External hemorrhoids

　　1. Occupation-related

　　Long-term standing or sitting, long-term carrying heavy loads, or long-distance travel can affect venous return, leading to slow blood flow in the pelvic cavity and congestion of abdominal viscera. This causes the hemorrhoidal veins to become overly engorged, the tension of the venous wall to decrease, and the vessels to become easily瘀血 expanded. Additionally, insufficient exercise, reduced intestinal peristalsis, delayed defecation, or habitual constipation can compress and stimulate the veins, causing local congestion and obstructed blood return, leading to increased pressure within the hemorrhoidal veins and decreased resistance of the venous wall.

　　2. Genetic Factors: For example, if the venous wall is thin due to congenital factors, it can lead to the formation of hemorrhoids. Clinical observations show that such symptoms are often caused by genetic factors, that is, if there is a history of hemorrhoids in the family.

　　3. Anal Infection

　　The hemorrhoidal veins first become inflamed due to acute or chronic infection, the elastic tissue of the venous wall gradually becomes fibrous, weak, and lacks resistance, leading to expansion and varicose. Added to this are other reasons that cause varicose veins, gradually becoming more severe and forming hemorrhoid lumps.

　　4. Physical Stimulation

　　This point mainly relates to external or internal stimulation of the anus, which can lead to constipation and diarrhea, and also affect the congestion of the anal area, thus causing thrombosis hemorrhoids.

　　5. Local Stimulation

　　Cold and heat in the anal area, constipation and diarrhea, excessive alcohol consumption, and eating too many spicy foods can stimulate the anus and rectum, causing the hemorrhoidal veins to engorge, affecting the return of venous blood, resulting in decreased resistance of the venous wall and the failure of blood circulation, leading to thrombosis hemorrhoids.

　　6. Increased intra-abdominal pressure: Under the influence of some adverse diseases, it can lead to increased intra-abdominal pressure in patients, affecting the smooth blood circulation in the veins, thus causing thrombosis hemorrhoids. For female patients with this condition, it may also lead to tumors near the reproductive organs, abdominal tumors, prostatic diseases, and other conditions.

　　7. Lifestyle factors: Due to work-related reasons, prolonged sitting or standing, long-term carrying heavy loads, excessive mental tension, over-fatigue, and other factors can lead to the formation of thrombosis hemorrhoids.

　　1. Long-term hematochezia can lead to anemia.

　　2. Hemorrhoids prolapse outside the anal opening, with increased secretion, causing pruritus ani or anal eczema. Female patients may also lead to gynecological diseases.

　　3. Due to pain during defecation, forcing oneself to hold back stool, leading to a vicious cycle, it can eventually lead to the occurrence of liver and kidney diseases, anal fissures, colorectal tumors, and other conditions.

　　1. Varicose Hemorrhoids

　　It is a venous lump formed by the expansion of subcutaneous veins around the anus. The onset is slow, initially feeling swelling and discomfort in the anal area, which worsens during defecation. If complications such as inflammation occur, symptoms such as swelling and pain may occur. If infection recurs frequently, it can form thrombosis hemorrhoids and connective tissue hemorrhoids.

　　2. Connective Tissue Hemorrhoids

　　It is a skin tag formed by the enlargement of the skin folds around the anal margin, with hyperplastic fibrous connective tissue inside, rarely with expanded blood vessels. The base is wide, the body is large, and the free end is long and pointed, with various shapes, which can be single or multiple. Patients only feel a foreign body sensation locally or find it difficult to clean the anal area after defecation. Those with infection may experience pain. The primary cause is usually thrombosis hemorrhoids and the consequence of anal surgery. Initially, it is just the swelling of the folds, with feces and secretions accumulating in the middle, the skin is dark red with desquamation of the epidermis; due to repeated inflammatory stimulation, the skin around the anus has protrusions, soft in texture, yellow in color, often on the posterior median line of the anus, and sometimes in front or on both sides. It is often accompanied by hypertrophy of the papillae and hard nodules in the anal hairline, which are easily stimulated, causing spasms of the anal sphincter and pain.

