1.What are hemorrhoids? Hemorrhoids have a long history, recorded in our Shanhaijing more than two thousand years ago, and there are two foreign names for them, from Greek and Latin, hemorrhoid [?hem?’r??d], and piles [pa?lz], both with different meanings, but both named by symptoms or signs. They mainly refer to the venous masses formed by stasis, enlargement and varicosity of the venous plexus under the mucosa of the lower rectum and the skin of the anal canal. 2.How many types of hemorrhoids are there? Hemorrhoids can be divided into internal, external and mixed hemorrhoids depending on where they occur. There is a serrated line that divides the rectal mucosa and skin about 3-4 cm from the edge of the anus, called the dentate line. If the hemorrhoid occurs above the dentate line and at the lower end of the rectum, it is called an internal hemorrhoid; if it occurs below the dentate line around the anal canal and the edge of the anus, it is called an external hemorrhoid; if it crosses the dentate line at the same place, it is called a mixed hemorrhoid. The internal hemorrhoids can be divided into four degrees according to the degree of severity: ◎ Degree I: bleeding with blood, dripping blood or spraying bleeding during the stool, bleeding can stop on its own after the stool, no hemorrhoid prolapse; ◎ Degree LI: frequent blood in the stool, the hemorrhoid nucleus prolapses during defecation, can be returned after the stool; ◎ Degree III: occasional blood in the stool, the hemorrhoid prolapses during defecation or long standing, coughing, exertion, weight bearing, and needs to be returned by hand; ◎ Degree IV: occasional blood in the stool, the hemorrhoid prolapses cannot be returned or is returned after the return ◎ Grade Ⅳ: Occasional bleeding in the stool, hemorrhoid prolapses and cannot be returned or prolapses again after return. The external hemorrhoids are divided into connective tissue external hemorrhoids, varicose veins external hemorrhoids, thrombotic external hemorrhoids, and inflammatory external hemorrhoids, the most common being thrombotic external hemorrhoids. Mixed hemorrhoids are both, and in one person, these types of hemorrhoids can occur singly or in many cases. 3.How do I know I have hemorrhoids? The main manifestation of having hemorrhoids is bleeding in the stool, dripping blood during defecation or blood-stained hand paper at the end of defecation, and if the bleeding is jet-like, then you can basically be sure that it is bleeding hemorrhoids. The blood is bright and periodic, and bleeding over time can cause anemia, dizziness, shortness of breath, fatigue, and poor mental health. In addition to bleeding, a soft swelling (hemorrhoid nucleus) can come out of the anus when you have a bowel movement, and this swelling can return to its original position after a bowel movement. If the swelling does not return to its original position after a bowel movement and needs to be pushed back by hand, or if it comes out even when coughing or walking, then it is very serious. Some people may also have symptoms such as anal dampness, itching and constipation. If there is a sudden swelling in the anus with severe pain, most are external hemorrhoids that are inflamed or form blood clots, or internal hemorrhoids that are prolapsed and embedded, but care should be taken to distinguish them from infectious diseases around the anorectum. 4.Why do nine out of ten people have hemorrhoids? Hemorrhoids are the most common disease in the anorectal department and can develop at any age, but the incidence gradually increases with age. In our country, there are “nine hemorrhoids in ten men” and “ten hemorrhoids in ten women”. In the United States, the incidence of hemorrhoids is about 5 percent. When hemorrhoids appear, two pathological changes must occur within them: dilated blood vessels and problems with the tissues that hold these vessels in place, such as aging, decreased elasticity or fracture. The degree of dilatation of the blood vessels determines the size of the hemorrhoid, and problems with the fixed tissues can lead to prolapse of the hemorrhoid. So any factor that can lead to changes in these two areas is the cause of hemorrhoids. First of all, there are three “peculiarities” of the anal area that eventually lead to a high incidence of hemorrhoids: (1) special vascular structure: the rectal venous plexus has no venous valves, and blood reflux power is reduced; the tissue of the submucosa of the rectum is loose, and the resistance around the wall of the hemorrhoid vessels is weak, so it is easy to expand when the internal pressure increases; the vessels cross the rich muscle groups of the perianal area, and reflux is easily obstructed. (2) Special location of the anus: Unlike reptiles, humans are in an upright position, and the anus is located in the lowermost part of the abdominal cavity, which is subject to the greatest effect of gravity and has a heavy blood reflux burden. (3) Special function of the anus: it undertakes the task of excreting feces and is subject to friction, extrusion and various bacterial stimuli every day, which can easily lead to prolapsed hemorrhoids and vascular inflammation. These factors constitute the basic conditions for the high incidence of hemorrhoids, and will develop once the external factors are sufficient. There are more factors in this area. (1) poor body position, high fatigue: sedentary, standing, squatting, walking. (2) poor dietary habits: over-eating fat, sweet, thick, spicy and stimulating products. (3) bad defecation habits: squatting too often, for too long. (4) abnormal stool: long diarrhea, long-term constipation. (5) disease: lower abdominal tumors, hypertension, cirrhosis of the liver, anorectal chronic inflammation. (6) Other: excessive impure sexual life, women’s pregnancy. These causes independently or combined cause disease, of which bad bowel habits and anal impurity is the most important. 