Hemorrhoids are one of the most common diseases affecting human health, and their true incidence is not known, in the past there was the so-called “nine hemorrhoids in ten people”, and even the so-called “nine hemorrhoids in ten men and ten hemorrhoids in ten women”, which refers to the high incidence of hemorrhoids. 57927 people, suffering from anorectal diseases a total of 33837 people, the total incidence rate of 58,4%. Among them, the incidence of hemorrhoids accounted for 87,25%, with internal hemorrhoids being the most common, accounting for 59,86%, external hemorrhoids accounting for 16,01%, and mixed hemorrhoids accounting for 24,13%. The above situation is enough to show that hemorrhoids are common and frequent diseases. Haemorrhoids are called “Haemorrhoids” or “Piles” abroad, but these two words have completely different meanings. This is named after the clinical feature of bleeding, but not all hemorrhoids bleed, and some can never bleed. Later, it was named Piles from the Latin word Pila, which means “ball” and is named from the shape of hemorrhoids, which refers to all types of internal and external hemorrhoids, and is now called “Piles” by British scholars. Most scholars now believe that hemorrhoids are a part of the normal anatomy of the “vascular anal canal pad” and that they are common to all ages, men and women, and all races. Depending on where the internal hemorrhoids occur, there are primary internal hemorrhoids (mother hemorrhoids) and secondary internal hemorrhoids (daughter hemorrhoids). This is related to the vascular branches, and the main terminal branches of the superior rectal artery are distributed in the right anterior, right posterior and left median rectal column. Hemorrhoids are the result of displacement, congestion, and edema of the anal cushion. According to the location of hemorrhoids, they are classified as external, internal and mixed hemorrhoids. They are characterized by blood in the stool, pain, prolapse and swelling. It is also known as hemorrhoids or piles in Chinese medicine. It is believed that the basis of hemorrhoids is the deficiency of the internal organs and the loss of qi and blood, and that the internal organs and yin and yang are out of balance, the flow of qi and blood is not smooth, the meridians are obstructed, and the heat is internal, so that the heat and blood fight each other, and the qi and blood are crossed, the meridians are intertwined, and the stagnation is not dispersed. Symptoms Clinical manifestations (a) Blood in stool Painless, intermittent, bright red blood after stool is its characteristic, and it is also a common symptom in the early stage of internal or mixed hemorrhoids. Blood in the stool is usually caused by the rupture of dilated blood vessels due to feces rubbing the mucous membrane or excessive force of feces. In mild cases, it is mostly blood in the stool or on the stool paper, followed by dripping blood, and in severe cases, it is jet-like bleeding, which can often stop on its own after a few days. This is important for diagnosis. Constipation, dry and hard stools, drinking alcohol and eating irritating food are all triggers for bleeding. If the bleeding is repeated for a long time, anemia can occur, which is not uncommon clinically and should be differentiated from bleeding disorders. (ii) Prolapsed hemorrhoid is often a symptom of late stage, mostly with blood in the stool followed by prolapse, because of the late stage hemorrhoid body enlarges, gradually separates from the muscle layer, and is pushed out of the anus when defecating. In the lighter cases, the hemorrhoid prolapses only during stool and can return on its own afterwards, while in the more serious cases, the hemorrhoid can come out of the anus with a little abdominal pressure, such as coughing and walking, and when the abdominal pressure increases slightly, the hemorrhoid can come out and it is difficult to return and cannot participate in labor. A few patients complain that prolapse is the first symptom. (iii) Pain Simple internal hemorrhoids are painless, a few have a feeling of swelling, when internal hemorrhoids or mixed hemorrhoids prolapse and become embedded, edema, infection, necrosis, there are varying degrees of pain. (iv) Itching Late internal hemorrhoids, prolapsed hemorrhoids and relaxed anal canal sphincter, often have discharge, due to the stimulation of secretions, there is often itching discomfort around the anus, or even skin eczema, which is extremely uncomfortable for the patient. Complications] It should not be mistaken that hemorrhoidectomy is a minor operation, but if it is taken lightly, serious complications can occur if it is not careful, and even cause a big tragedy. Buls (1978) analyzed 500 consecutive cases of hemorrhoidectomy, and the complications were as follows: anal fistula 0,4%, anal fissure 0,2%, anal canal stenosis 1,0%, anal incontinence 0,4%, skin prolapse 6,0%, fecal impaction 0,4% The percentage of thrombosed external hemorrhoids is 0.2% and urinary retention is 10%. 