Disease description: Hemorrhoids are a common disease of the anal canal that often recurs, heals spontaneously, or may have chronic symptoms and occasional acute attacks. The general population is susceptible to the disease. The incidence of hemorrhoids is higher in women of childbearing age, especially during pregnancy, and pregnancy and childbirth are the main causes of hemorrhoids in young women. Hormone levels, venous congestion, and increased pelvic floor pressure during pregnancy all contribute to the development of hemorrhoids, and they can be exacerbated by the constipation that often accompanies pregnancy and the increased pressure of pregnancy and childbirth. After childbirth, hemorrhoids can gradually improve, so there is no need to rush surgical treatment for hemorrhoids during pregnancy. Causes: The physiological functions of the colorectum change during pregnancy, but these changes are usually mild and do not affect the pregnant woman significantly. Constipation is a common problem during pregnancy, and if there is a history of constipation, it tends to worsen during pregnancy. The main causes of constipation are mechanical obstruction from compression of the lower gastrointestinal tract by the uterus; weakened smooth muscle activity of the colon, prolonged transmission time and increased water absorption. Whether changes in hormone levels are an important cause of constipation during pregnancy has been debated. In adults aged 15-50 years, constipation often occurs in women. Women also frequently reflect changes in bowel function during different phases of the menstrual cycle. However, under normal physiological conditions, sex hormones do not have a major impact on bowel function. In contrast, during pregnancy they can cause changes in bowel function and produce intestinal symptoms. During pregnancy, changes in hormone levels are accompanied by significant increases in the levels of estrogen and progesterone receptors in different parts of the body. During pregnancy hormonal modifications are accompanied by a significant increase in estrogen and progesterone receptor levels in different parts of the body. The increase in progesterone receptor levels in the colorectum leads to a slowing down of their normal transmission function. Etiologically, both mechanical factors and hormone levels play a role. The enlarged uterus of pregnancy directly compresses the portal vein, inferior vena cava, and superior rectal vein, leading to stasis and dilation of the geniculate branches. At the same time, the enlarged uterus causes a gradual rise in abdominal pressure. Due to the mechanical compression of pregnancy, venous return is obstructed and the internal sphincter develops an arteriovenous short-circuit opening. The circulating blood volume increases by 25-40%, leading to venous dilatation and stasis. In addition lower limb and pelvic venous reflux is obstructed during pregnancy and venous pressure increases. These changes also lead to increased stasis in the hemorrhoidal venous plexus due to the weakness of the hemorrhoidal supporting tissue and can cause recurrence or exacerbation of hemorrhoid disease. The process of vaginal delivery will have a dramatic effect on the colorectal system, and even a very smooth delivery will inevitably damage the neuromuscular structures of the anal sphincter. If forceps are used, the damage is even greater. Treatment: 1. Measures to prevent constipation should be taken throughout pregnancy and constipation should be treated. Most patients can improve constipation with dietary modifications and laxatives. (1) Dietary modification Dietary factors play an important role in preventing and reducing changes in bowel function during pregnancy. A randomized, controlled, double-blind study showed that pregnant women with constipation, compared with non-constipated women, drank less water in the first trimester, ate more in the middle trimester, and consumed less iron and ate less in the second trimester. Iron supplements are often thought to cause gastrointestinal discomfort symptoms during pregnancy, including constipation. To assess the adverse effects of iron supplementation during pregnancy, another randomized controlled double-blind trial was structured to show no significant gastrointestinal side effects with ferrous fumarate 20-80 mg taken between meals, so there is no need to be overly concerned about the side effects of iron supplementation during pregnancy. It is well established that increased water and fiber intake can improve constipation. Either ingestion of pure water or isotonic isotonic fluid is fine, and there is no significant difference in the changes to the bowel between the two. Daily consumption of fiber-rich foods such as fruits, fresh vegetables, and whole wheat bread with bran is also recommended. (2) Laxatives The use of medication to treat constipation during pregnancy must be weighed against its advantages and disadvantages. If laxatives must be used, volumetric laxatives should be the first line of treatment: they have a “sponge” effect, retaining water in the stool and therefore softening it and increasing its volume. Stimulant laxatives (plant extracts such as rhubarb, senna, aloe vera; glycerin enemas) have an irritating effect on the colorectal mucosa, stimulating peristalsis and causing colorectal inflammation when abused. Therefore, it is only applied for a short period of time to patients whose diets have been changed and whose dietary fiber fillers are ineffective. 2.Surgery Asymptomatic hemorrhoids during pregnancy do not require treatment, hemorrhoids with bleeding and/or pain affecting the patient’s daily life require treatment. The main measures are conservative treatments: e.g. dietary changes, laxatives or topical treatments. Surgical treatment is postponed to the postpartum period as much as possible. If conservative treatment is not effective, less damaging interventions such as injection of sclerosing agents (5% phenol lentil oil), adhesive ring ligation treatment, infrared coagulation treatment, etc. can be considered. When there are serious complications of hemorrhoids: acute thrombosis, prolapsed internal hemorrhoids strangulation/embolism, severe pain, etc., although in this case the surgical treatment room is the most effective means of treatment. However, there is no obvious answer to the question of how to manage it during pregnancy. If surgery is required for hemorrhoids, try to perform it after delivery. The use of aggressive surgical treatment of hemorrhoids with complications such as combined thrombosis and hematoma should be limited as much as possible. Even in severe cases, surgery needs to be done with caution. If surgery must be taken, the recommended surgical position: the left lateral position is required in the last trimester of pregnancy, the prone folded position in other periods, and the surgery should be performed under local anesthesia.