According to the condition and pathological characteristics, hemorrhoids are divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids.
The hemorrhoid core on the teeth can be divided into four stages according to its protrusion. Acute hemorrhoids do not sag. Acute hemorrhoids sag can be reset by themselves. Acute hemorrhoids sag needs surgical reset. Acute hemorrhoids sag cannot be reset manually.
External hemorrhoids are located far from the dentate gland and are covered with scaly epithelium. Pain occurs only when acute thrombosis occurs, but there is no pain in other aspects (Fig. 1).
Figure 1 origin and location of internal and external hemorrhoids
Patients with external hemorrhoids and internal hemorrhoids are collectively referred to as mixed hemorrhoids.
Shame is mainly manifested as painful swelling. Anal skin is the excess skin left after inflammation and thrombosis in the past, without pain.
The main clinical symptoms of mixed hemorrhoids are slow local blood flow and increased blood volume, resulting in congestion. Changes in vascular contents lead to thrombosis. The permeability of the vascular wall changes, causing edema and bleeding, showing typical symptoms of decline, expansion, pain and bleeding.
In October 2021, the American College of Gastroenterology (ACG) issued guidelines for the management of benign anorectal diseases, including hemorrhoids management methods. For hemorrhoids treatment' target='_blank'>hemorrhoids treatment, ACG's guidelines are as follows:
Symptomatic hemorrhoids include spectacular [liquid (6-8 cups of liquid per day) and dietary fiber intake] increased by 20-30 grams per day, and conservative treatment that does not encourage long-term use in the bathroom. For patients who cannot increase dietary fiber, polyethylene glycol or adrenaline can be taken.
In the case of symptomatic hemorrhoids, dietary control (including adequate intake of liquid and fiber) and minimizing the power of defecation are recommended as first-line treatment (strongly recommended). Quality of evidence: medium). Agreement score: 29
For symptomatic and acute internal hemorrhoids with drug treatment failure, it is recommended to carry out effective treatment through external surgery (such as art this autumn). Alternative surgery includes infrared coagulation, sclerotherapy and bipolar electrocoagulation. Quality of evidence: medium). Agreement score: 28
Symptomatic hemorrhoids can be treated by Doppler guided hemorrhoid ligation combined with hemorrhoid fixation, mucosal fixation or stapler hemorrhoidectomy.
Doppler guided surgery (hemorrhoid artery ligation, etc.) is similar to hemorrhoidectomy in the treatment of symptomatic hemorrhoids. Quality of evidence: very low). Agreement score: 29
Thrombotic external hemorrhoids are called thrombotic external hemorrhoids, which are characterized by sudden onset of pain and swelling, and can be located outside or within the anal edge. People who observe the quality of thrombotic data within 4 days can be treated surgically.
In the past 4 days, if patients with acute thromboembolism have been observed, it may be helpful to undergo surgery or incision of thrombus. Agreement score: 30
Talk about changeable, causes of hemorrhoids, treatment and prevention of diseases [J]. Chinese medical guide, 2014, 12 (25): 379-380.