Hemorrhoids

　　Internal hemorrhoids are mainly caused by irregular diet, overeating of strong alcohol and rich food, fondness for spicy, cold, and stimulating foods such as pepper, chili, scallions, and garlic, and excessive drinking, which can stimulate the rectal and anal mucosa, causing local congestion and triggering hemorrhoids. Or irregular eating and drinking, or due to carelessness in daily life, prolonged sitting or standing, carrying heavy loads, or excessive sexual activity, or due to chronic diarrhea and dysentery, long-term constipation, pregnancy and childbirth, abdominal tumor compression, and other factors, can lead to the internal generation of dampness, dryness, and heat, causing disharmony of Qi and blood, leading to obstruction of meridians and collaterals, and turbid Qi descending to the anal opening to form internal hemorrhoids.

　　Due to individual other reasons, the continuous increase in anal canal resting pressure, the increased tension in the internal and external sphincter and vascular space pressure, as well as the increased tension during the static period, can also cause a decrease in blood return, leading to the continuous occurrence of internal hemorrhoids. The anal canal venous engorgement and swelling are also constantly causing internal hemorrhoids. The anal sphincter plays the role of a 'plug' at the anal opening, and when defecating, the formed fecal mass compresses the anal sphincter. The contraction of the smooth muscle under the anal canal epithelium and the longitudinal muscle fibers cause the proximal anal sphincter to elevate. Irregular defecation or sitting in the toilet for too long can trigger hemorrhoids. For example, some people like to read books or newspapers, or smoke while sitting on the toilet, and spend too much time squatting. Some people have habitual constipation and difficulty in defecation. Chronic constipation and excessive forceful straining during defecation can block venous return, causing the anal cushions to become congested and enlarged, which over time can also lead to the occurrence of internal hemorrhoids. Abnormalities such as arteriovenous shunts, hyperamylasemia, and abnormal blood lipids can increase the incidence of internal hemorrhoids.

　　Urinary retention Urinary retention is the most common complication after hemorrhoid or anal canal surgery, with about 6% requiring catheterization (Crytal 1974). To prevent urinary retention, the causes of bleeding after internal hemorrhoid surgery are early and late. The former is due to loose knots and slippage. The latter occurs about 7-10 days after surgery, due to infection at the ligated site. Due to the action of the anal sphincter muscle, blood tends to flow upwards into the intestinal cavity rather than out of the anus, so the phenomenon of red stained dressing cannot be found in clinical practice. Any of the following phenomena should be considered as complications of internal hemorrhoids.

　　① There may be intermittent bowel sounds, abdominal pain, and a sense of urgent defecation.

　　② The patient may have symptoms of fainting, nausea, cold sweat, and a rapid pulse due to exhaustion.

　　For any of the above conditions, an immediate rectal examination or endoscopy should be performed under pain relief to facilitate timely diagnosis and treatment. In case of confirmed hemorrhage, immediate hemostasis should be carried out. If there is a lot of blood in the anal and rectal canal and the bleeding point is not clear, a balloon compression hemostasis can be used first. If there is no balloon, a 30-gauge肛管 can be used, wrapped with Vaseline gauze, tightly tied with silk thread at both ends, and then coated with anesthetic ointment before being inserted into the anus for hemostasis. This method can usually stop the bleeding.

　　Painless hemorrhoids, intermittent hemorrhoids, bright red in color, or attached to the surface of feces, or stained toilet paper, or may be in the form of dripping or jetting blood are the only symptoms of early internal hemorrhoids. Hemorrhoids, prolapse, pain, mucus discharge, itching, etc., are another common clinical symptom of internal hemorrhoids.

　　1. Hemorrhoids: Bleeding during or after defecation, bright red in color, sometimes with a small amount of blood on the surface of feces, or the toilet paper is stained red, or it may be in the form of dripping or jetting blood. Due to the abrasion of the mucosa by feces, or due to excessive force during defecation, the blood pressure in the blood vessels increases, causing the varicose veins to rupture, resulting in喷射状出血 during defecation.

　　Due to the enlargement of hemorrhoid nodules, they are gradually separated from the muscular layer and prolapse outside the anus during defecation. Sometimes, 1-2 hemorrhoid nodules may prolapse simultaneously, and sometimes all hemorrhoid nodules may prolapse together with the rectal mucosa. Initially, they only prolapse during defecation and can be self-repaired after defecation. For those with more severe symptoms, they need to be pushed back by hand or rest in bed to recover. For those with severe symptoms, in addition to prolapse during defecation, any forceful actions, walking, coughing, sneezing, squatting, etc., may cause re-prolapse.

　　3. Pain: Simple hemorrhoids generally do not cause pain, but sometimes only a feeling of坠胀 or difficulty in defecation. If inflammation and swelling occur, thrombosis or incarceration may occur in the hemorrhoids, accompanied by varying degrees of pain. If the prolapse is not复位 promptly, the pain will worsen. If incarceration occurs, with ulceration and necrosis, it may cause inflammation and edema around the anal margin, resulting in severe pain, making the patient restless whether sitting or lying down.