　　3. Thrombotic external hemorrhoids

　　Symptom diagnosis: After defecation or exertion, a circular or elliptical mass suddenly appears under the skin around the anal margin, causing the patient to feel abnormal pain, which worsens during activity or defecation. Due to spasm of the anal sphincter, there is a sense of foreign body in the lower rectum and anal area, hindering walking and causing discomfort when sitting or lying down. The surface of the mass is slightly dark, sometimes purple-red, slightly hard, and the pain is obvious. Sometimes the blood clot absorbs after 2-3 days, the pain decreases, and it can heal spontaneously. Sometimes infection and suppuration occur, the skin breaks down, and anal fistula is formed.

　　4. Typical symptoms of external hemorrhoids prolapse

　　It is caused by thrombosis in the veins of the lower rectal venous plexus, or due to the rupture of the veins around the anal edge during defecation and strenuous activity, causing blood to seep into the subcutaneous tissue, forming a mass locally. The clinical manifestations are severe pain and local swelling. Initially, the local area is relatively hard and painful to touch, and the pain can decrease and the local mass becomes soft after a few days. Finally, skin tags remain, forming a connective tissue external hemorrhoid. Local bleeding forms a blood clot when the vein ruptures, which can lead to infection, forming abscesses and anal fistulas.

　　5. Inflammatory external hemorrhoids

　　It is mainly caused by infection after anal injury. When the anal area is infected, the patient feels burning pain and wet itching in the anal area, and the symptoms worsen after defecation or excessive activity. An examination of the anal area can find hyperplastic skin tags,明显充血水肿的肛门皱襞, and a small amount of secretions may be discharged. The pain is relatively strong, and slight contact can cause severe pain. It is also accompanied by symptoms such as anal moisture and anal itching.

　　Pay attention to personal hygiene habits. Wash the residual matter around the anal area with warm water every day. Do not use hot water to rinse, promote normal blood circulation in the anal area, keep the anal area clean and tidy, and use personal items exclusively, do not mix them together.

　　Maintain good defecation habits. Do not squat in the toilet for a long time to read books or play games, and try to control it within 10 minutes. It is best to defecate regularly every day and do not hold in stool or urine to form a habitual reflex of defecation.

　　Maintain normal living and working habits. For those who work for a long time standing or sitting, they should change their sitting and standing postures in time.

　　Participate actively in outdoor sports such as climbing, walking, running, etc., to enhance resistance and promote blood circulation in the anal area, making the anal sphincter contract powerfully. The commonly used anal exercise and self-massage methods can effectively improve the problem of poor blood flow around the anus.

　　Control your weight. People who are overweight are more prone to hemorrhoids because their lower limbs bear greater pressure. Therefore, they are also more likely to develop varicose veins.

　　Do not scratch the affected area. Although the affected area of hemorrhoids may be itchy, do not scratch to relieve discomfort, as this may damage the fragile venous wall of the rectum, making the situation worse.

　　7. Do not sit on the toilet for too long, do not sit on the toilet for more than 5 minutes each time, especially do not read while on the toilet, which is a very unhygienic habit.

　　8. After defecation, you should gently clean the anus, which is very important. Some toilet paper is rough, and some contain irritating chemical ingredients. Colorless (white) and odorless toilet paper should be used. It is best to install a bidet at home to rinse after each defecation.

　　9. Do not lift heavy objects, lifting heavy objects or strenuous exercise is like straining during defecation. If you are prone to hemorrhoids, you should avoid overexertion.

　　Examinations needed for hemorrhoids:

　　Anorectal palpation, anorectal inspection, and rectal scope examination.

　　1. Anorectal palpation: Palpation can feel hemorrhoid nodules.

　　2. Anorectal inspection: Check for blood, pus, feces, mucus, masses, and external orifices of fistulas around the anus to judge the nature of the lesion.

　　3. Anorectal scope examination: Anorectal scope examination can see the location, size, and shape of hemorrhoids, which is the basic method of diagnosis.

