Mixed hemorrhoids are varicose veins that occur above and below the dentate line in the same direction, forming a single mass.
Diagnostic points.
1.Blood in the stool and swelling in the anus, there may be anal swelling, foreign body sensation or pain.
2.It may be accompanied by local discharge or itching.
3. The swelling appears in the same direction above and below the dentate line (the subdentate line may also be superfluous).
Differential diagnosis.
1.Prolapse of anal canal and rectum.
2, rectal cancer.
3, low rectal polyps.
4, anal papillary fibroma.
5.Anal acromegaly.
6, inflammatory bowel disease
Examination.
1.Compulsory items: visual diagnosis, finger diagnosis, anoscopy, etc.
2.Preparatory items: anal canal and rectal manometry, pathology, etc.
Treatment
I. Chinese medicine.
1. Internal treatment
If the evidence belongs to wind injury to intestinal ligaments, the treatment is to clear heat and cool blood, dispel wind and stop bleeding. The formula is Cool Blood Dihuang Tang or Sophora Pill plus or minus.
If the evidence belongs to damp-heat injection, the treatment is to clear heat and relieve dampness. The formula is based on pain relief like Shen Tang, Doulian Wan or Sanmiao Wan and Huaijiao Wan with addition or reduction.
In cases of Qi stagnation and blood stasis, the treatment is to remove Qi, activate blood stasis, eliminate swelling and stop bleeding. The formula is based on Red Flower and Peach Nut Soup or Blood Mansion and Blood Stasis Soup with addition and reduction.
For those with spleen deficiency and Qi stagnation, the treatment is to tonify the middle and strengthen the spleen, benefit the Qi and elevate it. The formula is Huang Tu Tang or Tonifying Zhong Yi Qi Tang or Gui Shen Wan with addition and subtraction.
2.External treatment
(1) Fumigation: External fumigation with Chinese herbal soup in hemorrhoid department.
(2) plugging medicine: hemorrhoid cream or hemorrhoid plugs plugging anal, 2 times a day.
(3) dressing: external hemorrhoids partly swollen and painful, embedded hemorrhoids can be applied externally with the general anti-swelling powder mixed with Huanglian oil ointment, and when conditions permit, the external treatment can be applied with withered hemorrhoids.
Second, Western medicine.
Treatment principles: hemostasis, anti-inflammatory, elimination of prolapse.
The objectives are
I. control the bleeding symptoms.
Second, eliminate inflammation, reduce or eliminate swelling and pain; eliminate prolapse symptoms.
Specific treatment.
1.Medication: 4 tablets of anti-prolapse, 3 times a day.
In case of prolapsed internal hemorrhoids, inflammatory external hemorrhoids, thrombosed external hemorrhoids, sensitive antibiotics can be used orally, and if necessary, sensitive antibiotics can be injected intramuscularly or intravenously.
2.Injections: The internal hemorrhoids of mixed hemorrhoids can be treated by injection of “603 Anti-Hemorrhoid Liquid” and “Anti-Hemorrhoid Ling” hardening injection. The varicose external hemorrhoids can be treated with “603 anti-hemorrhoid liquid” as “four-point injection of external muscle”.
3.Surgical treatment：It is suitable for those whose internal hemorrhoids are prolapsed and whose external hemorrhoids are large, often swollen and painful or obviously swollen and painful. Commonly used procedures such as external and internal ligation of mixed hemorrhoids.
4.Other treatments
The internal part of mixed hemorrhoids can be treated with dilation therapy, hemorrhoid treatment machine, microwave cautery, infrared coagulation therapy and other therapies. These therapies are mainly used for internal hemorrhoids that are one or two stage. Laser can be used for external hemorrhoidectomy and prolapsed third and fourth stage circumferential internal hemorrhoids treated by anastomotic suprahemorrhoidal mucosal circumcision, etc.