5.How to identify bleeding hemorrhoids? A medical expert who has been seeing people all his life said sadly when he was diagnosed with advanced rectal cancer: “If I had paid attention to blood in the stool, I wouldn’t be like this”. In fact, two years ago when he first developed blood in his stool, if he had not been treated for hemorrhoids, but had been examined and operated on in time, he could have had a better outcome. In fact, not only this medical expert, there are many clinical lessons like this, many people think that blood in the stool is just hemorrhoids, tolerate or use some medicine will be over, there is no need to go to the “big fight”. Blood in the stool is a sign of no less than dozens of anal and digestive tract diseases, and we can make a self-judgment based on a comprehensive analysis of the manner, amount, color and accompanying symptoms of blood in the stool. Hemorrhoids are the most common cause of blood in the stool, which occurs during or after defecation, with bright red blood, blood and feces do not mix, in the form of drops and drops, but also jets, bleeding can be large or small, after the stool since the stop, some also show a certain periodicity. Some patients have small lumps protruding outward from the anus when they struggle to defecate, but there is no anal pain. Anal fissures can also produce bright red blood, dripping or wiping blood on hand paper, but unlike hemorrhoids, they often have severe anal pain after defecation. Among intestinal tumors, rectal cancer is the most similar to hemorrhoid bleeding due to its lower location. Blood in the stool is bright red and attaches to the surface of the stool in the form of drops, but most of it is mixed with mucus and dark blood clots in the blood or in the stool, and is accompanied by bad odor and is persistent. In the advanced stage, it is accompanied by anorectal cramping and generalized wasting, increased frequency of stool, and alternating constipation and diarrhea, which can be initially distinguished from hemorrhoids. Rectal polyps and blood in the stool in children are mostly caused by this disease. The blood in the stool caused by polyps is bright red, painless and small in amount. Some patients have grooves on the surface of the stool, and polyps can grow to a certain length and come out of the anus with the stool. Ulcerative colitis, dysentery and other diseases can also cause blood in the stool. Blood in the stool caused by these inflammatory diseases of the large intestine is usually mixed with mucus or pus and blood, accompanied by lower abdominal pain, fever, frequent stools and urgency and other symptoms, which are common in adults. In addition, some rare diseases such as intestinal typhoid fever, intestinal tuberculosis, and intussusception may also cause blood in the stool. Systemic diseases such as leukemia, aplastic anemia, primary thrombocytopenic purpura, hemophilia, disorders of coagulation mechanisms, collagen disease, uremia, and certain rare infectious diseases such as plague and typhus can present with blood in the stool. However, in these diseases, blood in the stool is only part of the systemic bleeding, and blood in the stool is accompanied by bleeding from other parts of the body, so it is not difficult to identify. 6.Can hemorrhoids be cured? Many hemorrhoid patients always ask before receiving treatment, “Will it recur later?” The actual fact is that some doctors will always say, “No, it will be cured at once” in order to keep the patient. Is there such a once and for all method? The hemorrhoid is actually a local expansion and displacement of blood vessels in the anorectum, and as long as the cause of this change still exists, it will inevitably regenerate, and surgery and other methods to solve only the lesions that have occurred, but not to eliminate the cause of the disease, so it can be cured, but it is difficult to cure and ensure that it never regenerates in the future. Some patients choose not to treat the disease when they hear that it cannot be cured, which is also wrong. Here we do not use the word “recurrence” but “regeneration”. First of all, the incidence of regeneration is very low, and even if regeneration occurs, it will take a long period of time. Secondly, regeneration is not the fault of surgical treatment, and to give up treatment because of this is actually choking. The scientific attitude is to solve the problem in time, and then develop good habits and learn preventive measures so that it will be truly eradicated. 