In our daily outpatient clinics, we find that many patients do not distinguish between hemorrhoids, anal fissures and perianal abscesses. How to distinguish between hemorrhoids, anal fissures and perianal abscesses? 1, hemorrhoids Its pathogenesis currently has two mainstream theories, one is the rectal anal canal varices caused by the plexus, and the other is caused by the anal cushion subluxation. Clinical work has revealed that both theoretical doctrines have manifested in patients. The two clinical manifestations of hemorrhoids are painless blood in the stool plus prolapse of the anal hemorrhoid mass during defecation. The blood in the stool is fresh and can manifest as blood on the stool table or on the stool paper, dripping blood, or spraying blood, or in large amounts. Hemorrhoids are generally painless, but thrombosed external hemorrhoids, inflammatory external hemorrhoids, and mixed hemorrhoids can be accompanied by pain, even severe pain. The first and second stage hemorrhoids can be treated conservatively; the third and fourth stage hemorrhoids and the first and second stage hemorrhoids with serious blood in the stool need to be treated surgically. 2, anal fissure The occurrence of anal fissure is mainly due to the absolute narrowing of the anus or the relative narrowing of the anus, and the rupture of the skin and subcutaneous tissue of the anal canal when defecating; a few patients suffer from chronic colon and rectal diseases or perianal eczema/perianal neurodermatitis, anal pruritus and other diseases that cause degeneration of the perianal skin and subcutaneous tissue and decrease in elasticity. The characteristic symptoms of anal fissure are pain during stool, blood in stool, pain first and then bleeding, pain in the form of tearing, obvious during stool, some patients have pain relief after stool, and pain again about half an hour after stool (caused by spasm of anal canal after stool); blood in stool is mostly blood on stool table, blood on stool paper, and dripping blood. Patients with congenital anal stenosis need surgery. Patients with relative anal stenosis, such as fresh anal fissure, can avoid surgery by paying attention to dietary habits and defecation habits in general after regular treatment. However, if the fissure is recurrent, the scar growth is obvious, and the fissure becomes old, surgery is inevitable. If the fissure is caused by chronic anorectal disease, it can be improved by conservative treatment after the primary disease is controlled. 3.Perianal abscess Its onset is due to the infection of the anal gland and the soft tissue space next to the anus. It is a detailed infection with rapid development. The clinical manifestations are redness, swelling, heat and pain in the paranal area. The initial manifestation is a hard lump next to the anus with pressure pain and swelling, then the lump increases rapidly, pain is obvious, it may be accompanied by swelling, local tissue edema, skin redness, high skin temperature, and heavy with chills and fever; deep abscesses are quite light in pain, but anal swelling (post-acute) is obvious, and chills and fever are heavy. When the abscess matures, it becomes locally soft and can be felt as a fluctuating sensation. In some patients, the pain can be relieved after the abscess breaks down and the pus spills out by itself and the tension is reduced. However, because of the thicker paranal skin and more perianal soft tissue spaces, abscesses are generally not easy to break outward and can easily spread to the perianal soft tissue spaces, so if the abscess is mature, it must be treated surgically.