Brief Answer:
Get proctoscopic examination done by surgeon.Please attach a high resolution photo of it with follow up.

Detailed Answer:
Hi,
Thanks fpor query

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. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop.
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.

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-
Take Tylenol thrice daily for pain.
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 hence would help in pain.

-Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) 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.

-A probiotic like VSL#3 should also be taken regularly with these medicines. Probiotic improves overall digestion and help in formation of smooth stools easier to pass.

Oral flavonoids: These venotonic agents were first described in the treatment of chronic venous insufficiency and edema. They appeared to be capable of increasing vascular tone, reducing venous capacity, decreasing capillary permeability, and facilitating lymphatic drainage as well as having anti-inflammatory effects
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 day care 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.
Taking Sitz bath will help.



Suggestion-
Go to a General surgeon and get a digital rectal examination of anal canal and rectum along with proctoscopic examination.
This should be done initially to rule out the cause.
Please attach a photograph.
Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.
Regards.

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