1. Bleeding There are two causes of bleeding after internal hemorrhoid surgery: early and late. The former is due to the slip of the thread knot; the latter occurs about 7 to 10 d after surgery, due to the infection at the ligature. Due to the role of the anal sphincter, blood mostly flows back upward into the intestinal cavity and does not flow outside the anus, so the phenomenon of “red dressing” cannot be found clinically. Therefore, this kind of “acute bleeding” is often not easily detected early. Any of the following phenomena should be considered as early signs of “hidden bleeding”: ① paroxysmal bowel sounds, intestinal pain and urgent bowel movement; ② patient with dizziness, nausea, cold sweat and rapid pulse and other symptoms of deficiency. In case of the above, rectal examination or microscopy should be performed immediately under the condition of pain relief for timely diagnosis and treatment. If bleeding is diagnosed, it should be stopped in time. If more blood accumulates in the rectum of the anal canal and the bleeding point is not visible, the bleeding can be stopped first by compression with a balloon. If there is no airbag, use No. 30 anal tube, wrapped with petroleum jelly gauze, tied with silk thread at both ends, and then coated with anesthetic ointment outside, plugged into the anus for compression to stop bleeding, and generally apply this method can stop bleeding. If bleeding points are found, sutures can be used to stop bleeding, and systemic application of hemostatic drugs and antibiotics. 2.Stenosis Careful surgical operation and early anal canal dilation can prevent anal canal stenosis. Stenosis can be at the anal verge, at the dentition or at the dentition. Stenosis at the anal verge is mainly due to excessive excision of skin and mucosa at the anal verge, resulting in wound contraction causing stenosis at the anal verge. The scar is often accompanied by anal fissure, which is caused by tearing during defecation. It is often treated by multiple surgical procedures because of the ineffectiveness of anal dilation by manipulation and instruments. Stenosis at the dentate line can occur after closed hemorrhoidectomy, and stenosis at the dentate line is due to overly wide ligatures at the base of the hemorrhoid, the latter can be treated with multiple small ligatures instead of large ligatures. Dilation of the anal canal is often effective, failing which surgical correction is required. 3. Urinary retention Urinary retention is the most common complication after hemorrhoid or other anal canal surgery, with about 6% requiring catheterization (Crytal 1974). To prevent urinary retention, the following measures can be used: ① Instruct the patient to restrict drinking before surgery and for 12 h on the day after surgery to cause a mild state of water loss. This is considered to be an important measure because premature bladder distension before anesthesia wears off often leads to urinary retention; ② postoperative sedation should be used sparingly; ③ get up and move around early; ④ get up and go to the toilet to urinate when urinating for the first time to cause a conditioned reflex; ⑤ local anesthesia is preferable; ⑥ the anal margin skin wound should be left unstitched as much as possible, and no anal canal or large piece of gauze should be placed in the rectum as much as possible after surgery to stop bleeding, which can reduce postoperative pain and This can reduce postoperative pain and primary urinary retention. The etiology of hemorrhoids is not fully understood, but can be caused by a variety of factors, and there are several theories as follows: (a) Anal cushion subluxation theory The anal vascular cushion is a tissue cushion located in the anal canal and rectum, referred to as the “anal cushion”, which is an anatomical phenomenon existing since birth. The symptoms of hemorrhoids arise when the pad is loose, hypertrophic, bleeding or prolapsed. The anal cushion consists of three parts: (1) veins, or venous sinuses; (2) connective tissue; and (3) the Treitz muscle, which is a smooth muscle between the anal lining and the internal sphincter of the anal canal, and which holds the anal cushion in place. Goligher believes that if the Treitz muscle is preserved during hemorrhoidectomy, damage to the sphincter can be prevented, reducing the surgical wound and facilitating wound healing. He reported that in 100 cases, 80% of the wounds healed in one stage and the postoperative pain was mild, with most people having painless bowel movements. Under normal conditions, the anal cushion is loosely attached to the muscle wall and retracts back into the anal canal after defecation by its own fiber contraction. When the anal cushion is congested or hypertrophied, it is easy to be injured and bleed, and can be prolapsed outside the anal canal; the degree of anal cushion congestion is affected by the pressure of the anal canal, such as constipation, pregnancy, etc. It is also related to hormonal, biochemical factors and emotions. (B) varicose veins theory From the anatomical point of view, the portal vein system and its branch rectal veins have no venous valves, blood is easy to stagnate and make the veins dilate, plus the upper and lower rectal vein plexus wall is thin, shallow, low resistance, and the terminal rectal submucosal tissue is loose, which are conducive to venous dilatation, if combined with various factors that block the venous return, such as frequent constipation, pregnancy, prostate hypertrophy and huge tumors in the pelvis, etc., can