1.What are hemorrhoids? During the Warring States period, Zhuangzi was disgusted with the Song ambassador Cao Shang’s mission to Qin to curry favor with the king and mocked him, saying, “When the king of Qin has an illness and is seeking medical help, he can get a car if he can break the pus and break the acne; he can get a car if he can lick the hemorrhoids with his mouth. The more you can heal, the more chariots you can get. You got a lot of money, but did you lick the hemorrhoids for the king of Qin?” This shows that people had already known about hemorrhoids in that period. Hemorrhoids are also called hemorrhoids, and the professional name is hemorrhoids. Let’s look at the origin and meaning of the word “hemorrhoid”. The earliest prototype can be found in the oracle bones 3000 years ago, and in the Spring and Autumn period some medical books appeared without the sickness character “temple” and “chi” to describe the disease, and only in the late Warring States period did the “52 Disease Formula” really appear. It was not until the late Warring States period that the current word “hemorrhoid” appeared in the “Fifty-two Diseases Formula”. The Ming Dynasty’s “Medical Compendium” explains the meaning of this word by saying, “There are small mountains protruding from a large swamp that are called hemorrhoids, and where there is small flesh protruding from the nine orifices of a person, they are called hemorrhoids.” , so in ancient China, the most significant understanding of hemorrhoids was a class of diseases characterized by a localized protrusion from the anus. There are two English words for hemorrhoids, one comes from the ancient Greek word Hemorrhoids, which means bleeding or hemorrhage. The other is from the Latin word pile, which means bulbous or protruding. The two words describe the symptom and the shape, respectively. So is this localized “bulge” in the anus necessarily a hemorrhoid condition? No. Why did the ancient Chinese 2500 years ago use the words “temple” and “chi” without the sickness side? In 1975, the American scholar Thomson found sponge-like protrusions in the lower rectum of 42 normal people, arranged in 3, 7 and 11. He believed that this tissue was not only not a disease, but could also act as a cushion to help the anus close tightly, so he named it the “anal cushion”. So what exactly are hemorrhoids? Traditional textbooks say that “hemorrhoids are elevated tissues formed by tortuous dilatation of the veins of the anal verge, anal canal and lower rectum”, a definition that clearly defines the site and nature of the disease. However, since the emergence of Thomson’s “anal cushion” theory, this definition has been overturned and has been revised by professional books and industry organizations, such as “abnormal anal cushion tissue with symptoms is called hemorrhoids”, “hemorrhoids is a pathological hypertrophy, displacement of the anal cushion and stagnation of blood flow in the perianal subcutaneous vascular plexus”, “internal hemorrhoids are pathologically dilated or proliferating elevated tissue of the vascular cushion under the rectal mucosa above the dentate line of the anal canal”. Our research confirms four pathological changes in hemorrhoids, namely, venous vascular manifest dilatation, intravascular or thrombosis, tissue edema and inflammation. From these new definitions we can easily see that the anal cushion formed by the general elevation of the lower rectum and the local anus is not a disease and not a hemorrhoid, but only when the cushion is excessively elevated, pathologically hypertrophied, displaced or accompanied by the emission of blood is it a disease and called hemorrhoid. 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 to 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. Internal hemorrhoids can be divided into three stages according to their severity. Stage I: blood in the bowel movement, no prolapse, nodular elevation of the mucosa on the dentate line. Stage 2: Blood in the bowel movement, dripping or shooting blood, prolapsed internal hemorrhoid, which can be retracted by itself. Stage III: Internal hemorrhoids prolapse during defecation or when the abdominal pressure increases due to coughing, exertion or weight bearing. External hemorrhoids are further divided into connective tissue external hemorrhoids, varicose veins external hemorrhoids, inflammatory external hemorrhoids and thrombosed external hemorrhoids depending on their nature. These types of hemorrhoids can occur singly or more often in a person. 3.How do I know I have hemorrhoids? The most important 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 are there nine hemorrhoids in ten people? Although “nine out of ten hemorrhoids” is somewhat exaggerated, the high incidence of hemorrhoids is recognized, so why is the human body so susceptible to hemorrhoids? It is generally believed to be the result of a combination of internal and external factors. When hemorrhoids appear, there are two types of pathological changes that must occur within them: dilated blood vessels, and problems with the tissues that hold these vessels in place, such as aging, decreased elasticity, or fractures. 