I. Overview Mixed hemorrhoids. The varicose and enlarged internal and external venous plexus of hemorrhoids, which communicate and anastomose with each other, and the disappearance of the sphincter sulcus, so that the internal and external parts of hemorrhoids form a whole are called mixed hemorrhoids. The cause of hemorrhoids is the absence of venous valves in the rectal veins and the thin walls of the upper and lower rectal plexus. The formation of hemorrhoids is accelerated by prolonged sitting and prolonged bowel movements. The direct causes are: 1. habitual constipation and bad bowel habits 2. increased intra-abdominal pressure 3. chronic inflammation of the lower rectum and anal canal 4. long-term alcohol consumption and irritating diet 5. chronic prostatitis and chronic pelvic inflammatory disease 6. cirrhosis of the liver. Clinical manifestations 1. Blood in stool: painless, intermittent, bright red blood after stool is the typical clinical manifestation of mixed hemorrhoids, and also the clinical manifestation of internal hemorrhoids or early common mixed hemorrhoids. The blood in the stool is mostly caused by the feces rubbing the mucous membrane or fecal force, causing the dilated blood vessels to rupture and bleed. The clinical manifestation of mixed hemorrhoids in the lighter cases is mostly blood on the large case or stool paper, followed by dripping blood, while in the heavier cases the clinical manifestation of mixed hemorrhoids is jet-like bleeding, which can often stop on its own after a few days of bleeding in the stool. This is important for diagnosis. Constipation, dry and hard stools, drinking alcohol and eating irritating food are all triggers for bleeding. If the bleeding is repeated over a long period of time, anemia may develop, which is not uncommon in clinical practice. However, you need to see a professional doctor to perform anal finger diagnosis and electronic colonoscopy to exclude colorectal malignancy. 2.Pain: Simple internal hemorrhoids are painless, a few have a feeling of swelling, when internal hemorrhoids or mixed hemorrhoids are prolapsed and embedded, edema, infection, necrosis, the pain is severe, which is a common clinical manifestation of mixed hemorrhoids. 3, itching: internal hemorrhoids, hemorrhoid block prolapse and anal canal sphincter relaxation, there is often secretion outflow, due to secretion stimulation, there is often itching discomfort around the anus, and even skin eczema, the patient is often unbearable to this clinical manifestation of mixed hemorrhoids. 4.Prolapse of hemorrhoid block: It is often the clinical manifestation of late mixed hemorrhoids, mostly with blood in the stool followed by prolapse, because the hemorrhoid body increases in late stage, gradually separates from the muscle layer and is pushed out of the anus when defecating. In the lighter cases, the hemorrhoid prolapses only during stool and can return on its own after stool, while in the heavier cases, it needs to be pushed back by hand, and in the more serious cases, the hemorrhoid can come out of the anus with a little abdominal pressure, such as coughing, walking, etc. When the abdominal pressure increases slightly, the hemorrhoid can come out and it is difficult to return and cannot participate in labor. A few patients complained that prolapse is the first clinical manifestation of mixed hemorrhoids. Auxiliary examination 1.Anal finger diagnosis, anal visual examination 2.Electron colonoscopy V. Treatment principles (a) Non-surgical treatment 1.Change the diet structure, drink more water, diet with meat and vegetables, avoid alcohol and spicy stimulating food, keep the bowels open. 2. Sitting bath with warm and cool water can improve local blood circulation. Avoid hot water. 3.Thrombosed hemorrhoids can be treated with local Chinese medicine and topical anti-inflammatory and pain-relieving drugs, and the pain can sometimes be relieved by itself. If the pain cannot be relieved, or if the anal skin is broken, surgery is often required. 4.If the internal hemorrhoid is prolapsed, it needs to be reset immediately by hand, and if the internal hemorrhoid is embedded, the nucleus should be returned by hand as soon as possible. Surgery is also recommended. 5.Injecting drugs and suppositories into the anal canal can relieve the symptoms. Surgical treatment, there are internal hemorrhoid ligation, internal hemorrhoid injection, hemorrhoidectomy, thrombosed external hemorrhoid stripping, anal skin grafting, PPH surgery (suprahemorrhoidal mucosal circumferential anastomosis). (ii) Surgical treatment: It is mainly applied to those with long duration of disease, severe bleeding, prolapsed hemorrhoids, mixed hemorrhoids and non-surgical treatment including external hemorrhoid thrombosis or hematoma that is ineffective. For surgical treatment, there are internal hemorrhoid ligation, internal hemorrhoid injection, hemorrhoidectomy, thrombosed external hemorrhoid stripping, anal skin grafting, PPH surgery (suprahemorrhoidal mucosal circumferential anastomosis).