a lot, and more serious complications such as mucosal ectasia and anal stricture, loss of anal canal sensation, and anal incontinence occur in 10% of patients after surgery. It is rarely used at present. 2.Open and closed hemorrhoidectomy The most classical ones are Milligan-Morgan and Ferguson, Milligan-Morgan is also called open hemorrhoidectomy, external stripping and internal ligation, the principle of this operation is to retain sufficient skin bridge after stripping and removing the main hemorrhoidal tissue to prevent postoperative anal stenosis, and the incision is open for second stage healing. The Ferguson procedure, also known as closed hemorrhoidectomy, is similar to the Milligan-Morgan procedure in its basic steps, but the final incision is closed with absorbable sutures. Both procedures are more effective for hemorrhoid bleeding and prolapse. Compared to hemorrhoid circumcision, there are fewer complications and safer, but for circumferential hemorrhoids and IV degree internal hemorrhoids, this procedure may often leave some small hemorrhoid tissues behind. 3.Doppler-guided hemorrhoid artery ligation The artery above the hemorrhoid is directly ligated by using a special Doppler probe to detect the artery 2 cm~3 cm above the dentate line to block the blood supply of the hemorrhoid for the purpose of relieving the symptoms. It is suitable for internal hemorrhoids of degree II-IV (stage). This method is less painful and has fewer complications, but there is a lack of large samples and long-term follow-up studies, and its efficacy needs further observation. 4. supra-hemorrhoidal mucosal loop stapling (PPH) This procedure relieves prolapse and bleeding symptoms by circumferentially removing the rectal mucosa above the anal cushion, pulling the anal cushion upward while blocking its blood supply. PPH differs from the traditional surgical approach of removing and ligating hemorrhoidal tissue by preserving the anal cushion, which is more physiological and reflects a change in the philosophy of hemorrhoid surgical treatment. The indications for PPH surgery are III and IV degree (stage) circumferential internal hemorrhoids with prolapse as the main symptom and circumferential mixed hemorrhoids with internal hemorrhoids as the main symptom, as well as II degree internal hemorrhoids with recurrent bleeding. This surgery can also be considered for II degree internal hemorrhoids that cannot be relieved by conservative treatment and where sclerosing agent injection and ligature methods have failed. PPH procedure has been widely recognized for its less painful and faster recovery than traditional surgery. The recent efficacy is better for circumferential hemorrhoids and grade IV (stage) hemorrhoids, often with immediate results after surgery. However, there are still few prospective studies with large samples on its long-term efficacy and recurrence. The treatment of special patients (1) Acute embedded hemorrhoids: It is an emergency case of hemorrhoids and can be treated by either manual repositioning or surgery depending on the patient’s condition. For those who have been embedded for a long time or have necrosis on the surface of the hemorrhoid, local application of drugs to release the spasm of the sphincter can be used followed by manual repositioning; it is better to first conservative treatment and wait for the local inflammation and edema to subside before surgery to improve safety; for those who have failed to reposition the embedded hemorrhoid by manual repositioning or have been embedded for a long time and have strangulated necrosis, surgical treatment should be taken to release the embedded, remove necrotic tissue and prevent infection. (2) Thrombosed external hemorrhoids: For those with early onset, severe pain and no tendency of mass reduction, emergency surgery can be performed to eliminate the symptoms more quickly and the recurrence rate is lower. Simple incision and drainage should be avoided, which will allow the thrombus to form again, and the thrombus formed is bigger and the symptoms are more serious. If the symptoms are relieved after 72 hours, conservative treatment is recommended. (3) Hemorrhoids in pregnancy and early postpartum period: conservative treatment is preferred. For patients with severe complications of hemorrhoids and those for whom drug therapy is ineffective, simple and effective surgical procedures should be chosen. Sclerotherapy injections are prohibited. (4) Hemorrhoids complicated by severe anemia: care should be taken to exclude other diseases that cause anemia, and treatment such as active surgery should be performed. (5) Hemorrhoids in patients of advanced age, hypertensive disease, and diabetes: non-surgical treatment should be the mainstay, and in severe cases, treatment of related diseases should be addressed, and simple surgical methods of treatment should be used as appropriate after their stabilization. The treatment of hemorrhoids should be strictly based on the characteristics of each patient’s hemorrhoids, paying attention to both the effectiveness of the treatment and the possibility of potential complications, especially serious ones, and their prevention. The choice of hemorrhoid treatment should follow the principles of the most effective, safest, simplest and most economical to bring the maximum therapeutic effect to the patient, and it is not necessary to use apparatus treatment if you can use medication, or surgery if you can use apparatus treatment, and the surgical method should be as simple, economical and equally effective as possible to avoid excessive surgery.