As we all know, but any operation that is associated with a knife carries the risk of blood, and mixed hemorrhoid surgery is no exception. Before we start the article, let’s understand two concepts, namely primary and secondary bleeding. Primary bleeding refers to bleeding that occurs within 24 hours of surgery; secondary bleeding refers to bleeding that occurs after 24 hours of surgery. The two are bounded by 24 hours after surgery. First, the cause of primary bleeding surgical operation is mainly some blood vessels are not done clearly, one is the operator found small arteries during surgery, and no bleeding was seen after hemostatic forceps clamping; second, the surgeon considered that the patient’s postoperative stitch removal brought great pain to the patient, and no further bleeding was seen after clamping, and third, the blood vessel ligation was not accurate enough. In addition, the anal filling was too loose or fell off and the wound was not compressed tightly, while causing the wound to ooze blood. Patients themselves Patients get out of bed too early, or urinate too often, walk around too much, or defecate too early, causing the internal hemorrhoid ligature to slip out of place, or the wound to split open. During the period of dislodgement, the internal hemorrhoid bleeds due to wound injury caused by the patient’s vigorous activity or dry stool and toilet struggle; the hemorrhoid nucleus bleeds due to tissue necrosis caused by secondary infection, which is the main cause of secondary hemorrhage after surgery. Injected drugs in the hemorrhoid nucleus are too concentrated, too large a dose, and too deep a site, which can damage the blood vessels in the muscle layer and cause bleeding. Systemic diseases, certain blood diseases, such as acute and chronic leukemia, aplastic anemia, hemophilia, and others such as hypertension, arteriosclerosis, portal hypertension causing coagulation mechanism disorders can also cause postoperative bleeding. Second, the prevention of pre-operative systemic conditions need to be carefully examined, especially the examination of the hemostatic function, to exclude contraindications to surgery. The key to prevent primary bleeding is to strictly follow the operating procedures, operate carefully and stop bleeding thoroughly. Postoperatively, intra-anal fillers such as petroleum jelly and gelatin sponges, tartar gauze to compress the wound and fix it with adhesive tape, and lie down to rest. Appropriate postoperative antibiotics should be used to prevent bleeding due to postoperative infection. Excessive activity should be avoided after surgery, especially during the period of internal hemorrhoid exfoliation (7-15 days after surgery) lying still and moving little. Keep the stool unobstructed to avoid bleeding due to dry stool and loss of trauma caused by clinical toilet struggle. If symptoms of hemorrhage are found (discharge of large amount of blood or clots during defecation, dizziness and panic, etc.), patients in the hospital and their families should quickly notify the medical staff and actively deal with them; for patients outside the hospital, they should rush back to the hospital or enter a hospital not far from home as soon as possible accompanied by their families and perform basic treatment. If the wound is not completely healed, a small amount of bleeding (dripping or intermittent outflow, stopping after relieving the stool) is normal and there is no need to worry too much. Rest in bed and reduce activity, especially during the period of hemorrhoid detachment. Control the diet and keep the stool open: for a small amount of bleeding patients do not need to control the diet, the stool is open. For patients with heavy bleeding, a liquid diet or soft food can be given for 2-3 days. For dry stools, take oral laxatives. Strengthen anti-infection and hemostatic treatment. Treatment of localized bleeding Dressing can be changed and re-pressurized, or localized with gelatin sponge, thrombin, epinephrine gauze, etc. For severe bleeding and shock, resuscitation should be actively performed, suturing to stop bleeding, rehydration, anti-shock, blood transfusion and other treatments. The most important thing that the medical staff is worried about is the bleeding of the hemorrhoid nucleus during the period of dislodgement, generally as long as this does not happen, the post-operative recovery is better. The most fear is that the patient friends feel good about themselves after surgery and take it lightly, walking too much and moving too fast and too big. Perhaps there are many patient friends who have never seen heavy bleeding and may wonder how much blood can come out of a hemorrhoid? In fact, this is not the case, there have been patients who walked too much and participated in activities such as playing mahjong during the period of hemorrhoid shedding, resulting in heavy bleeding, and fainted on the road before they even entered the hospital because of too much bleeding. Of course, in the end, it was resuscitated. However, for this example I hope that my friend will pay attention to mixed hemorrhoid surgery and the prevention of post-operative hemorrhage.