Definition: Mixed hemorrhoids refers to the same orientation of the internal and external hemorrhoidal venous plexus expanding varicose, communicating with each other anastomosis, so that the internal hemorrhoidal part and the external hemorrhoidal part of the fusion of the formation of a whole person. Mostly in the truncal position 3, 7, 11 points, to 11 points at the most common. Both internal hemorrhoids, external hemorrhoids double symptoms. Diagnosis and clinical manifestations: blood in stool, prolapse and foreign body and swelling in the anus. There may be anal swelling, foreign body sensation or pain. May be accompanied by local secretion or itching. Swelling in the same place above and below the dentate line in the anorectum (below the dentate line can also be redundant). Third, the experience of diagnosis: the diagnosis should be clear inside and outside the differential diagnosis should be differentiated Ask the history to be detailed clinical examination to be careful Fourth, personal experience: mixed hemorrhoids is a common clinical anal and intestinal diseases, in general in the clinic to diagnose mixed hemorrhoids is not difficult, the differential diagnosis is also relatively easy, but sometimes need to be and the rectal mucosal prolapse or rectal mucosal laxity to distinguish, because the diagnosis of the different direct decision of the different surgical and treatment methods. The difference in diagnosis directly determines the difference in surgery and treatment. Common clinical symptoms and signs include: blood in the stool, prolapse and foreign body and swelling in the anus. There may be anal swelling, foreign body sensation or pain. May be accompanied by localized discharge or itching. Swelling in the same place above and below the dentate line in the anal canal and rectum (below the dentate line can also be redundant). However, a small number of patients do not have the above obvious symptoms, mostly in patients who are not very old, often due to a sense of blockage or constipation to the bowel to consult the doctor. At this time with anoscopy can be clearly seen in the ambulatory position of the left middle, right anterior, right posterior hemorrhoidal area of mucosal bulging prolapse is more obvious, and exclude other causes of constipation, I think it is mainly due to the increase in abdominal pressure during defecation, resulting in internal hemorrhoidal prolapse of the blockage and external hemorrhoids caused by the presence of foreign bodies, so I believe that the diagnosis of mixed hemorrhoids should be more appropriate. Therefore, in order to avoid misdiagnosis and omission of diagnosis, we need to ask for a detailed medical history and careful examination of the patient.