make the rectal venous reflux occur. If combined with various factors of obstructed venous return, such as frequent constipation, pregnancy, prostate hypertrophy and huge tumors in the pelvis, etc., can make rectal venous reflux occur and expand and bend into hemorrhoids. Perianal gland and perianal infection can also cause perivenous inflammation, and the veins lose their elasticity and expand into hemorrhoids. (iii) Genetic, geographic, and food factors There is no definite evidence that genetics can cause hemorrhoids, but hemorrhoids often have a family history that may be related to food, bowel habits, and the environment. Most people believe that the low incidence of hemorrhoids in developing countries, such as in rural Africa, may be related to a high-fiber food diet. Currently, a high-fiber diet in developed countries can reduce the incidence of hemorrhoids in addition to preventing the development of colorectal cancer. (a) Internal hemorrhoids The surface is covered by mucous membrane, located above the tooth line, and formed by the intra-hemorrhoidal venous plexus. They are commonly found in the left median, right anterior and right posterior areas. They often have a history of blood in the stool and prolapse. (ii) External hemorrhoids are covered by skin, located below the dentate line, and formed by the external venous plexus. The common ones are thrombosed external hemorrhoids, connective tissue external hemorrhoids (skin prolapse), varicose external hemorrhoids and inflammatory external hemorrhoids. (iii) Mixed hemorrhoids are formed near the dentate line, covered by skin-mucosal junction tissue and formed by anastomosing veins between the internal and external hemorrhoidal plexus. There are two characteristics of internal and external hemorrhoids. Stage I, no pain, mainly blood, discharge and itching. In stage II, there is blood in the stool and the hemorrhoid prolapses with defecation, but it can return on its own. Stage III (also called late stage), internal hemorrhoid prolapses outside the anal opening, or prolapses out of the anal opening with each bowel movement, and cannot be returned by itself, and must be held back by hand. In stage IV, the internal hemorrhoid prolapses out of the anal opening and cannot be returned to the inside of the anus. This is the most serious condition of internal hemorrhoids. Diagnosis】 The diagnosis of internal hemorrhoids is mainly based on the rectal examination of the anus. The first thing to do is to do an anal visual examination, using both hands to hold the anus open to both sides, except for stage 1 internal hemorrhoids, the other 3 stages of internal hemorrhoids can mostly be seen under the anal visual examination. For those who have prolapse, it is best to observe immediately after squatting and defecating, which can clearly see the real situation of the size, number and location of hemorrhoids, especially for the diagnosis of circumferential hemorrhoids. Next, do rectal palpation: internal hemorrhoids are not easy to find out when there is no thrombosis or fibrosis, but the main purpose of finger palpation is to understand whether there are other lesions in the rectum, especially except rectal cancer and polyps. Finally, anoscopy should be done: first observe whether there is congestion, edema, ulcers, lumps, etc. in the rectal mucosa to exclude other rectal diseases, and then observe whether there are hemorrhoids in the upper part of the dentate line, if so, the internal hemorrhoids can be seen to protrude into the anoscope as dark red nodules, at this time, attention should be paid to their number, size and location. Differential diagnosis】 According to the typical symptoms and examination of internal hemorrhoids, the diagnosis is generally not difficult, but it needs to be differentiated from the following diseases. 1, rectal cancer Clinically, lower rectal cancer is often misdiagnosed as hemorrhoids, which delays treatment. The main reason for misdiagnosis is that the diagnosis is based on symptoms only, without rectal examination and anoscopy, so the above two examinations must be done in the diagnosis of hemorrhoids. In the case of rectal cancer, the rectal finger can find uneven and hard fast, with ulcers on the surface, and the intestinal cavity is often narrow, and the finger stains are often bloodstained. The particular point to note is that internal hemorrhoids and circular hemorrhoids can coexist with rectal cancer, must not see internal hemorrhoids or circular hemorrhoids, satisfied with the diagnosis of hemorrhoids and hemorrhoid treatment, until the patient’s symptoms worsen to rectal diagnosis or other tests to clarify the diagnosis, this misdiagnosis, misdiagnosis of the tragic lessons, not rare in clinical practice, worth paying attention to. 2, rectal polyps low rectal polyps with a tip, if prolapsed outside the anus sometimes misdiagnosed as prolapsed hemorrhoids, but polyps are mostly seen in children, round, substantial, with a tip, movable. 3, anal canal rectal prolapse Sometimes misdiagnosed as circular hemorrhoids, but the mucosa of rectal prolapse is circular, the surface is smooth, and the sphincter is relaxed during rectal palpation; the mucosa of circular hemorrhoids is plum petal-shaped, and the sphincter is not relaxed.