The incidence of hemorrhoids is relatively high, as the saying goes, “nine hemorrhoids in ten people” and “ten hemorrhoids in ten women”. According to the 1975-1977 census of 769,692 people in China, anorectal diseases accounted for 59.1%, and hemorrhoids accounted for 87.25% of all anorectal diseases, of which internal hemorrhoids were the most, accounting for 53.9% of all anorectal diseases. The incidence of hemorrhoids in foreign surveys is also 60% to 70%. Hemorrhoids can develop at any age, and the incidence gradually increases with age. We who have hemorrhoids often have the question: Do they all need surgery? What kind of hemorrhoids require surgery? Well, let’s first understand what hemorrhoids are. We clinically classify hemorrhoids into three categories, namely internal, external and mixed hemorrhoids, depending on where they occur. The current more authoritative definition of hemorrhoids is that internal hemorrhoids are masses formed by pathological hypertrophy or displacement of the supporting structures of the vascular lining of the anal canal, the vascular plexus and the anastomotic branches of the arteries. External hemorrhoids are masses formed by pathological dilatation, thrombosis or tissue hyperplasia of the subcutaneous vascular plexus distal to the dentate line of the anal canal. The clinical symptoms of internal hemorrhoids are mainly blood in the stool, blood in the stool paper, blood dripping from the anus, linear or jet bleeding, bright red, or prolapse of the hemorrhoid body during defecation, coughing or weight-bearing, which can be repositioned by itself after stool in mild cases, or need to be returned by hand pressure in severe cases. The clinical symptoms of external hemorrhoids are mainly anal foreign body sensation, anal discomfort or anal dampness, itching discomfort, etc. Anal pain can occur when there is thrombosis or inflammation. The first thing you need to do is to find out what hemorrhoids are, what are the ways to treat them, and what kind of hemorrhoids need surgery? The principles of hemorrhoid treatment: asymptomatic hemorrhoids are not treated, and only symptomatic hemorrhoids need to be treated. The purpose of treatment is to reduce and eliminate the main symptoms, not to cure them. It makes more sense to relieve the symptoms of hemorrhoids than to change the size of the hemorrhoids. There is no cure for hemorrhoids, but timely treatment is necessary. Treatment of hemorrhoids is divided into general treatment, medication and surgery. General treatment, which is the basis of various therapies, is effective for all types of hemorrhoids. There are three main points: one is to improve the diet, eat more vegetables and fruits, avoid eating chili, mustard, etc., and prohibit drinking alcohol. The second is to keep the bowels open, to develop the habit of regular bowel movements, do not hold the stool, avoid doing other things when defecating, such as playing with cell phones, reading newspapers, etc., after the stool warm water bath dry, keep the anus clean, the stool paper should be soft. The third is to have a regular life, work and rest, should not stand for a long time or sit for a long distance. The treatment can be Chinese and Western medicine, for early internal hemorrhoids, external hemorrhoids and mixed hemorrhoids have certain effect, through internal and external use, can achieve to relieve and relieve the symptoms, delay the development of hemorrhoids role. For the surgical treatment of hemorrhoids, there is a classic saying in the anorectal department, “Do not treat the signs without the symptoms, do not treat the symptoms without the signs”. If there is no blood in the stool, prolapse, or anal discomfort, surgery is generally not needed. Because surgery would be traumatic, destroying the local anal cushion and affecting the closure function, a slight inadvertence could lead to some degree of anal incontinence. For early Ⅰ and Ⅱ degree internal hemorrhoids, conservative treatment can be considered when the amount of blood in the stool is small. If the amount of blood in the stool is large or if conservative treatment is ineffective, internal hemorrhoid injection or internal hemorrhoid ligation is recommended for treatment. For internal hemorrhoids of grade III and IV, surgical treatment is recommended, and surgical methods such as internal hemorrhoid ligation, PPH or TST surgery can be considered. For external hemorrhoids, if the symptoms are mild, conservative treatment can be given for the time being, and if conservative treatment is not effective, surgery is feasible; for thrombosed external hemorrhoids, anal pain is usually severe, and early surgery can quickly and effectively relieve anal pain, so early surgery is recommended. Mixed hemorrhoids are the fusion of internal hemorrhoids through the rich anastomosing branches of the venous plexus and the corresponding parts of the external hemorrhoids. There are predominantly internal hemorrhoids, external hemorrhoids, or both internal and external hemorrhoids. There are single and multiple hemorrhoids, as well as those that are raised in a circular pattern around the anus for a week. In the case of mixed hemorrhoids, the internal and external hemorrhoids are fused together, so it is difficult for the internal and external drug treatment to work, so surgery should be performed. In the case of single or multiple hemorrhoids, external peeling and internal ligation, external excision combined with internal hemorrhoid ligation, etc. Circumferential mixed hemorrhoids are more likely to be treated with external peeling and internal ligation or circumferential hemorrhoid segmental ligation, PPH surgery, etc. There are many treatment methods for hemorrhoids, depending on the type and degree of treatment. In conclusion, if you don’t have symptoms, try not to have surgery, but if you do have symptoms, you should either use conservative treatment or surgery, which also depends on the type and severity of the hemorrhoid.