Hemorrhoids (commonly known as “piles”) are a common disease located in the anal area and can develop at any age. As the saying goes, “Hemorrhoids are not at an advanced age”. Therefore, the severity of hemorrhoids is not proportional to age, but the incidence gradually increases with age. In our country, hemorrhoids are the most common anorectal diseases, there are “ten men nine hemorrhoids”, “ten women ten hemorrhoids” said. First, hemorrhoids are divided into which categories? Hemorrhoids occurring parts to points, hemorrhoids are divided into internal hemorrhoids, external hemorrhoids, mixed hemorrhoids. The connection between the skin of the anal canal and the mucous membrane of the rectum has a jagged visible line called the anal canal dentate line. Above the anal dentate line, the hemorrhoidal venous plexus under the mucosa of the end of the rectum is enlarged, and the soft venous mass formed by varicose is internal hemorrhoids. Below the dentate line, the external hemorrhoidal venous plexus is enlarged and varicose, the external hemorrhoidal veins are ruptured, and the fibrous hyperplasia formed by repeated inflammation is external hemorrhoids. External hemorrhoidal venous plexus varicose, communicate with each other anastomosis, so that the internal hemorrhoid part and the external hemorrhoid part of the formation of a whole person for the mixed hemorrhoids. When the external hemorrhoids into a week or at least three hemorrhoids fusion, the external hemorrhoids were plum-shaped, known as ring-shaped hemorrhoids. 1, internal hemorrhoids are divided into four degrees: I stage: blood or drip blood or jet bleeding, no internal hemorrhoids prolapse, bleeding can stop by itself after stool. Stage II: blood, drops of blood or jet bleeding, with internal hemorrhoids prolapse, after stool can be self-contained. Stage III: blood or dripping blood during stool, with internal hemorrhoid prolapse, or prolapse of internal hemorrhoids when standing for a long time, coughing, straining and weight-bearing, which can be restored by hand. Stage IV: internal hemorrhoids prolapse can not be returned, accompanied by anal laxity and varicose veins type of external hemorrhoids, if not sent back in time easy to form a ton. 2, external hemorrhoids are divided into four kinds: ① inflammatory external hemorrhoids: anal margin skin breakage or infection. Local redness, swelling, oozing or ulceration, pain is obvious. ② thrombosed external hemorrhoids: anal edge of the subcutaneous sudden greenish-purple lumps, local skin edema, the lump is still soft at the beginning, the pain is intense, and gradually become hard, can be active, clear demarcation, tenderness is obvious. Middle-aged males are predominant. ③ varicose external hemorrhoids: when defecating or squatting for a long time, there is a soft greenish-purple lump under the skin of the anal verge, which may be accompanied by a feeling of swelling, and may disappear after pressing. ④ connective tissue external hemorrhoids: anal edge of the superfluous skin flap, gradually increase, soft texture, generally painless, no bleeding, only feel foreign body sensation in the anus, occasionally infected with swelling pain, swelling disappears after the skin still exists. Second, the clinical manifestations of hemorrhoids: 1. internal hemorrhoids are mainly manifested as blood in the stool, the nature of the blood in the stool can be painless, intermittent, fresh blood after the stool, blood dripping or blood on the toilet paper, constipation, drinking or eating irritating food aggravated. 2. Simple internal hemorrhoids painless only swelling feeling, can bleed, development to prolapse, combined with thrombosis, ingrown, infection only when the pain. 3. external hemorrhoids usually no special symptoms, thrombosis and inflammation can be swollen, pain. Third, what are the triggering factors of hemorrhoids? There are many triggering factors for hemorrhoids, among which constipation, long-term alcohol consumption, eating a lot of stimulating foods and sedentary lifestyle are the main triggers. In addition genetic factors are also an important reason. That’s why many children also suffer from hemorrhoids, some young people hemorrhoids is also very serious a reason. The actual hemorrhoids are usually a lot more than a few of the most common types of hemorrhoids in the marketplace. The treatment of hemorrhoids Many friends say that hemorrhoids are not serious and that they will pass if they endure. This indicates that your hemorrhoids are not serious. If hemorrhoids manifest as recurrent anal pain, frequent blood in the stool, anal prolapse affecting defecation, etc., you need active treatment. Because serious hemorrhoids may also be life-threatening. 