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 is reduced; the tissue of the submucosa of the rectum is loose, and the resistance around the walls 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 hemorrhoid nuclei 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. (1) General drug therapy: Through the internal and external use of drugs for symptomatic treatment, it can temporarily relieve symptoms and reduce pain. It is mainly used for patients with mild hemorrhoids or more severe hemorrhoids that are not suitable for surgery. For those who have frequent blood in the stool, you can take Chinese medicines such as Diyu Sophora Pills, Yunnan Baiyao or Lotus Leaf Pills; use Sophora flowers in water as a tea substitute; use Taining pessary, Puji hemorrhoid plugs, etc. for anal or use Jiuhua cream, Ma Yinglong musk hemorrhoid cream for external application as well. The most important thing is that you should take a lot of blood in your stool, and you should take a lot of iron in your blood. For repeated prolapse of hemorrhoids, fumigate with a decoction of 10 grams each of pentaphyllum, alum, park salt and thorny mustard after defecation, and then gently return it to the anus. If it is difficult to return it, you can first use paraffin oil or Jiuhua paste externally, then slowly push and rub to send it back to the anus. Those who have prolapsed hemorrhoids can also take Tonic Chinese and Yi Qi Tang and Ten Perfect Great Tonic Pills together. If the hemorrhoid is inflamed and swollen, take Wu Wei Disinfectant Drink, Pain Relief as Shen Tang, and locally use Exorcism Soup or Pepper Salt Water for external washing. Take Dioscorea Infiltration and Dampness Soup for more secretions. In case of infection, take San Huang Liquid or use antibiotics. Patients with frequent constipation can take laxative and laxative drugs such as Ma Ren Lun Gao Wan, Fang Feng Tong Sheng Wan, Laxative, Liquid Paraffin, or use lactulose and Dou Mei Ke to soften the stool, or use senna leaf, loquat leaf, almond 3 grams each to make water for tea daily. (2) Drug intervention therapy: Injecting or inserting drugs into the hemorrhoids to make them shrink or fall off can have a curative effect. It is mainly suitable for mild to moderate internal hemorrhoids. Withered hemorrhoid therapy: Some corrosive drugs are made into nail agents, and these nail agents are inserted into the hemorrhoid nucleus to make it wither and fall off. This method was more commonly used clinically in China in the 1970s, but is rarely used now because of the tendency to cause local necrotic infection and hemorrhage during the treatment. Injection therapy: The drug is made into the injection directly into the hemorrhoid, or hardening and shrinkage, or necrosis off to play the purpose of treatment. The injected drugs can be divided into sclerosing agent, necrotic agent and softening and shrinking agent (peony times injection) according to their characteristics. Since this method is less painful, shorter in duration, and can also achieve a cure for simple mild to moderate internal hemorrhoids, it is widely used in clinical practice. However, care should be taken to select agents with high safety, master the operation, and also prevent infection after the operation to avoid bleeding and necrosis and prevent the occurrence of rectal stenosis. (3) Physiotherapy: Using the physical effects of sound, light, electricity, heat and magnetism, local tissue protein coagulation, electrocoagulation hemostasis, electrocautery cutting, tissue denaturation, necrosis shedding and atrophy, some of which can achieve a curative effect. At present, it is mainly applied to the treatment of external hemorrhoids. Now there are roughly liquid nitrogen freezing, laser, microwave, infrared coagulation, Doppler, electron (low frequency, high frequency, radio frequency, capacitive field, iontophoresis, electric oscillation), etc. It is important to emphasize that physical therapy can only be used for mild hemorrhoids or as an instrument used in surgery at best, and should be used strictly to master the skills and indications, otherwise not only painful, but also some serious complications and sequelae. Don’t be confused by the advertising slogans of “no hospitalization, no surgery, no pain”. 8. What surgical treatments are available for hemorrhoids? Many patients are afraid of surgery, and when they hear about it, they instinctively become fearful, but it is not necessary. 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.How should I prevent hemorrhoids? Although the incidence of hemorrhoids is high, it can be prevented before it happens if active prevention is carried out against the causes of the disease. (1) Actively participate in various physical exercises to enhance the body’s physical fitness and maintain an optimistic mood. (2) Eat more vegetables and fruits. Do not read a book when you have a bowel movement, do not squat for a long time or use excessive force. Drink a glass of cold water in the morning to help prevent constipation. (3) Avoid prolonged sitting, standing and walking, and actively treat heart, lung and liver diseases. (4) Promptly treat inflammation in the intestinal tract and around the anus. Avoid drinking a lot of alcohol, eating chili peppers, etc., taking warm water baths and changing underwear regularly. (5) Do anal health exercises and self-massage. Here is an introduction to post-poo and bedtime health care exercises. The post-poo exercise is to clean the anus once after the stool, then use the tip of the right index finger to press at the edge of the anus, gently push the anus upward, while contracting the anus, and then relax, so repeat 30 times. Before going to bed, kneel on both knees, elbows on the bed, head down, waist down, hips a little higher, and deep inhalation, while forcefully contracting the anus, and then relax. Repeat this 30 times to effectively dissipate local congestion, more applicable to the elderly and infirm, and the chronically ill. You can also do half an hour of anal exercise daily or directly press the anus with your index finger. 