Hemorrhoids are also called piles. Literally, hemorrhoid means protrusion, and any soft swelling that protrudes from inside or outside the anus is called a hemorrhoid. The essence of the protrusion is mainly the varicose and enlarged venous plexus localized in the anorectum. Not only are there a large number of highly tortuous and dilated veins within the hemorrhoid tissue, but also the interstitial tissue within the hemorrhoid is edematous with inflammatory cell infiltration and thrombus formation within some of the vessels. Hemorrhoids are divided into internal, external and mixed hemorrhoids using the dentate line as a boundary. The dentate line is the junction line between the anus and the rectum, about 3 to 4 cm from the edge of the anus, and is shaped like a serration. Those that occur on the dentate line are called internal hemorrhoids, those that occur below the dentate line are called external hemorrhoids, and those that span above and below the dentate line are called mixed hemorrhoids. The external hemorrhoids are divided into connective tissue external hemorrhoids, varicose veins external hemorrhoids, inflammatory external hemorrhoids and thrombosed external hemorrhoids depending on their nature. 1.How do I know I have hemorrhoids? The most common manifestations of having hemorrhoids are blood coming out of the anus or spraying out of the anus during stool, soft swelling coming out of the anus in severe cases, anal dampness or itching, or painful swelling outside the anus. The main manifestation of early internal hemorrhoids is anal bleeding during stool, with more blood, bright red blood, sometimes dripping down, sometimes like arrow jets, without pain and other discomfort, with a certain periodicity. The bleeding for a long time can cause anemia, and the patient feels dizzy, short of breath, fatigue and poor spirit. When internal hemorrhoids develop to the middle stage, in addition to bleeding, the hemorrhoid nucleus will come out of the anus during stool, and the nucleus can return to the original position by itself after stool. In the advanced stage of internal hemorrhoid development, the hemorrhoid nucleus cannot come out of the anus after stool and cannot return to its original position by itself, and it needs to be pushed back by hand. In severe cases, coughing and walking can also cause the hemorrhoid nucleus to come out of the anus. The anus often feels moist and itchy due to increased secretions that irritate the anus. If the hemorrhoid nucleus is not sent back in time after prolapsing, it will swell up and become painful or even necrotic over time. External hemorrhoids will feel severe pain when they become inflamed or form a blood clot. 2.When is it necessary to treat hemorrhoids? A foreign scholar concluded in a symposium on hemorrhoids in 1980: “Do not treat symptoms without anal signs, and do not treat anal signs without symptoms”. Anal signs are local examination of the anus that reveals hemorrhoidal changes, and symptoms are blood in the stool, prolapse, anal dampness, anal itching and anal pain. This passage means that only symptoms and anal signs are available at the same time for treatment to be meaningful. It is generally believed that hemorrhoids only have local signs and do not require immediate treatment, but it is still very beneficial to treat them as early as possible when clinical symptoms appear. If the hemorrhoids bleed, untreated for a long time can lead to pernicious anemia, causing serious damage to the body; if the hemorrhoids are not treated in time, it is likely that the nucleus of the hemorrhoid will prolapse and become embedded and necrotic, causing not only severe pain, but also hemorrhage and sequelae after surgery. However, one thing must be corrected, some advertisements say that untreated hemorrhoids can cause or induce rectal cancer, this statement is wrong, rectal cancer is misdiagnosed as hemorrhoids cases exist, but there is no causal relationship, which is confusing the concept. 3.What are the methods of treating hemorrhoids and what are the advantages and disadvantages of each? There are many different types of hemorrhoid treatment methods, but they can be broadly categorized as drug therapy, surgical therapy and physical therapy. (1) Drug therapy: Mainly used for patients with mild hemorrhoids or heavier hemorrhoids that are not suitable for surgery, which can relieve symptoms and temporarily relieve pain. Patients who are often constipated can take laxative drugs such as hemp nut laxative pills, feng tong shen pills, laxative, liquid paraffin, or use lactulose and dulcimer to soften the stool, or use senna leaves, loquat leaves, almonds 3 grams each to make water for tea daily. If you have blood in your stool, you can take Chinese medicines such as Diyu Sophora Pills, Yunnan Baiyao or Lotus Leaf Pills; use Sophora flowers to make water for tea; use hemorrhoid plugs to take anal or use Jiuhua cream, Ma Yinglong musk hemorrhoid cream to apply externally. If the hemorrhoid is repeatedly prolapsing, fumigate it with a decoction of 10 grams of each of five times, alum, park salt and thorny mustard after the stool, and then gently send it back to the anus. If it is difficult to return it, you can first use paraffin oil or Jiuhua cream externally, and then slowly push and rub it back into the anus. Those who have prolapsed hemorrhoids can also take Tonic Chinese and Yi Qi Tang and Ten Perfect Great Tonic Pills together. If the hemorrhoid is inflamed and swollen, take Wu Wei Disinfectant Drink, Pain Relief as Shen Tang, and locally use Exorcism Soup or Pepper Salt Water for external washing. Take Dioscorea Infiltration and Dampness Soup for more secretions. In case of infection, take San Huang Liquid or use antibiotics. Take blood rich iron for anemia. Injectable therapy is a special type of drug therapy, which is a drug made into the injection directly into the hemorrhoid, or hardened and shrunken, or necrosis off to play the purpose of treatment. For simple mild to moderate internal hemorrhoids, the injection method can completely achieve a cure. The advantage is that it is less painful and shorter, but improper operation can cause bleeding or rectal stricture. Withered hemorrhoid therapy also belongs to the drug therapy, which is to make some corrosive drugs into nail agents, and insert these nail agents into the hemorrhoid nucleus to make it wither and fall off. For example, the medical work “Taiping Shenghui Fang” of the Song Dynasty recorded the use of arsenic and yellow wax mixed well and twisted into strips to treat hemorrhoids, which is this kind of therapy. This method was more commonly used clinically in China in the 1970s, but is now rarely used because of the tendency to cause local necrosis and infection and hemorrhage during the treatment. It is worth mentioning here that this method, which has been gradually phased out, is now made into a cream in some places to be applied externally and said to be painless and free of after-effects. In fact, after treatment with this method, a large number of patients experienced severe pain, local hemorrhage, anal skin defects and other adverse reactions. (2) Surgical treatment: It is the most dominant method used in clinical practice, and its principle is to remove the hemorrhoids directly by excision or ligation. The advantages are high precision and thoroughness, but the specific procedure and the clinical experience and proficiency of the operator will have a great impact on the results. Physical therapy is the use of sound, light, electricity, heat, magnetism and other physical effects, so that the local tissue protein coagulation, electrocoagulation hemostasis, electrocautery cutting, tissue degeneration, necrosis off atrophy to get the purpose of treating hemorrhoids. Now there are roughly liquid nitrogen freezing, laser, microwave, infrared coagulation, electronic (low frequency, high frequency, radio frequency, capacitive field, electric ion penetration, electric oscillation), etc. (3) Physical therapy: at most, it can only be used for mild hemorrhoids or as a supplement to surgical therapy, some of which are not only painful and complications exist but are greater than surgical methods, do not be confused by its “no hospitalization, no surgery” veneer, the machine is not a panacea.