Brief Answer:
oral Calcium Dobesilate therapy should be given a try.

Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
I've gone through your details.
I am a Gastroenterologist and would be addressing your concerns.

As per your queries answers are-

As per your history and the attached image, your case appears to be grade 3 hemorrhoid (i.e.hemorrhoids prolapse and usually require manual reduction).

As per the protocol stage 1 to 3 are managed conservatively while surgery is done on stage 4 hemorrhoid.

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. Don't just use any stool softener.

-Secondly, instead of using PreprationH use a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc. It will provide much better relief marketed as brand name Ruticool.

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.

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.

-A probiotic should also be taken regularly with these medicines. Probiotic improves overall digestion and relieves constipation.

However, if not relieved even after 3 months of aggressive therapy proceed for Rubber bands ligation- inexpensive and are easy to deploy. It's a daycare procedure usually done under local anesthesia. The success rate varies from about 70-80%.

Strict lifestyle modification should be followed along with medications-

Take simple organic and vegetarian home cooked low-fat food for few days.
Avoid alcohol, smoking aerated beverages, junk food like pizza burger etc.

Take lots of probiotic rich food like yogurt.
Increase your fiber intake take oats, wheat, barley, vegetable and fruit like Pear, apple, and oranges.

No aerated beverages.
Take fiber containing easily digestible food.
Avoid red meat.
Drink a glass of lukewarm water before going to the washroom in morning.
Continue taking Sitz bath.

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

Regards

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Brief Answer:
Follow up.

Detailed Answer:
Hello again dear,

1) Docustate sodium is a stool softener and can be taken for relief in constipation to make stools soft while Lactulose is a laxative. So you can judge it better. If you have a problem in defeating then try laxative as it irritates the rectal mucosa and causes it to expel stools without straining (as your hemorrhoids usually appear on straining) otherwise you can keep on taking the stool softener you are on.
My suggestion is switch over to lactulose.

2- Mainstay of conservative management is Calcium dobesilate.

3- I think Doxiproct plus is available in states(Please search online) otherwise I will write down the composition you need to ask your local pharmacy for the generic name -(Calcium Dobesilate, Hydrocortisone, Lignocaine, Phenylephrine, and Zinc Oxide) cream.

4- Going through your history conservative management would be best for you. Oral calcium dobesilate would most likely cause this hemorrhoid to shrink in 3 months.

Don't panic, stay relaxed, you should be fine in few months.
Follow other advises as given by me earlier.
Feel free to follow up.

Thanks!

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