1. Definition of hemorrhoids:
Hemorrhoids are masses formed by pathological hypertrophy and displacement of the anal pad and stagnant blood flow in the subcutaneous vascular plexus perianal.
2. Classification of hemorrhoids:
(1) Internal hemorrhoids: displacement of anal cushion and pathological hypertrophy. Including vascular plexus expansion, fiber support structure relaxation, breakage.
(2) External hemorrhoids: refers to vascular external hemorrhoids. That is, the perianal subcutaneous vascular plexus expands, showing up as a soft mass.
(3) Mixed hemorrhoids: the internal hemorrhoids and the external hemorrhoids in the corresponding part are fused.
3. Clinical manifestations of hemorrhoids and the index of internal hemorrhoids:
(1) Grading and clinical manifestations of internal hemorrhoids.
Degree I: bleeding, dripping or jet-like bleeding in the stool, without prolapse of internal hemorrhoids, bleeding can stop automatically after stool.
Degree II: Bloody, dripping or jet-like bleeding in the stool, accompanied by prolapse of internal hemorrhoids, can be taken back by itself after the stool.
Degree Ⅲ: Blood and dripping in the stool, prolapse of internal hemorrhoids or prolonged standing, coughing, fatigue, prolapse of internal hemorrhoids when bearing weight, need to be taken back by hand.
Degree IV: Internal hemorrhoids prolapse and cannot be taken back. Internal hemorrhoids may be accompanied by strangulation and incarceration.
(2) Clinical manifestations of external hemorrhoids: anal discomfort, dampness and uncleanness, which may be accompanied by thrombosis and subcutaneous hematoma.
(3) Clinical manifestations of mixed hemorrhoids: The symptoms of internal hemorrhoids and external hemorrhoids can exist at the same time.
4. Diagnosis of hemorrhoids:
Based on medical history and physical examination of the anus, digital anorectal examination and anoscopy, the diagnosis is made with reference to the classification of hemorrhoids and the grade of internal hemorrhoids. If it is slightly suspicious, further examination should be performed to exclude benign and malignant tumors and inflammatory diseases of the colon, rectum and anal canal.
5. Principles of treatment of hemorrhoids:
Asymptomatic hemorrhoids do not require treatment. Symptomatic hemorrhoids are hemorrhoids and require treatment. The purpose of treatment is to reduce and eliminate the main symptoms, not to cure them. Relieving the symptoms of hemorrhoids is more meaningful than changing the size of hemorrhoids and should be regarded as the standard of treatment effect. Generally, general treatment should be used first. General treatment includes changing diet, drinking more water, adding more dietary fiber, maintaining smooth stools, preventing diarrhea, warm bathing, keeping the perineum clean, etc. These are necessary for the treatment of various hemorrhoids. The doctor should adopt the treatment method that is most beneficial to the patient based on experience and equipment conditions. If the general treatment fails, medication or surgery can be used.
(1) Non-surgical treatment: Mainly suitable for I and II degree internal hemorrhoids. Including suppositories, ointments, oral medications to protect mucous membranes, injections of sclerosing agents and various other therapies.
(2) Surgical treatment: mainly suitable for patients with grade III and IV internal hemorrhoids, mixed hemorrhoids, and non-surgical effects including external hemorrhoid thrombosis or hematoma. No matter what kind of surgery is used. Care should be taken to avoid complications such as postoperative bleeding, anal stenosis, anal insufficiency, and urinary retention.