1, non-surgical treatment of asymptomatic hemorrhoids do not need treatment; symptoms of mild, infrequent episodes of hemorrhoids to non-surgical treatment. (1) General treatment Applicable 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 bad defecation habits, keep bowel movement, take laxative if necessary, and wash the anus after defecation. 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, warm water before going to bed, hot water sitz bath and so on. (2) Topical medication has been widely used, including suppositories, creams and lotions, most of which contain Chinese medicine. (3) Oral medication Generally, laxative and hemostatic drugs are used. (4) Injection therapy is more effective for hemorrhagic internal hemorrhoids of degree I and II; sclerosing agent is injected around the submucosal venous plexus to cause inflammatory reaction and fibrosis, so as to press and close the varicose veins to achieve the therapeutic purpose. (5) adhesive ring ligation ligation hemorrhoid root, blocking its blood supply to make hemorrhoids off necrosis; for II, III degree internal hemorrhoids, for huge internal hemorrhoids and fibrosis internal hemorrhoids more suitable. 2.Surgical treatment. (1) Surgery indications Conservative treatment is ineffective, hemorrhoidal prolapse is serious, large fibrotic internal hemorrhoids, injection and other poor treatment, combined with anal fissure, anal fistula, and so on. (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 surgery 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 surgery is performed after the ulcers have healed; bowel preparation is done. (4) Surgical methods: ① thrombosed external hemorrhoid stripping surgery is suitable for thrombosed external hemorrhoids after conservative treatment of pain is not relieved or the mass does not shrink. ② Classical 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. ④PPH 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 area more efficient. Compared with traditional hemorrhoidectomy, PPH surgery has shorter operation time, lighter postoperative pain and faster recovery, but the incidence of postoperative complications varies greatly among patients operated by different surgeons, and some of them will have serious complications, such as rectal stenosis, etc. At the same time, the price of the instruments is more expensive, and it is necessary to grasp the indications for the surgery strictly for the surgery. ⑤ Postoperative treatment Sitz bath, change medicine. Observe whether there is any complication, pay attention to diet and keep the bowel movement smooth. V. How to prevent hemorrhoids? 1.Physical exercise: appropriate physical exercise can promote venous return, promote intestinal peristalsis. 2.Prevention of constipation: increase fiber foods, such as fresh fruits and vegetables; avoid alcohol and spicy foods; drink more water; no diabetic patients drink 1 cup of honey water on an empty stomach early in the morning (250ml). 3, develop good defecation habits; from childhood to develop the habit of regular defecation; to overcome the squatting to read books, newspapers or smoking bad habits (smoking in the toilet can buffer the brain’s defecation reflexes easy to cause constipation). 4, keep clean around the anus; regular cleaning, in addition, every day, the buttocks soak in warm water for about 15 minutes, help promote blood circulation in the affected area. 5, Pay attention to keep the lower body warm. 6.Avoid sitting and standing for a long time. 7, pay attention to menstruation and pregnancy and childbirth health care. (1) due to pregnancy fetal compression of the pelvic veins, so that venous reflux obstruction, anorectal vascular expansion, can affect intestinal peristalsis so that fecal discharge difficulties, easy to constipation and induced hemorrhoids. (2) female menstruation luteinizing hormone secretion inhibit anal canal movement and anal canal sensitivity to stimulation and aggravate congestion, due to the stimulation of menstrual blood and toilet paper friction, can aggravate the external hemorrhoids. 8, often do anal lifting exercise. 9, self-massage. 10, timely treatment: to prevent small hemorrhoids drag weight.