Hemorrhoids

　　1. Anal infection:

　　The causes of mixed hemorrhoids include the pre-existing inflammation and infection of hemorrhoidal venous plexus due to acute and chronic infections, the gradual fibrosis of elastic tissue in the venous wall, making it weak and insufficient in resistance, leading to expansion and varicose veins. Adding other causes, the varicose veins gradually become more severe, forming hemorrhoidal masses.

　　2. Genetic factors:

　　The venous wall is congenitally weak, resistance reduced, and unable to withstand intravascular pressure, thus gradually expanding.

　　3. Occupation-related:

　　The causes of mixed hemorrhoids include prolonged standing or sitting, long-term heavy carrying and long-distance travel, which affect venous return, slow down the blood flow in the pelvic cavity, and cause abdominal viscera to become congested, leading to excessive filling of hemorrhoidal veins, reduced tension of the venous wall, easy to瘀血 expansion. Moreover, insufficient exercise, reduced intestinal peristalsis, slow downward movement of feces, or habitual constipation can compress and stimulate the veins, causing local congestion and blood return obstruction, leading to increased pressure in the hemorrhoidal veins and reduced resistance of the venous wall.

　　4. Local irritation and irregular diet:

　　The cold or heat of the anal area, constipation, diarrhea, excessive alcohol consumption, and eating spicy foods can all stimulate the anal and rectal areas, causing the hemorrhoidal venous plexus to become congested, affecting venous blood return, and reducing the resistance of the venous wall. In addition, old age with weak physique, chronic illness with weakened body, relaxed and weak anal sphincter muscles, overwork, and other factors can all induce the formation of hemorrhoids.

　　1. Hemorrhoid incarceration

　　A major symptom of mixed hemorrhoids is the prolapse of hemorrhoid nodes. The prolapsed hemorrhoid nodes outside the anus are held by the sphincter muscle, and the venous return is obstructed. The arterial blood still continuously enters, causing the hemorrhoid nodes to increase in size until the arterial vessels are compressed, thrombosis occurs, and the hemorrhoid nodes become hard and painful, making it difficult to push them back into the anus. The traditional view is called 'strangulated internal hemorrhoids'. However, in clinical observations, thrombosis in hemorrhoids is more common, so they often accompany pain. When the hemorrhoid nodes cannot be pushed back, they are also called ' incarcerated hemorrhoids'. Long-term incarceration of hemorrhoid nodes.

　　2. Infection

　　After hemorrhoid incarceration, there is often varying degrees of infection, with symptoms such as urgent need to defecate and significant anal坠胀 sensation. At this time, the infection is often limited to the local anal area. If a strong reduction is performed, it is easy to cause the spread of infection, leading to submucosal, perianal, or ischiorectal abscess. If the bacteria-containing plug that falls off travels along the veins, combined with improper use of antibiotics or without any antibacterial drugs, it can lead to portal vein sepsis or even septicemia, and can also form liver abscess. There have been reports abroad of fatal portal vein sepsis associated with hemorrhoid incarceration.

　　3. Necrosis

　　When the hemorrhoid nucleus is incarcerated outside the anus, due to a series of pathological changes, local metabolic products accumulate, further aggravating local anal edema and the incarceration of the hemorrhoid nucleus, which is a kind of vicious cycle. Therefore, if internal hemorrhoids are incarcerated for a long time, necrosis is inevitable. At this time, the necrosis is often limited to the mucosal part of the hemorrhoid nucleus, but there are also cases where it invades other parts of the human body. There have been reports abroad that thrombi in the hemorrhoid nucleus spread upwards, and the necrotic area expands to the rectal wall, causing severe pelvic sepsis. Although this situation is rare, it must be highly regarded by clinical doctors.

