When there is fresh blood in the stool, anal swelling prolapse, painful swelling outside the anus, anal dampness or itching you should consider whether you have hemorrhoids. The main manifestation of early internal hemorrhoids is anal bleeding during stool, more blood, bright red blood, sometimes dripping down, sometimes like arrow jets, no pain and other discomfort, with a certain periodicity. The bleeding for a long time can cause anemia, and the patient feels dizzy, short of breath, fatigue and poor spirit. When internal hemorrhoids develop to the middle stage, in addition to bleeding, the hemorrhoid nucleus will come out of the anus during stool, and the nucleus can return to the original position by itself after stool. In the advanced stage of internal hemorrhoid development, the hemorrhoid nucleus cannot come out of the anus after stool and cannot return to its original position by itself, and it needs to be pushed back by hand. In severe cases, coughing and walking can also cause the hemorrhoid nucleus to prolapse out of the anus. The anus often feels moist and itchy due to increased secretions that irritate the anus. If the hemorrhoid nucleus is not sent back in time after prolapsing, it will swell up and become painful or even necrotic over time. External hemorrhoids will feel severe pain when they become inflamed or form a blood clot. 1. Diagnosis (1) The main clinical manifestations of internal hemorrhoids are bleeding and prolapse, which can be accompanied by difficulty in defecation and can occur as thrombosis, strangulation, and impaction. Internal hemorrhoids are graded as follows: 1. Degree I: bleeding with blood, dripping blood or spraying bleeding at the time of stool. There is no hemorrhoid prolapse. 2.Degree II: There is often blood in the stool; the hemorrhoid prolapses during defecation, and can be returned by itself after the stool. 3.Degree II: Occasional blood in stool; hemorrhoid prolapses during defecation or when standing for a long time, coughing, exertion, or weight-bearing, and needs to be returned by hand. 4.Degree IV: Occasional blood in the stool; hemorrhoid prolapses and cannot be retracted. (2) The main clinical manifestations of external hemorrhoids are anal discomfort, moist and unclean, and severe pain if blood formation and subcutaneous hematoma occur. There are four types of hemorrhoids: 1. Inflammatory external hemorrhoids: After the skin of the anal margin is damaged or infected, it forms a protrusion of the anal skin folds, which is red, swollen, hot and painful inflammatory manifestation. 2.Thrombosed external hemorrhoids: painful subcutaneous elevation with thrombus formation in the anal vein plexus due to inflammation of the anal vein or excessive force during stooling. 3.Connective tissue external hemorrhoids: Due to the stimulation of chronic inflammation, repeated attacks cause local skin fibrosis and connective tissue hyperplasia at the anal edge, forming skin pendulous, also known as superfluous external hemorrhoids. (4) Varicose external hemorrhoids: when squatting or attracting for a long time, subcutaneous swelling of the anus can be seen as a varicose vein mass, which cannot dissipate immediately. (3) Mixed hemorrhoids: The main clinical manifestation of mixed hemorrhoids is that the symptoms of both internal and external hemorrhoids can exist at the same time, and in severe cases, they are manifested as prolapsed circumferential hemorrhoids. 2. Differential diagnosis (1) When blood in the stool, it should be distinguished from anal fissure, inflammatory bowel disease, polyps, colorectal cancer, etc.; (2) When prolapse, it should be distinguished from anal papillary fibroma, polyps, rectal prolapse, etc.; (3) When pain, it should be distinguished from anal fissure, anal sinusitis, perianal abscess, etc.; (4) When anal dampness and itching, it should be distinguished from anal eczema, anal fistula, etc. Once there is fresh blood in the stool, anal swelling prolapse, painful swelling outside the anus, anal dampness or itching timely examination in a regular hospital, a few minutes to confirm the diagnosis of hemorrhoids.