Treatment of circumferential mixed hemorrhoids

　　Treatment options for circumferential mixed hemorrhoids include conservative management, rubber band ligation, stapled hemorrhoidopexy, external dissection and internal ligation, and ultrasound-guided hemorrhoidal artery ligation. The choice of treatment depends on the severity of the condition, with the primary goals being symptom relief and minimizing recurrence. If there is severe rectal bleeding, intense pain, or prolapsed tissue that cannot be reduced, prompt medical attention is recommended.

　　1. Conservative treatment: Suitable for mild cases, this approach involves dietary adjustments and maintaining regular bowel movements, combined with warm sitz baths and topical hemorrhoid ointments to reduce swelling and pain, control disease progression, and prevent worsening symptoms—without invasive procedures.

　　2. Rubber band ligation: A specialized rubber band is placed at the base of the hemorrhoid using a ligator, cutting off its blood supply and causing it to necrose and fall off. This procedure is simple, minimally invasive, and allows for quick recovery. It is ideal for patients with a limited number of hemorrhoids and mild prolapse.

　　3. Stapled hemorrhoidopexy: This technique uses a stapling device to remove a portion of the mucosa above the hemorrhoids and resect and staple the tissue, lifting and repositioning the prolapsed hemorrhoids. It is minimally invasive, associated with less bleeding and postoperative pain, and is suitable for patients with severe circumferential mixed hemorrhoids.

　　4. External dissection and internal ligation: Involves surgical excision of external hemorrhoidal components and ligation of internal hemorrhoids to achieve hemostasis. This method effectively removes hemorrhoidal tissue and is appropriate for patients with significant mixed hemorrhoid symptoms and severe prolapse. Postoperative wound care is essential to prevent infection.

　　5. Ultrasound-guided hemorrhoidal artery ligation: Hemorrhoidal arteries are precisely located using ultrasound and then ligated to reduce blood flow to the hemorrhoids, leading to their shrinkage. This method is highly accurate, minimally invasive, and particularly suitable for elderly or middle-aged patients with low surgical tolerance or those with mild disease.

　　After treatment, maintain cleanliness and dryness of the anal area, avoid prolonged sitting or standing, and perform moderate pelvic floor (Kegel) exercises. Diet should be light and easily digestible, rich in dietary fiber, with adequate hydration to ensure regular, soft bowel movements.