　　4. Mucus discharge: The rectal mucosa is stimulated by hemorrhoids for a long time, causing an increase in secretions. In the late stage of hemorrhoids, due to the relaxation of the anal sphincter, there is often mucus discharge from the anus. The mild case may discharge during defecation, while the severe case may discharge naturally without defecation, polluting the underwear, causing great inconvenience to the patient. More secretions are discharged when the hemorrhoids prolapse.

　　5. Itching: Due to the stimulation of secretions or prolapsed hemorrhoids, the perianal area becomes moist and unclean, leading to eczema and itching. Sometimes, itching is caused by the prolapse of hemorrhoids due to reflex action.

　　The bleeding and prolapse caused by hemorrhoids are headache-inducing and severely affect people's normal lives. How to prevent hemorrhoids? The key to preventing hemorrhoids is to do what you say. It is impossible to achieve the effect of prevention if you only understand the knowledge of preventing hemorrhoids but do not take action. Now, I will introduce how to prevent hemorrhoids.

　　1. Balance between meat and vegetables, or reduce the occurrence or severity of hemorrhoids. Properly mix coarse and fine grains: In terms of diet, pay attention to not overeating meat or vegetables, and adjust the coarse and fine grains properly, so that the stool is not too loose or dry.

　　2. Regular defecation, avoid holding back or straining: Develop the good habit of regular defecation, do not hold back defecation, do not strain, and reduce the symptoms of congestion in the anal and rectal area.

　　3. Avoid spicy and stimulating foods: Avoid eating too much raw scallions, ginger, garlic, and pepper, especially chili and other foods.

　　4. Combine work and rest: In work and life, combine work and rest. Overwork, carrying heavy loads, or squatting for a long time can cause venous stasis or insufficient activity in the anal and rectal area, leading to varicose veins. It can promote blood circulation on one hand.

　　5. The anal muscle exercise should be promoted: strengthening local exercise is very beneficial for reducing local venous stasis and varicose veins. Perform anal muscle exercises (30-50 times before going to bed every day, making the anus contract rhythmically) to exercise the contraction ability of the anal muscles, which can prevent the occurrence of hemorrhoids.

　　6. Patients undergoing hemorrhoid surgery should relieve their mental concerns before the operation. Generally, patients should eat less roughage on the day of surgery and switch to normal diet the next day. Some patients are afraid to eat much, afraid that defecation will cause pain, wound infection, etc. To keep the bowels smooth, patients can eat more fruits and vegetables, such as bananas, oranges, celery, spinach, etc., which are easy to digest and have less fat. Avoid smoking, drinking, and spicy scallions, ginger, and garlic.

　　7. Try not to sit or stand for a long time, so that blood flow is not stagnant in the anus.

　　8. Pregnant women with hemorrhoids should avoid sitting or standing for a long time, prevent constipation, and correct the fetal position in time. Eat more vegetables, fruits, and vegetable oils, and eat some sesame seeds, honey, to keep the bowels smooth.

　　9. Soak in warm water for 30 minutes after defecation, which can both clean and promote blood circulation.

　　10. Exercise (at least 15 minutes, avoid wind when sweating, and be persistent) can promote blood circulation.

　　The diagnosis of internal hemorrhoids mainly relies on anal rectal examination. First, perform anal inspection: use both hands to pull the anus to the sides, and except for the first stage of internal hemorrhoids, other three stages of internal hemorrhoids can often be seen under anal inspection. For those with prolapse, it is best to observe immediately after defecation in a squatting position, which can clearly see the size, number, and location of the internal hemorrhoid masses, especially for the diagnosis of annular hemorrhoids, which is more significant.

　　Secondly, the diagnosis of internal hemorrhoids is rectal palpation: when there is no thrombosis or fibrosis in internal hemorrhoids, they are not easily palpable, but the main purpose of palpation in the diagnosis of internal hemorrhoids is to understand whether there are other lesions in the rectum, especially to exclude colorectal cancer and polyps.

　　Finally, perform an anal anoscope examination: first observe whether the rectal mucosa is congested, swollen, ulcerated, or has masses, and exclude other rectal diseases after that. Then observe whether there are hemorrhoids above the anal verge. If there are, they can be seen protruding into the anal anoscope, presenting as dark red nodules. At this time, attention should be paid to the number, size, and location.

　　There is a saying in folk medicine that 'Nine out of ten people have hemorrhoids'. The occurrence of internal hemorrhoids is closely related to diet. When accidentally affected by internal hemorrhoids, internal hemorrhoid patients should consider the factors of the disease and try to eat some foods that can alleviate symptoms and prevent recurrence of the disease. How to adjust the diet of internal hemorrhoid patients has always been a question many netizens consult. Below, we introduce how to adjust the diet of internal hemorrhoid patients.

　　1. Strive for smooth defecation. Internal hemorrhoid patients should eat foods rich in fiber, such as fresh vegetables, fruits, silver ear, kelp, etc.