7.What non-surgical treatments are available for hemorrhoids? There is a wide range of non-surgical methods, which can be divided into three main categories: general medications, pharmaceutical interventions and physical methods. These methods can relieve or eliminate symptoms within a certain range, and some can even serve the purpose of cure. Also, pay attention to your diet, avoid alcohol and spicy stimulating foods, increase fibrous foods, consume more fruits and vegetables, drink more water, change bad bowel habits, keep your bowels open, take laxatives if necessary, and wash your anus after defecation. For prolapsed hemorrhoids, pay attention to gently holding the hemorrhoid back with your hand to stop it from prolapsing again. Avoid sitting for long periods of time, take proper exercise, and take a sitz bath with warm water (can contain potassium permanganate) before going to bed. 8.What surgical treatments are available for hemorrhoids? Many patients are “scared of surgery” and instinctively fear surgery when they hear about it, but there is no need to be. For really serious patients, surgery is a hurdle that cannot be bypassed. Surgery is currently the main and most reliable clinical method, and the vast majority of patients ultimately rely on surgery to obtain a cure. The principle of surgical treatment is to remove the hemorrhoid by removing it with a scalpel or by ligating the lesion with a wire, and can be applied to all kinds of hemorrhoids. The final outcome of surgery depends on the specific procedure and the clinical experience and proficiency of the surgeon. The most commonly used clinical procedures are external hemorrhoidectomy, external hemorrhoid dissection, internal hemorrhoid ligation and mixed hemorrhoid external peeling and internal ligation, etc. The indications and operating techniques should be mastered when applying them. 9.What is suprahemorrhoidal mucosal circumcision (PPH)? The surgical principle of supra-hemorrhoid mucosal circumcision is to remove the rectal mucosal tissue above the hemorrhoid area in a circular fashion and use the anastomosis to anastomose the rectal mucosa so that the slippery anal cushion can be suspended upward and return to its normal anatomical position. At the same time, the blood flow is reduced by cutting off the branches of the artery, causing the hemorrhoid nucleus to gradually shrink. Compared with traditional hemorrhoidectomy, the operation time is short, postoperative pain is light, recovery is fast, and complications are few, but the price of instruments is more expensive. 10.What are the current misconceptions about hemorrhoids? The answer is undoubtedly no, hemorrhoids are hemorrhoids can never become cancerous, just like a mule can’t become a horse. This misconception appears one is that some medical advertisements are misleading and intimidate you to accept their treatment. The second is that hemorrhoids are really easy to confuse with rectal cancer, treating bleeding rectal cancer as bleeding hemorrhoids, and when you find out it is rectal cancer, you still think it’s hemorrhoids that have changed. Although hemorrhoids are not cancerous, the occurrence of blood in the stool must not be taken lightly, and timely examination to clarify the cause is the most important. The second misconception is that bleeding hemorrhoids are trivial. Bleeding hemorrhoids should never be underestimated, and if a person has bleeding hemorrhoids for more than 10 days, he may become anemic, and once anemia occurs, it takes months to recover on its own. The main reason why many hemorrhoid patients are afraid to go into the hospital is because they are afraid of pain, and even on the internet some people say that hemorrhoid surgery is the first pain in the world, which is of course alarming. This misconception arises on the one hand because some old, outdated treatment methods are really damaging and painful. On the other hand, some medical advertisements deliberately amplify the pain of surgery in order to advertise their treatments, using surgery as a comparison. But in recent years, with the continuous improvement of treatment methods and the application of many new analgesic methods, hemorrhoid surgery to achieve basic pain-free has become a reality. Myth #4: Painless treatment by applying medicine The medicine applied here is not the usual hemorrhoid medicine, but a drug that can make the hemorrhoids fall off. Some advertisements say this is an advanced method that can be used painlessly instead of surgery. Usually, people are afraid when they hear about surgery, and now it is said that applying the medicine will do, which caters to the psychology of many hemorrhoid patients, many of whom try the medicine on their own, and what is the result? Scam. The method of using medicine to make hemorrhoids fall off can be traced back to the Chinese medicine withered hemorrhoid therapy that was popular in the 1950s and 1960s. This method is a corrosive medicine made into a nail agent that is inserted into the hemorrhoid when used to make it necrotic and fall off, which was mainly used for internal hemorrhoids at the time, and has been slowly eliminated in the clinic due to more complications such as infection and bleeding. The principle of applying medicine for hemorrhoids is also withering hemorrhoids, and the purpose of getting rid of them is achieved through the corrosive effect of the medicine. In fact, the method is not painless nor safe, the erosion and ulceration process will continue to be painful locally, and at the same time, due to the poor positioning of the coating, often the hemorrhoids and the surrounding normal skin together with ulceration, resulting in anal skin defects and anal stenosis. Many experts call for the clinical should be eliminated this method as soon as possible. The new terms for the treatment of hemorrhoids have been appearing in recent years, such as laser, infrared, microwave, Doppler, copper ion and so on, some of which are also titled Korea, Japan, the United States and so on, seemingly not to cure the disease, but to fight a United Nations high-tech war against hemorrhoids. In fact, these so-called “high-tech” is not as magical as advertised, glorifying a method and an instrument of advertising, to be viewed with caution, never blindly follow.