1, pain No anal surgery can bypass the topic of pain, although many publicity are selling “minimally invasive”, “painless” label, but really can do, and a few. There are two types of pain after anal surgery, reflex pain and inflammatory pain. Because the human anal region is rich in nerves and innervated by spinal nerves, pain is very sensitive, so surgical trauma and inflammatory stimulation can lead to pain. Pain has the following causes: (1) Patients are extremely sensitive to pain due to fear, and the anal sphincter is in a state of tension, which can cause pain at the slightest stimulation. This pain is mainly seen during surgery and postoperative dressing changes. (2) Postoperative infection, edema of the wound, constipation, and foreign body irritation can also cause pain. (3) Narrow anal canal, pain caused by tearing the skin of the anal canal by force when defecating. (4) Large traumatic surface, excessive scarring after healing, and pain caused by scar contracture compressing nerve endings. Treatment: No treatment is needed for mild pain, and those with severe pain are treated separately according to the situation. If the pain is severe, it should be treated according to the situation. Lactulose should be given to those who have difficulty in defecation. For scar pain, no treatment is needed for mild pain, and for severe pain, fumigation with herbal sitz bath. For inflammatory pain, anti-inflammatory treatment should be performed, and if the inflammation has become septic, it should be incised in time. 2, anal edema Anal edge edema is also a common reaction after anal surgery, edema will intensify anal pain, edema occurs for a number of reasons. (1) Too much anal margin tissue is removed or ligated during surgery, too many incisions and unreasonable selection of incisions, etc., resulting in local blood and lymphatic reflux obstruction, increased vascular permeability and water retention in the tissue interstices. (2) Inadequate stripping of the venous mass at the anal verge. (3) Uneven filling of postoperative dressing and difficulty in urination and defecation, squatting for too long. Treatment: Mild edema can be absorbed slowly on its own, so there is no need to go to trimming repeatedly. It can be taken orally and washed externally with the toxin-eliminating soup, and applied wetly with 40% hypertonic saline during local dressing change, or applied externally with golden ointment. If you have edema, you can make a decompression incision surgically. (1) Anesthesia, especially lumbar anesthesia and sacral anesthesia, appears on the day after surgery. (2) Excessive and tight dressings for dressing the incision, making it impossible to vent the anus. (3) Postoperative bed rest and poor intestinal peristalsis. (4) Excessive consumption of milk, sugar and other foods. Treatment: first use abdominal hot compress, after seeking the doctor’s consent to properly loosen the bandage wrapped around the wound, you can also request the doctor to give the anal canal exhaust, and if necessary, take oral rheumatism and digestive medicine, Mu Xiang Shun Qi Wan, Si Mo Tang, etc. 4, fever The main reasons are: (1) intraoperative blood loss, sweating and fluid loss, the body’s resistance decreases, resulting in a cold and fever. (2) Reaction to the drugs used during the operation, such as some sclerosing agents and withered hemorrhoid solution. (3) Infusion reaction. (4) Surgical disinfection is not strict, causing local infection. Treatment: First find out whether it is local infection, and the diagnosis can usually be confirmed by routine blood test and local examination of the anus. If the infection is localized, surgical incision of the infected area and systemic anti-infection should be performed in a timely manner. If the infection is not local, consider other causes and give symptomatic treatment. If there are no other symptoms and signs, and the body temperature does not exceed 38°C, it should be considered as drug absorption fever, which does not require special treatment and can generally resolve on its own in 5-7 days. 5, blood in the stool Anal surgery is mostly open wound, mainly using local pressure to stop bleeding, a few days after surgery every time a small amount of bleeding during defecation, since the stool stops, is normal. If the bleeding does not stop, you should seek immediate medical treatment. There are the following reasons for blood in the stool