　　4. Anemia

　　Iron deficiency anemia caused by bleeding from mixed hemorrhoids usually develops slowly, and there may be no symptoms or mild symptoms in the early stage. When anemia is severe or progresses rapidly, symptoms such as pale complexion, fatigue, loss of appetite, palpitations, increased heart rate, and shortness of breath after physical activity may occur. Some patients may experience nervous system symptoms such as irritability, excitement, and restlessness, which some believe are caused by a lack of iron-containing enzymes in cells. These symptoms can disappear after correcting anemia and treating mixed hemorrhoids. Therefore, if mixed hemorrhoids are found, they should be treated as soon as possible to avoid the above symptoms and complicate treatment.

　　Mixed hemorrhoids can be divided into: ① Inflammatory mixed hemorrhoids; ② Thrombotic mixed hemorrhoids; ③ Connective tissue mixed hemorrhoids; ④ Varicose mixed hemorrhoids. Clinically, the latter two are more common.

　　1. Hematochezia: Painless, intermittent, with bright red blood after defecation as its characteristic, and it is also a common early symptom of internal hemorrhoids or mixed hemorrhoids. Hematochezia is often caused by the mucosal erosion by feces or the strong effort during defecation, leading to the rupture of expanded blood vessels and bleeding. Mild cases are mostly blood on the stool or toilet paper, followed by dripping blood, while severe cases are jet-like bleeding. Hematochezia can usually stop on its own after a few days. This is of great significance for diagnosis. Constipation, hard stools, alcohol consumption, and eating刺激性 foods are all triggers for bleeding. If there is long-term and repeated bleeding, anemia may occur, which is not uncommon in clinical practice and should be distinguished from bleeding disorders.

　　2. Hemorrhoid prolapse: It is often a late symptom, and it usually occurs after hematochezia. Due to the gradual enlargement of the hemorrhoids in the late stage, they gradually separate from the muscular layer and are pushed out of the anus during defecation. Mild cases may only prolapse during defecation and can return to normal on their own after defecation. Severe cases require manual pushing back, and in more severe cases, even slight abdominal pressure can cause prolapse, such as during coughing, walking, etc., which is difficult to recover and prevents participation in labor. Some patients report that prolapse is the initial symptom.

　　3. Pain: Simple internal hemorrhoids are painless, but a few patients may experience a sense of坠胀. When internal hemorrhoids or mixed hemorrhoids prolapse and become incarcerated, with symptoms such as edema, infection, and necrosis, varying degrees of pain may occur.

　　4. Itching: In the late stage, internal hemorrhoids, prolapse of hemorrhoids, and relaxation of the anal canal sphincter often have secretions, and due to the stimulation of secretions, the perianal area often has itching and discomfort, even skin eczema, which is very uncomfortable for the patient.

　　5. Mucus Extrusion: Long-term stimulation of the rectal mucosa by hemorrhoids can produce inflammatory exudate, causing an increase in secretions. When the anal sphincter is relaxed, secretions can be discharged at any time, causing the anal skin to be frequently stimulated and developing eczema and itching.

　　The late symptoms of mixed hemorrhoids are the prolapse of hemorrhoids, most of which occur after bleeding, as the hemorrhoids gradually increase in size and gradually separate from the muscle layer, being pushed out of the anus during defecation. Those with mild symptoms may only prolapse during defecation and can recover on their own after defecation. Severe cases require pushing back with hands. In more severe cases, slight increase in abdominal pressure, such as coughing or walking, can cause the hemorrhoids to prolapse, which is difficult to return, and it is impossible to participate in physical labor.

　　(One) Prevention of Mixed Hemorrhoids - Daily Life Prevention

　　1. Develop good living habits, eat less spicy food.

　　2. Pay attention to changing body positions in daily life.

　　3. Maintain smooth defecation, eat more fibrous foods, such as sweet potatoes, corn, kelp, bamboo shoots, green leafy vegetables, etc.

　　4. Diseases that can cause increased abdominal pressure, such as chronic cough and benign prostatic hyperplasia, should be treated early.

　　5. commonly use warm potassium permanganate water to wash the anus.

　　(Two) Anal Contraction Exercise Method Anal contraction exercise is an effective method for preventing mixed hemorrhoids.

