’Nine out of ten people have hemorrhoids, ten women have hemorrhoids’, I often hear this expression. How many people actually treat hemorrhoids? In addition to asymptomatic hemorrhoids that are not treated, many of those that require treatment are not treated because they are afraid of pain. There are two kinds of pain: intraoperative pain and postoperative pain. Intraoperative pain can be solved by anesthesia, but postoperative pain is often difficult to deal with. The doctor burns his hands and the patient is scared. Therefore, who can reduce post-operative anal pain, so that the patient can accept the pain (level 3 or less), who is considered a master. Although the anorectal predecessor, Mr. Ren Quanbao, discovered the long-acting pain reliever – methylene chloride, it is not perfect. Think about it, in the surgery you do, the same long-acting pain relief is used, some patients have light pain, or even no pain, and some patients have a lot of pain? On this issue, analyze the reasons and treatment. 1.Post-operative pain caused by methylene chloride: burning pain is intense, and sometimes it is impossible to urinate because of the pain. Generally, the pain starts to decrease after urination. In addition to the degree of sensitivity (pain threshold) of the individual, it has a great relationship with the site of injection. In general, when the tissue is loose or there is a decompression incision, the pain is mild. When there is no incision in dense tissues, the pain is severe. Pain medication is given according to the severity of the pain, and morphine-based pain medication can be given if necessary. I usually do not use morphine because it is not available in the hospital. If you need to play another sacral anesthesia, it will solve the problem. 2.Pain caused by postoperative anal edge edema: mainly occurs on the second day after surgery, due to anal edge edema, pressure increases, squeezing nerve endings, resulting in pain. Prevention: postoperative edema can be prevented by cutting open the skin (decompression port) in the perianal edema-prone area. The edema can be drained by opening the exudate. 3. Pain caused by inflammatory hyperplasia at the incision margin: generally occurs after 3 days after surgery. Inflammatory nodules appear at the edge of the wound, with obvious tenderness and pain when touched. It is mainly caused by unreasonable incision design and poor drainage. Prevention:Trim and unclog the incision after surgery to facilitate smooth outflow of exudate. Treatment:Excision if necessary 4. Pain caused by excessive postoperative tissue damage: this kind of pain is difficult to control, pain is strong and long, and long-acting painkillers are not effective. So when anal surgery, try to reduce the area of tissue damage. Incision is the main reason, excision is supplementary. 5, postoperative downward pain: mainly for various reasons stimulate the rectal mucosa, rectal mucosa edema, the brain thinks there is a bowel and the sense of defecation. Proctitis and after injection of antihemorrhoid spirit is most common. Prevention:Proctitis and ulcers should be treated before surgery. Injections of antihemorrhoid spirit should pay attention to the concentration, depth, and amount, and pay attention to gentle smoothing by hand. Treatment:Treatment of proctitis and rectal drip medication can relieve. 6, post-operative pain caused by scars: can occur in the months or even years after surgery, some of them become ‘difficult’. It is mainly the pain and discomfort caused by adhesions, contractures, and extrusion of the scars. Some patients are only aware of the discomfort that occurs after hemorrhoid surgery, but the anorectal department can’t find the problem, forming a ‘difficult case’. Prevention:Minimize damage and minimize spotting. Treatment:For superficial scars, sitz baths, hot packs, physical therapy, closure, etc. can soften the scars. For deep scars, it will be a matter of ‘eight immortals to show their talents’. Conclusion:Take the essence and remove the dross.