　　2. Internal hemorrhoid patients should often eat easily digestible, soft foods.

　　3. Internal hemorrhoid patients should consume foods with a lubricating bowel effect, such as pears, bananas, spinach, honey, sesame oil, and other vegetable oils and animal oils.

　　4. Internal hemorrhoid patients should choose foods with a cool texture, such as cucumbers, bitter melon, winter melon, watermelons, lotus root, bamboo shoots, celery, spinach, lettuce, lotus root, water spinach, eggplant, luffa, mushrooms, duck eggs, and duck meat, in order to avoid exacerbating heat and leading to hematochezia.

　　5. For patients with long-term treatment without improvement, persistent bleeding, and weakness, internal hemorrhoid patients should appropriately choose tonifying foods, such as longan, jujube, lotus seeds, lily, milk, sesame, honey, and walnuts.

　　6. Internal hemorrhoid patients should avoid eating spicy and刺激性, greasy, fried, grilled, and hot foods, such as mutton, dog meat, raw garlic, raw scallions, chili, etc., and should also be prohibited from smoking and drinking.

　　7. Internal hemorrhoid patients should avoid eating spicy and刺激性 foods, avoid eating hot, greasy, fried, and steamed foods that promote heat and dampness, and avoid eating trigger foods and alcohol and tobacco.

　　The above is the relevant knowledge we have introduced for you about 'How should internal hemorrhoid patients adjust their diet', hoping it will be helpful to you. Internal hemorrhoid patients should appropriately adjust their dietary habits, consider the factors of internal hemorrhoids, and try to eat some foods that can alleviate symptoms and reduce recurrence of internal hemorrhoids.

　　The treatment of internal hemorrhoids by ligation involves using a thread or thick silk thread, or a rubber ring to ligate the root of the hemorrhoid, blocking the blood supply to the hemorrhoid, causing it to become ischemic, dry, necrotic, and eventually fall off, thereby achieving the goal of cure. Common methods include ligation through the entire hemorrhoid and rubber ring ligation, etc.

　　1. Transfixing Ligature Method: Use silk thread to transfix and ligate at the root of the hemorrhoid to block the blood and Qi circulation in the lesion area, achieving the purpose of causing the hemorrhoid to necrotize and fall off. This therapy should be prohibited for patients with perianal acute and chronic inflammation, acute and chronic dysentery, diarrhea, infiltrative pulmonary tuberculosis, severe liver and kidney diseases, hypertension, various blood diseases, and pregnant women in labor.

　　Initially, we need to perform routine skin preparation, clean enema, and use lumbar plexus anesthesia or local anesthesia. Adopt a lateral or lithotomy position, fully expose the anal area, and perform routine disinfection and dressing. The operator interlaces the index fingers of both hands and slowly dilates the anal canal to relax the sphincter muscles, fully exposing the hemorrhoids. Clamp the base of the hemorrhoid with a curved hemostat, gently pull it outward with the left hand, and use the right hand to hold a curved needle to thread a 10号线 from the center slightly above the base of the hemorrhoid through the base. Then, use scissors to make a superficial incision along the dentate line and tie the suture around the base of the hemorrhoid in an '8' shape. After ligating, inject 15% alum solution or hemorrhoid solution into the hemorrhoid, or compress the hemorrhoid to accelerate its necrosis and fall off. Finally, shorten the ligature, leaving about 3.5 cm, and push the hemorrhoid back into the anal canal. After the operation, inject the herbal ointment and cover it with gauze to fix it. Generally, three hemorrhoids are treated at a time. If it is a ring-shaped internal hemorrhoid, first divide the hemorrhoids into several lumps, clamp the mucosa on one side of one lump with two hemostats. Cut it open from the middle, and treat the opposite side of the lump in the same way. Then, perform an '8' shape transfixing ligature on the lump and treat other lumps in the same manner.

　　2. Ring Ligature Method: Using instruments, a small rubber ring is wrapped around the root of the hemorrhoid, utilizing the tension force after the expansion of the rubber ring to block the blood supply of the hemorrhoid, causing it to become ischemic and necrotic and then fall off.

　　Operation Method: Before the operation, instruct the patient to empty their bowels or clean enema, adopt a lateral or knee-chest position. First insert the bevel-shaped anal speculum, determine the location and number of hemorrhoids, and select the ligature site. Fully expose the hemorrhoid area. Disinfect with 0.1% benzalkonium chloride swabs. Then, the assistant fixes the anal speculum, and the operator uses the left hand to hold the ligature device to wrap around the hemorrhoid, while the right hand holds a rice kernel forceps, clamping the root of the hemorrhoid through the ligature ring, pulling the hemorrhoid into the ligature device. Press the handle of the ligature device to move the outer sheath towards the root of the hemorrhoid; then push out the ring and tie it to the root of the hemorrhoid. Then, release the rice kernel forceps and the ligature device together and slowly withdraw the anal speculum.