In clinical practice, patients with mixed hemorrhoids complicated by chronic constipation often experience postoperative difficulties in bowel movements, delayed wound healing, and increased recurrence rates. Although previous studies have confirmed that press needle therapy can improve postoperative bowel function in patients with uncomplicated mixed hemorrhoids, there is limited research on postoperative bowel management in patients with mixed hemorrhoids and a background of chronic constipation.

To observe the clinical effects of press needle therapy on postoperative bowel management in patients with chronic constipation and gradeⅢ-Ⅳ mixed hemorrhoids through a prospective randomized controlled trial, with the goal of improving patients' quality of life.

From March 2023 to March 2024, 96 patients with chronic constipation and gradeⅢ-Ⅳ mixed hemorrhoids, who were scheduled for hemorrhoidectomy, were enrolled at the Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. The patients were randomly divided into a treatment group and a control group, each comprising 48 patients. The treatment group received press needle therapy combined with oral lactulose, while the control group received oral lactulose alone for 28 days. The study measured changes in the average weekly number of spontaneous bowel movements and the time to the first postoperative spontaneous bowel movement. Traditional Chinese Medicine syndrome scores, Self-rating Anxiety Scale (SAS) scores, and Self-rating Depression Scale (SDS) scores were assessed before and after treatment. Postoperative wound pain was evaluated on days 1, 3, 5, 7, 14, and 28, and wound oedema was assessed on days 1, 3, 5, 7, and 14. The Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire was administered before treatment and on postoperative days 5, 7, 14, and 28. Clinical efficacy was evaluated before and after treatment.

The treatment group showed a greater increase in the average weekly number of spontaneous bowel movements compared to the control group (P<0.05). The time of the first postoperative spontaneous bowel movement was significantly shorter in the treatment group (P<0.05). After treatment, TCM syndrome scores and depression scores were significantly lower in the treatment group than in the control group (P<0.05). Generalized estimating equation (GEE) analysis showed significant main effects of group and time on postoperative pain scores, oedema scores, and PAC-SYM scores (P<0.001), as well as significant group-time interaction effects (P<0.001). On postoperative days 3, 5, 7, and 14, VAS scores were significantly lower in the treatment group than in the control group (P<0.05). On postoperative day 7, wound oedema scores were significantly lower in the treatment group (P<0.05). PAC-SYM scores on postoperative days 5, 7, 14, and 28 were significantly lower in the treatment group (P<0.05). The overall response rate in the treatment group was 87.5% (42/48), significantly higher than the control group's 56.2% (27/48)(P<0.05).

Press needle therapy can improve postoperative bowel function in patients with chronic constipation and mixed hemorrhoids, promote wound recovery, and alleviate adverse postoperative reactions such as pain and oedema. Its effects may be related to the regulation of the gut-brain axis and the improvement of intestinal motility. This method is safe, simple, and well-accepted by patients, making it a viable option for perioperative comprehensive management of patients with constipation-hemorrhoid comorbidity.