Objective To evaluate the status quo of postoperative edema and pain in the elderly patients with mixed hemorrhoids and to analyze its influencing factors. Methods A retrospective analysis was made of the clinical data of 92 elderly patients with mixed hemorrhoids, who were treated with external stripping and internal ligation at Huainan First People′s Hospital from January 2020 to December 2022. The patients′ perianal edema and pain were evaluated using sphere volume formula and visual analogue scale (VAS) at five days after surgery. Patients with perianal edema grade Ⅱ and above and/or moderate-to-severe pain were positive and were included in the edema-pain group (29 cases), and non-positive patients were included in the non-edema pain group (63 cases). SPSS 24.0 was used for data processing. According to the data type, t test or Chi-square test was performed for comparison between groups. Binary logistic regression analysis was used to evaluate the influencing factors of perianal edema and pain at five days after external stripping and internal ligation. Results At five days after surgery, 29 cases of grade 0,35 cases of grade 1,22 cases of grade 2,6 cases of grade 3 and no case of grade 4 of anal margin edema in elderly patients with mixed hemorrhoids, and there were 32 cases of no pain, 34 cases of mild pain, 21 cases of moderate pain and 5 cases of severe pain. Binary logistic regression analysis showed that annular mixed hemorrhoids (OR=4.802,95%CI 2.965-7.776; P<0.05), surgical flap malalignment (OR=2.672,95%CI 1.510-4.729; P<0.05) and postoperative constipation/diarrhea (OR=2.818,95%CI 1.611-4.929; P<0.05) were risk factors for anal margin edema and pain at five days after surgery in elderly patients with mixed hemorrhoids, and postoperative traditional Chinese medicine sitz bath/fumigation was a protective factor (OR=0.373,95%CI 0.014-0.765; P<0.05). Conclusion Some elderly patients with mixed hemorrhoids have anal margin edema and pain at five days after external stripping and internal ligation. Annular mixed hemorrhoids, unreasonable operation and abnormal postoperative defecation can increase the risk of anal margin edema and pain. Traditional Chinese medicine sitz bath/fumigation after surgery is beneficial to relieving the anal margin edema and pain.