　　1. Exercise Time Exercise once in the morning after waking up and once before going to bed at night.

　　2. Exercise Preparation Lie on your back, close your eyes, tongue touching the upper palate, arms placed naturally by the sides, regulate your breathing, relax your whole body, and focus on the anus.

　　3. Exercise Movements

　　(1) Inhale, tighten the hips, and lift the anus. Inhaling is controlled within 2-3 seconds.

　　(2) Exhale, relax the hips, and relax the anus. Exhaling is also controlled within 2-3 seconds.

　　4. Number of exercise sessions: one pull and one relaxation counts as one session, with 30 to 50 sessions each time.

　　If there is inflammation of mixed hemorrhoids, severe prolapse of hemorrhoids, swelling and pain, or bleeding, the exercise can be suspended.

　　What kind of examination is generally needed for mixed hemorrhoids?

　　1. Anorectal Inspection

　　The patient assumes a prone position with the chest and knees to expose the anus. The doctor gently separates the anus with the index and middle fingers of both hands, causing the anal canal to flip outwards, to observe for any lesions, such as the position, number, size, color, presence of bleeding points, and the presence of anal fissures, or use a special glass anal suction instrument to suck out the internal hemorrhoids for examination. This visual examination is sometimes more accurate than anoscope examination for diagnosing anal fissures and circumferential hemorrhoids.

　　2. Digital Rectal Examination

　　Digital rectal examination is one of the simplest and most effective methods for the examination of anorectal diseases. Often, through digital rectal examination, early lesions of the anorectal area can be detected early. For the diagnosis of hemorrhoid disease, mild internal hemorrhoids are not easy to feel, while larger internal hemorrhoids can be felt as longitudinal folds and elevated hemorrhoid nodules above the anal verge. Thrombosed external hemorrhoids can be felt as hard oval thrombi with tenderness.

　　3. Anorectal Scope Examination

　　This is the main method of hemorrhoid examination, which can clearly see the location, size, and shape of hemorrhoids. This system uses internationally advanced medical video and imaging technology, breaking the disadvantages of traditional anal and rectal finger examination, and can collect images and make real-time diagnoses of deep lesions in the anal and rectal cavity. Both doctors and patients can observe the magnified lesions by tens of times during the examination process, avoiding misdiagnosis and mismanagement, and thus providing reliable evidence for clinical treatment.

　　Dietary precautions for mixed hemorrhoid patients. According to experts, mixed hemorrhoids are also known as 'internal and external hemorrhoids', which usually occur at the same location on the anal line of the teeth, forming varicose veins. Regarding the dietary precautions for internal hemorrhoids, many people are not aware of it. Below, we will give a simple introduction to the dietary precautions for mixed hemorrhoid patients.

　　Dietary precautions for mixed hemorrhoid patients:

　　1. Do not eat spicy and刺激性 food. Avoid eating scallions, ginger, garlic, and pepper, especially pay special attention to foods like chili.

　　2. Pay attention to the combination of work and rest, do not overwork, do not sit for a long time, all of which are easy to cause venous stasis in the anal and rectal area, leading to varicose veins.

　　3. Pay attention to the balance of meat and vegetables in your diet, with a moderate amount of coarse and fine grains. Pay attention not to overconsume meat and vegetables, and combine coarse and fine grains actively to prevent diarrhea and constipation.

　　4. Defecate at a fixed time every day, do not strain during defecation. Develop a good habit of regular defecation, do not force yourself to hold back when you have the urge to defecate. This can reduce the possibility of congestion in the anal and rectal area.

　　The following are 6 kinds of food recommended by Feihua editors for the prevention of mixed hemorrhoids:

　　Hemp flowers: Fresh hemp flowers can be used to make cold dishes or dumplings, with the effects of cooling the blood, stopping bleeding, and removing hemorrhoids, and can also be used as tea.

　　Sesame: Contains a large amount of amino acids, dietary fiber, and minerals, which can promote defecation. For patients with hemorrhoids and constipation, it can be taken for a long time, which has the effects of moistening the intestines and defecating, alleviating hemorrhoid bleeding, and preventing anal prolapse.