10.What are the current misconceptions about hemorrhoids? Myth #1: Hemorrhoids can become cancerous. 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 they are found to be rectal cancer, they still think they are hemorrhoids. 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. Myth 2: Bleeding hemorrhoids are trivial. The actual fact is that you can find a lot of people who have been in the business for many years, and they’ve been bleeding after every single bowel movement, and today he was just about to stand up after his usual bowel movement, when suddenly his eyes went black and he fell to the ground. When he woke up, the doctor told him that it was caused by severe anemia. He did not understand that bleeding hemorrhoids would have such consequences? The author often sees cases like Xiao Li in the clinic, these people think that hemorrhoids are not a major disease, and they are afraid of pain when they go to the hospital for treatment, even if they always bleed, they think it is a minor thing and do not go to the hospital for treatment. This is actually a misconception. Bleeding hemorrhoids should never be underestimated; a person with bleeding hemorrhoids that lasts more than 10 days may become anemic, and once anemia occurs, it takes months to recover on its own. Anemia can also be very harmful to the body. Not only will it cause sleepiness, weakness, fatigue, palpitations, shortness of breath, dizziness, blurred eyes, tinnitus, etc., as Xiao Li did, and seriously affect work and life, but for children and adolescents, it can cause anorexia and paranoia, stunted growth, memory loss, poor academic performance, difficulty sleeping, susceptibility to various infections, fever, colds, diarrhea, dizziness, headache, etc. For women, they may also experience inexplicable irritability, easy anger, severe menstrual pain and irregular periods. For pregnant women, it can affect the development of certain important organs of the fetus, such as brain tissue and the nervous system. It is also more dangerous during delivery, and complications from anemia are a major cause of death in pregnant women and newborns. Myth #3: Hemorrhoid surgery is the number one pain in the world. A lot of hemorrhoid patients are afraid to go into the hospital, the main reason is the fear of pain, and even on the Internet some people say that hemorrhoid surgery is the world’s first pain, which is certainly in alarmist talk. This misconception arises on the one hand because some old and outdated treatment methods are really damaging and painful, coupled with the indiscriminate treatment of some low level doctors or quacks. On the other hand, some medical advertisements use surgery as a comparison in order to promote their treatments and deliberately expand the pain of surgery. The human body in the long-term evolutionary process, due to the need for defecation function, the anal local nerves are unusually rich and unusually sensitive to various stimuli, so relatively speaking, this local whether the disease or surgical treatment, pain will indeed be slightly greater, 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 medication. 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. Myth #5: High-tech effects are good. In recent years, the treatment of hemorrhoids high-tech new terms continue to appear, laser, infrared, microwave, Doppler, copper ion, HCPT, PPH and so on, some also crowned with Korean, Japanese, American and other titles, seems to be not in the cure, but in the fight against hemorrhoids of the United Nations high-tech war. The patient is dizzy, looking at these unfamiliar and attractive new methods, thinking, high technology frontier well, foreign goods, well, should be good, just believe it. The atomic bomb is powerful, but it can’t tell the good guys from the bad guys, and they all become its victims together. In fact, these so-called “high-tech” is not as magical as advertised, in the clinic they are causing more and more trouble or simply do not cure the disease. Patients suffer from bleeding, anal and rectal strictures, anal skin defects, rectal cramps, pain, etc. (Figures 4, 5, 6). Some of these are defects in the equipment itself that are simply not suitable for use in treatment, such as laser, which is now largely eliminated in clinical practice. Some of them are caused by doctors’ irrational and over-scope indiscriminate use, such as PPH, which was originally only suitable for the treatment of internal hemorrhoids and rectal mucosal relaxation, while some units are used even for anal fissures, even abscesses and anal fistulas. The actual fact is that there are many kinds of anorectal diseases, and there are also different degrees of severity of a disease, and there are different methods of treatment, for example, the same hemorrhoids, internal and external hemorrhoids are treated very differently. If a doctor doesn’t have solid basic theoretical knowledge and years of clinical experience, even the best medicine will become poison, and even the best equipment will only be used to hurt people. Therefore, the glorification of a method and an instrument and equipment advertising, to be viewed with caution, must not blindly follow.