According to the different parts of the onset of hemorrhoids, hemorrhoids can be divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids. (A) internal hemorrhoids occur above the anal canal tooth line, the end of the rectum under the mucosa of the hemorrhoidal venous plexus enlargement, varicose soft vein mass formed, known as internal hemorrhoids. Also known as “in the hemorrhoid”. Internal hemorrhoids are the most common disease in anorectal diseases, occurring in the truncus position of 3, 7, 11 points. Its clinical features are blood in the stool, hemorrhoidal prolapse, anal discomfort. Mostly occur in adults, infants and young children rare. 1, clinical manifestations (1) Symptoms ① blood in stool is the most common symptom of this disease, mostly in defecation, blood stained paper, or even drip bleeding or jets of blood, blood and stool do not mix, bright red color, mostly painless, intermittent episodes, often due to alcohol, fatigue, constipation, diarrhea and other triggers to aggravate the symptoms. ② prolapse With the prolongation of the disease, the hemorrhoidal nucleus will gradually increase in size, can be detached from the anus during defecation, the color of the prolapse of bright red or gray, if not timely retraction, the local swelling can be exacerbated. Itchy Hemorrhoids repeatedly prolapse, anal sphincter relaxation, secretions often overflow outside the anus, so the anus feels moist; secretions long-term stimulation of the perianal skin, easy to cause perianal eczema, itching discomfort. Pain The prolapsed internal hemorrhoids become embedded, causing edema, thrombosis, erosion and necrosis, which may cause severe pain. ⑤ constipation, often due to the fear of bleeding, artificially control defecation, causing changes in defecation habits, or resulting in habitual constipation; long-term constipation or fecal dryness, easy to bruise the hemorrhoidal nucleus surface mucosa, triggering internal hemorrhoidal bleeding, and the two cause and effect each other, resulting in the aggravation of the condition. If there is a long time, a large amount of bleeding, and not correct, timely and effective treatment, often can cause blood loss anemia, dizziness, fatigue, pallor and other symptoms. Anal hemorrhoid nucleus prolapse, such as can not timely self or manipulation reset, easy to lead to the prolapse of swelling, pain intensification, the occurrence of incarceration, or even thrombosis or edema, often friction stimulation, can cause local breakage, vesiculation, oozing taste and smell, and so on. (2) physical signs ① local visual diagnosis can be seen above the dentate line of the mucosa congestion, edema, ulceration and bleeding points, individual visible thrombosis, and even erosion, necrosis. ② rectal examination early internal hemorrhoids due to soft hemorrhoidal nuclei, do rectal examination is generally not easy to touch, such as hemorrhoidal nuclei repeatedly prolapse, its surface fibrosis, can be touched to the lump bulging. 2, other auxiliary examination ① anoscopy usually in the anus visual diagnosis, rectal fingerprinting, focusing on the observation of internal hemorrhoids, size, number, color, ulceration and bleeding points and so on. Inspection should follow the rules, one by one, can not be missed, after the inspection is completed timely record. ② endoscopic examination for anoscopy is not satisfactory, can not be clearly diagnosed, endoscopy can be used, the current commonly used fiber colonoscopy and electronic enteroscopy. If it is necessary to perform surgery and other special treatments, blood routine, urine routine, liver and kidney function, coagulation time, prothrombin time, electrocardiogram and X-ray chest X-ray and other tests should be carried out. 3.Disease staging I degree of internal hemorrhoids, with blood, dripping blood, or jet-like bleeding, no internal hemorrhoid prolapse, bleeding can be stopped on its own after bowel movement. The second degree of internal hemorrhoids, with blood in the stool, drip blood or jet-like bleeding, accompanied by internal hemorrhoid prolapse, can be self-contained after bowel movement. Ⅲ degree internal hemorrhoid Blood in stool, dripping blood, accompanied by prolapse of internal hemorrhoid or prolapse of internal hemorrhoid when standing for a long period of time, coughing, straining, weight bearing, and must be retrieved by hand. Ⅳdegree internal hemorrhoid internal hemorrhoid prolapse can not be retracted, internal hemorrhoid can be accompanied by strangulation, embedded. (ii) external hemorrhoids external hemorrhoids refers to the anal canal below the dentate line, by the hemorrhoidal venous plexus expanding varicose or hemorrhoidal venous rupture or repeated inflammation of fibrous hyperplasia and become the disease. Can occur at any age, its clinical characteristics are conscious anal swelling, pain, foreign body sensation. Because of the clinical symptoms, pathological characteristics and different processes, can be divided into connective tissue external hemorrhoids, varicose external hemorrhoids, inflammatory external hemorrhoids and thrombosed external hemorrhoids. 1.Inflammatory external hemorrhoids Mostly see the anal margin skin broken or infected, red, swollen or broken into pus, pain obvious. 2.Thrombosed external hemorrhoids occur in the anal margin outside the truncated stone position 3, 9 points, to middle-aged men mostly. The anal margin of the subcutaneous sudden greenish-purple mass, local skin edema, the mass is still soft at first, the pain is intense, gradually become hard, mobility is good, can be moved, clear demarcation, tenderness is obvious. 3, varicose external hemorrhoids, when defecating or squatting for a long time, there is a soft greenish-purple lump under the skin of the anal verge, which can be accompanied by a feeling of swelling, and the lump can be disappeared after pressing. 4, connective tissue external hemorrhoids anal edge at the superfluous skin flap, gradually increase, soft texture, generally painless, no bleeding, only feel the anus has a foreign body sensation, occasional dyeing and swelling, only feel the pain, swelling disappeared, the superfluous skin still exists. (C) “internal and external” mixed hemorrhoids Mixed hemorrhoids refers to the internal and external hemorrhoids venous plexus varicose, communicating with each other anastomosis, so that the internal hemorrhoids and external hemorrhoids part of the formation of a whole person. Most of them occur in the anal truncation position 3, 7, 11 points at the place, to 11 points more common. Both internal hemorrhoids, external hemorrhoids dual performance. The clinical manifestation of this disease is in the anal canal above and below the dentate line in the same direction, there is no obvious demarcation, see internal hemorrhoids, external hemorrhoids of the content.