　　Food that hemorrhoid patients should eat:

　　1. Roughly processed foods contain more nutrients and dietary fiber, suitable for constipation or hemorrhoid patients, and are beneficial for smooth defecation.

　　2. Increase high-fiber foods. High-fiber diet (fiber products, fiber information) can alleviate or disappear the symptoms of most patients, with effects similar to anal sphincterotomy and anal dilation.

　　3. Eat more fresh fruits or vegetables, such as apples, bananas, pears, green vegetables, spinach, cabbage, etc., which are beneficial for defecation.

　　Food that hemorrhoid patients should not eat:

　　1. Avoid spicy foods: Hemorrhoid patients who are fond of strong spicy foods such as chili, garlic, and ginger can promote hemorrhoid congestion, thereby aggravating pain.

　　2. Avoid overeating, overeating, and eating too much, as these can increase the severity of hemorrhoids.

　　Varicose hemorrhoids: For simple varicose hemorrhoids, venous plexus resection can be performed. ①Operation method: Take the lithotomy position or lateral position, and perform routine disinfection and drape under local anesthesia or lumbar puncture anesthesia. Use a tissue forceps to lift the hemorrhoid tissue, make a 'V' shaped incision on the hemorrhoid skin or cut a falcate incision, and then use scissors or hemostats to strip the subcutaneous varicose veins to the dentate line, and remove the skin and stripped venous plexus together, trim the skin margin, making it a tidy falcate incision surface. If the anal skin is not relaxed, a radiating incision can be made to strip and remove the varicose veins. After surgery, place a Vaseline gauze for drainage, compress with sterile gauze, and fix with adhesive tape. If the lesion is large, or has become annular, or there are many hemorrhoids, they should be treated one by one, retaining normal skin between them to prevent postoperative scar contracture and lead to anal stenosis. ②Postoperative treatment: Take Ku Shen decoction daily after surgery, or take a sitz bath with a 1:5000 potassium permanganate hot solution, and change the dressing until recovery. If there is infection,对症处理 should be performed.

　　Fibroma External Hemorrhoids: If the condition recurs frequently or the skin tags are long, surgical removal can be performed. ①Operation method: Take a lateral or lithotomy position, perform routine disinfection and cover with a surgical drape, and anesthetize locally. Make a radiating incision in the middle of the skin tag, excise the skin flaps on both sides, trim the skin edges, and make the wound into a diamond or radiating shape. Apply hemostatic powder externally, and place Vaseline gauze for compression and fixation. ②Postoperative management: Take a sitz bath with the bitter bean decoction every day after surgery, or use a 1:5,000 potassium permanganate hot solution, and change the dressing until the wound heals. If there is infection,对症处理.

　　Thrombotic External Hemorrhoids: If there are large blood clots that are hard and do not resolve, and local inflammatory edema is also limited, thrombotic external hemorrhoid stripping surgery can be performed. ①Operation method: Take a lateral position, with the affected side down, locally disinfect and cover with a surgical drape and anesthetize. Then, make a radiating or diamond-shaped incision at the anal margin, use hemostats to strip and remove the thrombus, trim the skin flaps on both sides, leaving the wound open. Apply hemostatic powder externally, use Vaseline gauze for drainage, cover with sterile gauze, and secure with adhesive tape. ②Postoperative management: Keep the perianal area clean, ensure smooth bowel movements, take a sitz bath with the bitter bean decoction or five-astragalus decoction every day after bathing, and change the dressing until the wound heals. If there is infection,对症处理.

　　Inflammatory External Hemorrhoids: If the condition does not improve after internal treatment, fumigation, and medication, surgical removal can be performed without the need for complete inflammation resolution. ①Operation method: Take a lateral or lithotomy position, disinfect and cover with a surgical drape; excise the tumor under local anesthesia, leave the wound open; use Vaseline gauze for drainage, cover with sterile dressing to stop bleeding, and secure with adhesive tape. ②Postoperative management: Same as for thrombotic external hemorrhoids.