Brief Answer:
Complete details are given below please go through them.
Conservative
Non invasive and invasive approaches are there depends on response of patient and primary doctors decision.

Detailed Answer:
Hi,
As per the history given by you most likely cause of your problem is Hemorrhoids. Hemorrhoids are swollen veins in the lowest part of your rectum and anus.
According to standard texts Hemorrhoids are classified as-
Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Your seems to be a grade 3 or grade 4 hemorrhoid.

Three types of managements are there
1)Conservative
2)Non invasive
3)Invasive surgical

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.

Keep using Prepration H locally over the prolapsed hemorrhoids.

Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.Take it 2 tsf twice daily with half cup of XXXXXXX warm milk.


Keep taking Sitz bath will help.
Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-

If not relieved by it in 3 months then Noninvasive methods are tried like-

1)Sclerotherapy: This is currently recommended as a treatment option for first- and second-degree hemorrhoids. The rationale of injecting chemical agents is to create a fixation of mucosa to the underlying muscle by fibrosis.

2)Rubber band ligation: Rubber band ligation (RBL) is a simple, quick, and effective means of treating first- and second-degree hemorrhoids and selected patients with third-degree hemorrhoids. Ligation of the hemorrhoidal tissue with a rubber band causes ischemic necrosis and scarring, leading to fixation of the connective tissue to the rectal wall.

3)Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.

In case if this is not successful then we have invasive surgical procedures like-

1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.

Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.

Regards

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