after anorectal surgery: (1) Small arteries forgotten during surgery are not ligated or the ligature line falls off after surgery. (2) The wound was not compressed when it was bandaged. (3) Defecation on the same day after surgery. (4) Intraoperative use of epinephrine and postoperative small artery bleeding. (5) Hemorrhoid nucleus necrosis infection haemorrhage after injection of sclerosing necrotizing agent. (6) Using laser treatment, the small arteries temporarily coagulate without bleeding, but they rupture and bleed as soon as the patient moves after surgery. (7) The patient is combined with medical diseases with bleeding tendency, such as leukemia, coagulation factor deficiency, liver cirrhosis, hypertension, etc. Treatment: First identify the cause and site of bleeding, locally by using gelatin sponge, Yunnan Baiyao and pressure bandaging or ligating the bleeding point. The whole body should be treated with haemostatic drugs, such as Lithopodium, vitamin K, haemostatic minerals, etc., and antibiotics in appropriate amounts. For more blood loss, rehydration, blood transfusion, and correction of water-electrolyte acid-base balance should also be used. Ask the patient to control the stool and try to rest in bed. 6. Difficulty in defecation The main reasons are: (1) Patients have fear of anal pain caused by defecation, intentionally prolonging the defecation time, so that the water in the stool is excessively absorbed and dry, resulting in difficult discharge. (2) Excessive intraoperative tension and sympathetic excitation, which inhibits bowel movements. (3) Postoperative bed rest and reduced activity slow intestinal peristalsis. (4) Low fiber in the diet. Treatment: the first defecation after anorectal surgery can be used to assist in defecation, later you can take some laxatives to prevent, such as honey, Astragalus Rundown oral solution, etc., can also take Dulcolax, lactulose to soften the stool. 7, urinary difficulties The main reasons are: (1) anesthesia factors, anesthesia makes the bladder expansion sensation dull or disappear, the bladder over-expansion loss of tension. (2) Spasm of the urethral sphincter. Postoperative anal pain makes the anal sphincter spasm, and since the anal sphincter and urethral sphincter are innervated by the same nerve, as a result, the urethral sphincter also spasms. (3) Change of urinary habits after bed rest. (4) Excessive filling of the anal local or intestinal cavity dressing, which compresses the urethra. Treatment: The following methods can be used. (1)Hot water bag on the small abdomen and anal perineum. (2)Artificial water drops sound stimulation to cause conditioned reflex and enhance the sense of urination. (3) Loosen the bandage after seeking the doctor’s consent. (4) Fresh ginger or raw garlic to stimulate the urethral opening. (5) Intramuscular injection of neostigmine 0.5~1mg, or 0.5% procaine 10~20ml to close the long strong point. (6) At the midline of the abdomen, four fingers below the umbilicus, press down vertically with the fingertips for a few moments and go to urinate when the feeling of urination arises. (7) 500ml saline enema to loosen the anus and relax the urethral sphincter as well. (8) Overfill the bladder and use catheterization. (9) After the first urine discharge after the operation, if you still feel the urine is not smooth, you can treat it by taking oral Chinese medicine Bazheng San or a small amount of psyllium as a tea substitute. 8, anal itching Anal itching after anal surgery, there may be several cases: (1) normal reaction during the healing process of the wound, generally in the late healing period, the wound crawl skin, the wound edge can be itchy, without treatment can slowly disappear. (2) One is allergic to postoperative topical creams or lotions, which can appear as flushing of the perianal skin and pimples, etc. (3) Surgery destroys the anal glands and the anal gland fluid flows out to stimulate the perianal skin, or surgery damages the anal sphincter, making the anal closure poor and the intestinal fluid leaks out to stimulate the perianal skin. Treatment: The following methods can be adopted. (1) Discontinue the use of general topical ointments and keep the area dry. Avoid alcohol, chili and seafood. (2) Take a sitz bath with pepper salt water. (3) Topical application of any one of Pirexone (no more than 5 days), Benadryl cream, and tylenol cream. (4) Local closure (in hospital).