　　Walnut meat: Can moisten the intestines, defecate, and tonify the body, alleviate the symptoms of hemorrhoids and hematochezia.

　　Bamboo shoots: Containing a wealth of fiber, they have the effect of moistening the intestines and defecating for hemorrhoid patients.

　　Seaweed: Rich in beta-carotene, vitamins, calcium, potassium, and iron, it can promote gastrointestinal motility.

　　Red beans: Boiled with angelica, it can treat hemorrhoid bleeding and swelling. Boiling it alone or with rice to make porridge also has a good effect and is an excellent food for preventing and treating hemorrhoids.

　　Traditional surgery and minimally invasive treatment have a variety of methods. Due to the development of medicine, both traditional Chinese and Western medicine have adopted some good methods. As for the surgical removal of hemorrhoids, it will be more thorough and less likely to recur. Traditional methods may be more painful because the degree of pain is proportional to the size of the wound. Consider minimally invasive painless surgery. Minimally invasive surgery uses small incisions for subcutaneous stripping, with small wounds and fast recovery, resulting in less pain for patients during and after the operation. The removal of hemorrhoid nodules is the most commonly used treatment method. Its characteristics are that with the improvement of mixed hemorrhoid surgical treatment, the pain during and after surgery is relatively light, the wound heals quickly, and the efficacy is definite. However, it requires higher surgical conditions.

　　During surgery, it is possible to remove inflamed anal sinuses, excess mucosa at the lower part of the rectum, excess skin around the anus; remove all varicose veins around the anus, and cut off the arteries; at the same time, remove associated external hemorrhoids, anal fissures, anal fistulas, and hypertrophic papillae, and maintain anal canal and anal function. This requires the operator to be clear about the physiological, pathological, and anatomical characteristics of the anal and rectal area to avoid recurrence due to incomplete resection of varicose veins or affecting anal function due to excessive resection.

　　Surgical resection of hemorrhoids has its corresponding indications and contraindications. For example, internal hemorrhoids with significant symptoms such as prolapse, bleeding, infection, unclean and itchy around the anal canal should be operated on in a timely manner. Patients with abscess, acute inflammation should control infection before surgical treatment. In addition, patients with portal hypertension-induced anal varices, patients with blood system diseases, and pregnant women are not suitable for surgical treatment.

　　Mixed hemorrhoids are divided into solitary mixed hemorrhoids and annular mixed hemorrhoids. In terms of surgical treatment, solitary mixed hemorrhoids can be removed, but annular mixed hemorrhoids cannot be removed in one go. If it is removed all at once, it will damage most of the perianal skin, causing anal stricture, difficult defecation, and bleeding during defecation. Currently, the most scientific surgical method for annular mixed hemorrhoids should be segmental ligation resection or staged surgery, which can eliminate the disease and prevent complications. Segmental ligation refers to finding the dividing line of the annular mixed hemorrhoid and performing segmental resection, trying to preserve the anal skin and mucosal bridge. And staged surgery is to first remove the more obvious, larger hemorrhoids, and then remove the remaining ones. In general, staged surgery requires two times, and it is generally difficult for patients to accept, so segmental ligation resection is often used.

　　HCPT minimally invasive painless surgery integrates high-tech, and the biggest feature of the HCPT minimally invasive painless surgery treatment system is that the patients do not bleed and have little pain during surgery.

　　Indications: The efficacy is very significant for various stages of hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fissure, anal fistula, rectal prolapse, perianal eczema, anal pain or bleeding, and other anorectal diseases. At the same time, patients can observe the whole process of hemorrhoid detachment through the computer screen.

　　Operation Principle: By using the heating principle of high-frequency capacitive field, high-frequency electrosurgical knife, and the function of capacitive field hemostat, enter the anal canal through the rectal fiberoptic scope, directly perform minimally invasive electrocoagulation on the internal orifice under the monitor, causing the internal orifice of the anal fistula to dry and close, and then clean the pus inside the fistula.